Op-ed: Inequities in Black birth 

By Omare Jimmerson, Executive Director of the Tulsa Birth Equity Initiative

Health and justice go hand in hand. One cannot truly exist without the other. During Black History Month there has been much discourse about the important contributions of African Americans to society.

Every day African American women wake up anticipating the joy that comes with motherhood.  All too often the focus is placed on the despair that birthing Black women fall victim to instead of the joy they often experience. 

The news of my second pregnancy was joyful and gave hope during an emotionally challenging time for our family.  My OBGYN felt the need to “remind me” that this birth would have to be delivered via cesarean section because of my previous birth history. I gently but sternly reminded him of my decades long work in maternal care and thanked him for his suggestion but knew it was not my only birthing option. 

That experience leaves so much to be unpacked, was he forcing judgment on the Black woman sitting in front of him or following insurance protocol that has created an atmosphere of convenience for providers? Either way, day in and day out, Black women sitting in healthcare settings around the world are oftentimes faced with conversations and decisions concerning their health based on implicit bias.  

Implicit bias and Black birth equity

We all have implicit bias, it is human nature created as a safety mechanism and we all judge based on what we have experienced and been taught, whether good or bad. But for some reason the term “implicit bias” moves people to quickly defend themselves against being racist, which results in them shutting down from exploring their own internal deficits that lead to recommendations in care that result in maternal health disparities. 

According to the Journal of the American Medical Association, Black women in the United States face significant inequities in maternal mortality and morbidity.

Black women die from pregnancy-related deaths at a rate three to four times more likely than white women, and are more likely to experience severe maternal morbidity, life-threatening complications caused or exacerbated by pregnancy, in the antepartum, intrapartum, and postpartum periods.

These inequities not only stem from socioeconomic factors affecting access to and quality of care, but are also linked to the stresses of racism both individual and institutional and their long-term physiological implications. 

A systemic approach for a systemic problem

Additionally, the American College of Obstetrics and Gynecology (ACOG) states that implicit and explicit biases in health care can influence whether Black women attend postpartum visits and could, in part, explain these racial disparities. 

I believe we have shared values and goals of reducing Black maternal mortality and morbidity but have lacked acknowledging this is a systemic issue that takes a systems approach.  The way implicit bias is addressed, if at all, in the healthcare industry needs to be challenged it is not working to get us to the outcome we all want to see.  

Birth work, Doula work, saves lives. For too long, because it is seen as women’s work, the work of attending to pregnant people during pregnancy, during delivery, and checking in on them afterwards, has been unpaid work. This is not a coincidence. The unpaid work of women is what this country is built on. 

Tulsa Birth Equity Initiative

The Tulsa Birth Equity Initiative (TBEI) is changing this. We are doing this one birth at a time, one birth worker at a time, one mother at a time, one baby at a time. 

This week the initiative is hosting an Association of Maternal Child Health Programs (AMCHP) national site visit in Tulsa. Funding representatives from Merck for Moms will also be present.

There are representatives from six cities coming to Tulsa from San Francisco, Pittsburgh, Austin, Norfolk, Columbus, and Tampa to see the work that Tulsa is doing. 

Our preliminary data shows that the Black women served by the Tulsa Birth Equity Initiative experience half the preterm birth rate as the state’s average for this population.  This is also true for black babies born experiencing low birth weight whose moms are served by the initiative.

Everyday Black women wake up anticipating Black joy that comes with motherhood.  All too often the focus is placed on the despair that birthing Black women fall victim to instead of the joy they often experience.  Systematic approach to confronting implicit biases, creating true individualized care, will create joyful moments for all birthing people. 

Omare Jimmerson is Executive Director of the Tulsa Birth Equity Initiative and an Aspen Global Innovators Group, 2023 Healthy Communities Fellow.