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Every March, on Beverly Taylor-Clark’s birthday, she releases a bouquet of balloons into the air. Her birthdays are usually a monthlong celebration, a time set aside to commemorate the stages of life to come and those that have passed. Together with her grandson, Jayceon, they gradually let the balloons loose and lift their sights to the sky.
This year, Jayceon said, “I think they are going to my dad.”
Taylor-Clark replied, “I think they are going to your mom, too.”
This December will mark two years without Jayceon’s father and Taylor-Clark’s son, Barry Taylor. He died on Dec. 14, 2021, after a car hit him as he crossed Southern Avenue at Ninth Street SE. He was 47.
Three days after Jayceon’s ninth birthday last May, it marked nine years without his mother, LaTisha Nicholson. Following a healthy pregnancy and birth, Nicholson returned home from the hospital, eager to introduce baby Jayceon, who goes by Jay, to her three other children. Soon after, Nicholson collapsed and died in her apartment. She was 34.
“Nine years later, I still don’t know what happened,” Taylor-Clark says.
In recent years, D.C. has recorded some of the highest maternal mortality rates in the nation. Compared to the national average of 28 pregnancy-related deaths per 100,000 live births, D.C. saw an average of 44, according to data recorded between 2014 and 2018. A 2021 report from the District’s Maternal Mortality Review Committee states that 90 percent of people who died within 42 days of the termination of a pregnancy were Black, despite them accounting for only half of all births. And in underserved, predominantly Black areas of D.C. such as wards 7 and 8, where Nicholson lived, medical providers remain scarce. The District’s health-care system, focused for generations in Northwest, remains inaccessible for parents across the city as demand for services increases.
With the establishment of the MMRC in 2018, more funding has been provided and funneled toward doula services and transportation options for pregnant people in recent years. But the limited number of accessible clinics, hospitals, and OB-GYNs—providers who care for new parents during and after their pregnancies—in these historically Black neighborhoods thwart progress to reduce racial disparities in maternal health outcomes.
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In a recent conversation, Taylor-Clark recalled how Nicholson had first revealed her unexpected pregnancy with an ultrasound. In it, she can already see Jay’s growing nose. A shocked Taylor-Clark could not believe the news, but Nicholson had already picked the perfect name for her baby boy: Jayceon Barry Demond Taylor, just like Jay’s father and Taylor-Clark’s son. That ultrasound is now framed in Taylor-Clark’s house.
“Who knew that would be a lifelong thing to keep?” she says.
Despite a complicated search for care, Nicholson’s pregnancy was safe and healthy. She traveled across the District for prenatal appointments and her delivery due to a lack of options in her ward.
Today in Ward 7, there are currently only four health clinics, one midwife-led mobile bus, and one OB-GYN that offers perinatal services, according to Amita Vyas, director of George Washington University’s Center of Excellence in Maternal and Child Health. In Ward 8, three currently operating clinics, along with an anticipated new facility, Cedar Hill Regional Medical Center (not slated to open until late 2024 or 2025), will be the only available centers to offer maternal care services. There has been no maternity wing or birthing site in D.C.’s southeast quadrant since 2017, when United Medical Care’s maternity ward closed due to reported medical mistakes. That doesn’t stop births from happening there, however: Multiple patients have delivered in UMC’s emergency department in the years since the labor and delivery unit closed.
In the interim period before Cedar Hill’s opening, women still lack obstetric care in the portion of the District that also has the highest birth rates of the city. Ward 2, which is about 70 percent White and has the lowest birth rates in Washington, has 12 prenatal care facilities. This section of the District, though structurally designed to support more health-care facilities, can be inaccessible to mothers who live in wards 7 and 8.
The lack of medical infrastructure in wards 7 and 8 extends to services like prenatal and peripartum counseling, delivery sites, and postpartum care. And many Black women, even if they do have medical attention and insurance, experience racial bias in the health system. They often describe not being believed or taken seriously, and feel they aren’t given appropriate time for an evaluation of their health. As a result, warning signs for serious issues, such as pain, can go unnoticed or undertreated. Studies have shown that Black Americans are often prescribed a lower dosage of pain medication than their White counterparts and those lower doses are provided less frequently. If this bias penetrates into a provider’s perception about the patient during pregnancy, it can cause life-threatening outcomes.
“If you know that you’re not going to access good care or if you’re going to be treated with a level of disrespect and not heard, I think it keeps women from even accessing early prenatal care,” Vyas says. Early prenatal care refers to medical attention within the first trimester of pregnancy. “We are really talking about access and utilization of quality health services, non-judgemental, respectful, non-racist healthcare.”
Throughout LaTisha Nicholson’s pregnancy, there was no reason to think anything would go wrong. She’d had three previous, uncomplicated pregnancies and her children were healthy, waiting for her at home and eager to meet the newest addition to the family.
The day she gave birth to Jay, Nicholson doubted that Taylor-Clark would make it to the hospital in time, leaving from her home. But Taylor knew, assuring Nicholson and saying, “She is coming. She’ll be here.” When Taylor-Clark got the call that Nicholson had given birth, she went to see her right away. There was no other option.
