Black mothers are dying. What can we do to save them?

(Courtesy of Mikayla Tillery)

18-year-old racial and reproductive justice activist Mikayla Tillery writes about the Black maternal mortality crisis in the U.S. and how to address it.

When I was first referred to see a gynecologist due to an issue with my hymen, I was terrified. Movies and TV shows had depicted a visit to an OB-GYN as especially invasive, and the thought of a speculum struck the fear of God into me. So when I went to my appointment, I found myself lying on the exam table crying — both because I was already in pain because of the symptoms I was experiencing and because of the anxiety of being vulnerable.

My doctor told me to stop my “crocodile tears.” Hearing that comment at a time when I was already apprehensive about seeing a doctor made me feel voiceless and disconnected from an institution that is supposed to do no harm. After a brief conversation, the doctor cut my visit short, telling me that the issue I was experiencing was not actually an issue and that the appointment was a waste of her time. I left her office feeling defeated. The visit reinforced the fallacy that I couldn’t advocate for myself and my body.

It wasn’t until I returned a year later that the doctor realized that my tears weren’t fake, and something was actually wrong with my hymen. I didn’t have an “I told you so” moment or feel vindication. Instead, I was doing mental gymnastics, trying to undo all of the time that I had spent telling myself that I was crazy and gaslighting my lived experience. For the first time, I was able to validate that my pain was real. 

“For too many expecting Black mothers facing otherwise non-fatal complications, a visit to a White gynecologist is just that: life or death.”

— Mikayla Tillery

Black women’s fear of seeing an OB-GYN isn’t unique to me. The fact that I was able to get a resolution at all was a rarity in and of itself. Black women in the U.S. are three to four times more likely to die from pregnancy-related complications than White women. The experiences of Kira Johnson, Dr. Shalon Irving and Serena Williams with medical racism helped the public understand why Black women treat every experience at the OB-GYN with a life or death hostility. For too many expecting Black mothers facing otherwise non-fatal complications, a visit to a White gynecologist is just that: life or death.

On a surface level, many attribute health disparities to general bedside racism within the health care field, meaning the interpersonal manifestations of either implicit or explicit biases. This is seen in the devastating cases of Rana Zoe Mungin and Dr. Susan Moore, where it’s clear that a less racist doctor would have saved these Black women’s lives. As a first step, we need to rebuild medical trust in Black communities and develop frameworks to ensure doctors listen to Black women. As COVID-19 continues to disproportionately impact the Black community — with Black women dying at three times the rate of White men — it is more important than ever for medical education to actively take an anti-racist approach.

We also need to focus in on the fact that Black maternal mortality is one of the most pointed issues within health care disparities: A Black woman is 22% more likely to die from heart disease and 71% more likely to die from cervical cancer than a White woman but an astounding 243% more likely to die from pregnancy- and childbirth-related complications. When we discuss Black maternal mortality, we have to understand that it is a unique problem within the medical racism conversation and deserves policy changes specific to the plights of expecting Black mothers. My own organization, Students for Black Maternal Health, advocates for policies that address how the intersections of maternity care deserts, mental health and incarceration impact maternal health outcomes. This includes connecting young constituents with mutual aid, petitions and their congressperson. We focus on exploring policies like the Kira Johnson Act and the Social Determinants for Moms Act, both centered on funding and researching community-based solutions to improve Black maternal health outcomes.

“Black maternal mortality is one of the most pointed issues within health care disparities: a Black woman is 22% more likely to die from heart disease and 71% more likely to die from cervical cancer than a White woman but an astounding 243% more likely to die from pregnancy- and childbirth-related complications.”

— Mikayla Tillery

After looking at these policies from an institutional and interpersonal perspective, we can talk about the systemic inequities that lead to disparate maternal health outcomes for Black women. When we look at the social determinants of health or the environments that shape our health status, it is clear that health inequities are consequences of redlining (the discriminatory practice of denying services like mortgages or loans to residents of certain areas based on their race or ethnicity), poverty and White supremacy. When we think about how redlining predisposes Black women to be more likely to live in areas with pollution, waste and food deserts, the prospect of negative health outcomes seems to be inevitable. The fact that in states like Washington Black people are two times more likely to be uninsured than their White peers leads to Black women having less access to health care.

To address the root of Black maternal mortality in the U.S. — especially as it impacts low-income Black women — we should focus on policies that alleviate poverty and expand reproductive and maternal health care access. To reduce immediate harm, we should zero in on bill packages like the Black Maternal Health Momnibus Act, which is an assortment of 12 bills addressing the driving forces behind maternal mortality disparities, championed by the Black Maternal Health Caucus. On a structural level, reducing health disparities requires us to address what led to the doctor's visit in the first place.

The Centers for Disease Control and Prevention says that more than 60% of pregnancy-related deaths in America are preventable. In solidarity with Kira, with Shalon and with every Black mother who has senselessly lost their life to Black maternal mortality, we must commit to policy changes to keep them safe.