Jessica Diggs
birth. life. spirit.
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graceful growth

sharing my journey as a doula, student midwife, sista-friend, educator, business woman, and believer. 

What I've Been Doing To Address Birth Disparities

Last month, two amazing birth professionals and myself put on an event entitled: Birth Disparities: The Anatomy of Prejudice. The one-day event took us several months, several meetings, and several hours of anxiety to make happen. I am damn proud of how well the event turned out and of the conversation it has started among the nonblack people within Los Angeles birth community. Let's be very clear, many of the black-identifying healthcare practitioners (midwives, doctors, doulas, etc.) have been starkly aware of this lived truth: that there are racial disparities within the US maternity care system. It wasn't news to us! And thus, the event was not put on for us.

I found it comical that one of the governing bodies of Obstetrics in this country, ACOG, made the following statement in their Committee Review entitled Racial and Ethnic Disparities in Obsterics and Gynecology, "As of 2013, nearly one half of U.S. births were to women of color (2), and projections suggest that nonwhite individuals will represent most of the U.S. population by 2050. With these changing demographics comes an awareness of previously unrecognized racial and ethnic disparities in women’s health and an urgent need to identify and address factors that can explain or contribute to these disparities." Only as we become a "majority" are the issues that have impacted our well-being for decades are worthy of urgency. These issues have been ignored. Simple as that. The fact that it has been ignored is the problem in this country.

For those who are still behind:

  • Birth disparities is the term used to describe the noticeable, unequal difference in birth outcomes among racial and ethnic groups. In this country, among various groups of racial and ethnic populations, these disparities alarmingly affect African-American women and infants.
  • Studies show that African-American women are 4 times more likely to die in pregnancy, children, or in the postpartum period than white women in this country. Our infant mortality rate is 3 times higher than for white families within the first year of life.
  • These statistics are roughly the same across all socioeconomic factors among black women in this country. Thus, making the root of the issue solely RACIAL.
  • To further support these facts, the maternal complications seen among African-Americans in this country are not seen among African immigrants (and immigrants of other ethnicities) until the second generation gives birth. Thus, the lived exposure to racism and prejudice within this country directly contributes to the embarrassing maternal and infant mortality rates.
  • The U.S. is ranked No. 42 on children's well-being and No. 61 on maternal health out of 170 surveyed countries. Among other developed, industrialized countries we are ranked at the bottom. 

Sit with this for a second.

In this country, the cause of death among pregnant African-American women and their babies is racism.

So, back to our event. Debbie, Julia, and myself wanted to make sure that this fact was understand. We did not want to just restate the statistics. They are known. We aimed to help the Los Angeles community of healthcare providers understand that these statistics affect our community and start a conversation that did not lighten the root of the inequity.

To do this, we had Jane Elliot share on the anatomy of prejudice. Her lecture highlighted the fact that people are not listening to black women as we share our stories. Whether it be because the tone of our voices are a little "too loud" or " too aggressive" for you or because the realities of our lives are too much for your privilege ears to bear. Either way, you are not able to remotely do your part in addressing the problem because you did not hear us when it was stated.

In addition to the speaker, we had an amazing panel of 6 black, local, healthcare providers who shared their personal and professional experiences with racial bias and prejudice.

 

Racha Lawler, a black midwife.

Debbie Allen, a black midwife.

Brandi Jordan, a black IBCLC.

Julia Underwood, a black doula.

Dr. Kimberly Gregory, a black OBGYN.

Dr. Kimberly Fletcher, a black ER doctor.

 

The panel was gracefully moderated by Erica Chidi Cohen, a black doula and local business owner.

From left to right: Dr. Kimberly Fletcher, Julia Underwood, Erica Chidi Cohen, Dr. Kimberly Gregory, Brandi Jordan, Debbie Allen, and Racha Lawler. photo by Ani at www.aniportraits.com

From left to right: Dr. Kimberly Fletcher, Julia Underwood, Erica Chidi Cohen, Dr. Kimberly Gregory, Brandi Jordan, Debbie Allen, and Racha Lawler.

photo by Ani at www.aniportraits.com

These women shared their truths. Divulging the horrific experiences their clients or patients go through merely because of the color of their skin. As well as sharing, how their clients are mistreated because their midwife, doctor, or doula is a black healthcare provider. I felt strongly about "personalizing" the inequity for our community. Meaning, making sure the other midwives, doctors, nurses, and doulas heard that this shit occurs right here in our facade of the "LA melting pot".