“He just knew me. He knew I would be there,” Taylor-Clark says. She found Nicholson in her hospital bed, wearing perfectly applied blue eye shadow and painted nails. “She said she wanted her baby to see her pretty,” Taylor-Clark recalls.
A photo captures one of Nicholson’s first moment’s with her baby, her arms wrapped around Jay with his head lying on her chest. The photo captures her wide, soft smile. “Mother + Son” is etched over the portrait.
In the hospital, hours after birth, Nicholson had described her eagerness to get to her three other children, but on the way home, Nicholson felt dizzy getting out of the car. She fainted for a moment but recovered and went inside. Later, Taylor left for work and Nicholson got in the shower. Not long after, Nicholson’s oldest son, DeMarco, then 17, knocked, trying to get into the apartment, and heard the sound of water running and Jay crying. When no one opened the door, he sought help from a neighbor, who called the police. Nicholson was found dead in the shower.
Following an autopsy and death report, Nicholson was found to have died from heart failure related to cardiomyopathy. Cardiomyopathy, a rare condition, is a disease of heart muscle that makes pumping blood difficult, and can occur in the months before or after giving birth. “I couldn’t understand accurately all the terminology,” Taylor-Clark says now.
Being of African American descent and having multiple pregnancies are considered risk factors for the development of cardiomyopathy. Common warning signs, which include feeling fatigued, faint, and short of breath, often mirror those of pregnancy itself. The condition is usually diagnosed from the results of an examination, chest X-ray, echocardiogram, or electrocardiogram. Once diagnosed, patients generally stay in the hospital until their symptoms have subsided.
Taylor-Clark is left with questions. “If she had proper treatment and care when she was pregnant, how come they didn’t detect a problem?” she wonders. “But, it’s gone. It’s over now. I guess.”
Cardiomyopathy contributes to 1 in 4 maternal deaths in the United States. And according to a recent study by the Population Reference Bureau, Black women are almost three times more likely to develop cardiomyopathy and five times more likely to die of cardiomyopathy or the pregnancy-related high blood pressure disorders preeclampsia and eclampsia than White women. This same report found that 84 percent of pregnancy-related deaths nationwide were preventable.
“We took the word for what they said. We read the death report. And we moved forward,” Taylor-Clark says.
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Physicians have attempted to explain unexpected deaths like Nicholson’s by pointing to the long-term impacts of systemic racism. Black people experience interpersonal, institutional, and internalized racism within the U.S. health-care system, before, during, and after pregnancy. To underscore how discrimination has contributed to racial maternal health disparities, researchers have proposed the weathering hypothesis. “Women’s bodies really become weathered over time, because of those experiences of racism and discrimination that lead to increased stress,” Vyas says. “We see that the risks for Black women become even greater.”
As a result, across D.C. and the country, racial disparities exist across all women, even those who are more highly educated and earn more money. “When we have institutional racism within the healthcare setting,” Vyas says, “we are not able to build trusted relationships between providers and people we want to serve.”
Today, Taylor-Clark, who cares for Jay alongside his godmother, talks to him often about both of his parents’ deaths. His life has been shaped around their absences, and he sees them in the same place the balloons float to, an endless, permanent blue.
“He told me one time he didn’t want to grow up, because everyone that grows up dies,” Taylor-Clark says.
Grief of a parent’s passing encompasses more than just their death, says Stephanie Handel, a therapist at the Wendt Center for Loss and Healing, which serves children coping with loss and trauma. Grief includes all the things that never got to happen. It lives and lingers in the space they once took, gripping a void that cannot be filled. Children experiencing the traumatic loss of a parent are more likely to develop depression and anxiety, as well as less likely to finish schooling and receive adequate child care.
Last year, 733 mothers in the U.S. died during or following pregnancy, a decrease from the pandemic surge in maternal death in 2021, when a record high of more than 1,200 maternal deaths were reported. But since 2000, the United States has been the only developed country to experience a rise in the rate of maternal deaths; today, that number is almost three times higher than that of other high-income countries. And maternity care deserts, places where people cannot access reliable health care, are spreading nationwide, impacting more than 2.2 million people of childbearing age and almost 150,000 babies.
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D.C.-based nonprofits such as Mamatoto Village have attempted to reduce these disparities by providing essential supplies like diapers and car seats and offering counseling, education, and doula services.
Janet Durig, executive director of Capitol Hill Pregnancy Center, says the faith-based organization serves any woman who walks in, most of whom live in the Southeast. The center holds a stock of baby clothes and formula for mothers to access if they cannot afford it otherwise. In the center’s basement, boxes are piled to the ceiling with infant and toddler items for every season, from Halloween costumes to swimsuits.
D.C. councilmembers, led by At-Large Councilmember Christina Henderson, have pushed for legislation that will ensure these essential resources and services, like doulas and transportation options, are covered under insurance plans such as Medicaid. Henderson found herself displaced as a result of the fractured health-care system woven throughout the city while in labor with her first child.