To say I was most excited about this part of the day is an understatement. As a black student midwife, I wanted and needed to hear the stories. I mean…I knew I would be a black midwife but the realities of being a black midwife had not dawned on me. I will not go into details about what that sparked in me. Honestly, I am still processing all of it as I type this. What I will share is what I plan to do now to aid the experiences of the clientele of current midwives and doctors of color and of my future clientele. I left from our event deeply angry, burdened, overwhelmed, tired as hell, yet full of hope and urgency to utilize my current, small platforms to make change.

Here's a few ways that I have been growing in knowledge, addressing systemic or direct racism, and making more room at the table for other people of color.

Let me preface this with: this is not a checklist that should invoke any sense of self-righteousness or cultural competency. If or when you do help address this issue, you get no pat on the back for utilizing your privileges to address injustice. You just don’t! This list is an example of how there is no excuse for you to not be doing something with your current positions, platforms, and/or resources to reduce the birth disparities among African-American women (and all women) in this country.

Many of these are pearls of wisdom that has either been learned from others, inspired by experience, podcasts, books, or you know, I sought out ways to be impactful.

Here ya go:

  1. Being unapologetically honest about the realities of being black in this country in all spaces of my life. Within professional dynamics, this is often suppressed. Not anymore!
  2. Listening to others!
  3. Reflectively and honestly addressing my own implicit biases.
  4. Continuing to educate myself on wording that can be racist, micro aggressions or triggering to others within my daily life and professional settings.
  5. Hosting an event that truly gives the local, black providers, nurses, doulas, etc. a space to share what their concerns are and what's really going on in your area.
  6. Informing myself of current practices in medicine that claim to combat the pregnancy complications that lead to the higher maternal and infant mortality rates. For example, knowing that the progesterone shot recommended to prevent premature birth is not accessible to low income women because it costs $750 WITH INSURANCE.
  7. Adding my perspective and voice on the boards, committees, or platforms I sit on.
  8. Challenging current research and initiatives to be more inclusive of people of color and associated factors. For example, I went to the March of Dimes Conference on Monday and after eager doctors shared their "intriguing" research projects, I made comments and asked the realistic questions about how most of their "groundbreaking" work was not accessible, affordable, considerate of cultural/social barriers restricting low income and/or people of color access to it, or that the fact that it was not even accurate. (My background is biology and chemistry with over 5 years of experience as one of them, (lab technician and researcher in UNC School of Medicine) so I utilize that to speak directly into their proposed objectives. It is also really fun (like amusement park fun) for me to publicly challenge people. If you know me, it all works very well with my personality. So, I'm using it for a greater good or at least that's what I tell myself.)
  9. Providing my time, experience and money to organizations that are already doing amazing, impactful work within marginalized communities. Not feeling the need to reinvent the wheel or play Savior but to give to those who are successfully doing the work. There are a number of providers putting in the work and reducing the health gaps. Not to my surprise, the initiatives are not costly and I'll argue, air on the side of basic common sense so much that embarrassing that they are not being implemented everywhere.
  10. Learning from those who are already doing the frontline work and systemic work. Listening, watching, and connecting with the many women and men serving the underserved communities. Taking their workshops, seminars, etc. to one day implement their techniques and wisdom into my practice.
  11. Adding a statistic or societal fact in my childbirth education series. The classes are typically to privileged, white folx, so seasoning the series with some social awareness. 
  12. Sitting and listening to others.
  13. My personal fav: traveling! Leaving my comfort zone and enduring the challenges and fun that comes with experiencing other cultures. If done as travel and not as explicit tourism, it can be full of enriching, life lessons and eye-opening experiences. Arguably not a real tip, but I have found that sheer exposure elevates fear, assumptions, and aids a sense of oneness even amidst the differences. (My background is also Anthropology, so learning about Others is kind of my thing.)

This is just a very short list of how I plan to continue to address birth disparities among African-American women. But, more so, a reflective approach rooted in reducing inequality and implicit bias will not only benefit African-Americans but will also set the stage to impact all people. The root that will anchor the solution is an equity-based approach that acknowledges the issue of systemic racism and bias. The branches, however, will look as vastly diverse as the women who we aim to support with the right to accessible and quality care.