“We don’t have room for you in labor and delivery,” she was told. When she went into labor with her first child, she was turned away from two D.C. hospitals, as they were on “diversion status” and working at capacity, Henderson says in an interview. With luck, Henderson was finally admitted the third hospital, where she eventually gave birth.
The limited number of maternity wards in D.C. present ongoing challenges for parents expecting to give birth with their specific provider at a certain hospital, a priority in the midst of the chaos and pain of labor and birth. These conditions create high levels of stress for mothers in an already extremely critical state and further exacerbate disparities, when most women already struggle to access a provider and attend prenatal and postnatal appointments. In wards 7 and 8, 67 and 62.9 percent of women received early prenatal care, respectively, compared to 82.3 percent in wealthy, majority White Ward 3.
After her labor experience, Henderson introduced the first city bill to increase access to maternal health resources. The legislation, the Maternal Health Resources and Access Act of 2021, proposes Medicaid reimbursement for doula services and transportation subsidies for maternal health appointments. It also provides resources toward a study to establish the feasibility of a birthing center in Southeast D.C. The Council session concluded without the bill being passed, and the legislation was submitted as a subtitle in the Fiscal Year 2022 Budget Support Act. Since then, funding was directed to the Department of Health Care Finance and the D.C. Healthcare Alliance to reimburse doula services at competitive rates and cover rideshare options and public transit for women going to medical appointments across the city.
“Black women want to be able to survive labor and delivery to live to see their children on the other side,” Henderson says. “That’s how dire the situation is right now.”
Nationwide, there has been a push for the Black Maternal Health Momnibus Act of 2021, led by the Black Maternal Health Caucus. The act encompasses a series of 12 bills, which similarly provide funding to community organizations, increase data collection on racial disparities, grow the perinatal workforce, and serve largely minority populations to reduce these maternal health disparities. Today, the act is still awaiting passage.
Greater availability and funding for doulas, which both of these pieces of legislation provide, have proven to drastically improve racial disparities for maternal health outcomes. As a result of doula care, babies are less likely to receive lower than a 5 Apgar score at birth and the birthing parent is two times less likely to experience a pregnancy complication.
Emily Smith, co-owner of Doulas of Capitol Hill, leads a citywide effort to provide doulas to mothers. Doulas, nonmedical health personnel, provide physical, emotional, and informational support to pregnant people and act as an advocate throughout pregnancy. “People get to have support for their decisions and ultimately help them to feel safe within their healthcare system,” she says. Through their work, women in a highly vulnerable period of both their and their child’s life receive more direct care and attention that can ensure a safe pregnancy and long-term health.
Given the expense of doula care, which can cost up to $3,000 per birth in D.C., affluent families are more likely to be able to afford these services. In D.C., doula services can be reimbursed through insurance plans, but doulas are often not paid at a living wage, often due to working as independent contractors. “I find that it’s important that for people who are helping people who are low-income or at poverty level, that the doulas themselves shouldn’t have to be low-income or at poverty level,” Smith says.
Similar community-oriented medical services can positively affect women experiencing prolonged stress. Supporting providers, such as Black doulas and birth workers who know more intimately the experience of mothers, can profoundly improve maternal health, as women feel more supported and seen. Increasing not only the availability, but the quality of this health care, is the path to a more equitable future to reduce the city’s racial disparities, Vyas says.
As both the Black Maternal Health Momnibus Act of 2021 and the Maternal Health Resources and Access Act of 2021 provide resources toward doula and health-care programs, this legislation paves the way for more equitable health outcomes for Black women. These initiatives, along with legislation to build more accessible options for maternal care in Southeast D.C. and expand insurance coverage to care after pregnancy and birth, can reduce the threats associated with motherhood in the District.
Funding care for the “fourth trimester,” the period following birth, under insurance plans could be the difference between life and death for some. “Where I see great hope is the expansion of Medicaid to include postpartum health services, so that we can expand Medicaid services to after that first year of birth,” Vyas says. Medical attention and policy protection focused on this vulnerable window of time, when Nicholson died, could prevent similar unexpected deaths or complications.
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The questions that Taylor-Clark has about Nicholson’s death days after Jay’s birth may never be resolved. Where did things go wrong? Could her health-care providers have prevented her death? “I guess I will never know,” she says.
Similar questions linger around the death of Somesha Ayobo, who was 35 and eight months pregnant, and the deaths of Shanetta Wilson, who was 43 and six months pregnant, and Wogene Debele, who was 43 and eight months pregnant, both of whom died of COVID complications.
Today, Jay now says, “Mommy and daddy died, but I got another mommy and daddy!” in his godmother and godfather. He takes karate, does well in school, and loves The Lion King.
“Jay is a total gift,” Taylor-Clark says.
Jay turned 9 in May. Taylor-Clark and Jay celebrated by seeing The Lion King at the Kennedy Center. And like all birthdays, it was a marking of time passing, a point to everything that lies ahead.
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