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The Inequity of Birth

My name is Jollina: Daughter to Joann. Granddaughter of Dorothy, and great granddaughter to Zadi.

I sit at the feet of my ancestors and elders. Not metaphorically, but literally. On a cool Los Angeles night in January 2019 I was sitting on the floor at the feet of Mama Hakima. She carries with her the knowledge of traditional midwifery and courage to name racism in all its forms. I sit with a group of black and latinx birth professionals, mental health providers, and community health workers ready to impact the outcomes of black and brown infants and women. In the classroom of Kindred Space LA, ‘Reindiginizing birth’ is our focus. With a collective desire we sat listening - never still, rarely quiet – listening, hearing, and understanding the challenges of the work ahead.

The foundational markers of a nation’s health are its’ Infant and Maternal morbidity and mortality rates. In 2015 the World Health Organization reported the United States’ maternal mortality rate at 14 deaths per 100,000.1 In data from 2011-2014 that number for black women is closer to 40 deaths per 100,000.2 I have worked in this field for over 15 years and through my work I have encountered these disparities first hand, but until this last year the greater medical world wasn’t paying attention.

With the publication of Serena Williams’ birth story America started to take noticed.3 As a world-renowned athlete, living at the top of the socio-economic strata, her story shocked the world. The hospital staff didn’t listen to her. She could have died. The history of institutionalized racism has affected the mortality and morbidity of black and brown babies and mothers.

The medical community continues to blame poverty, education, access to care, and lack of insurance for black maternal and infant. These have been shown to be myths in current research.4 The legacy of negating pain in black patience is common throughout medical text and treatment plans in hospitals.5 Hoffman, Trawalter, Axt, and Oliver6 state that there is still a racial bias in pain perception of black vs. white patience. Parents of black, native and latinx babies in hospital NICU’s experience these dismissive and concerning trends.7 These parents felt neglected, manipulated, and profiled by the hospital staff, and the parents felt the staff worked against the well being of their babies.

The level of institutional racism that marginalized communities face in doctor/patience encounter is deep and will documented. Those disparities persist across SES lines. A black woman with multiple degrees is less likely to survive childbirth than a white woman with only a high school diploma. These disparities are not completely related to poverty, lack of education, access to care, or insurance. They are tied to the unrelenting and ongoing systematic racism that black women face in this country every day.

When we can start to address these facts for what they are - a manifestation of America’s racist past and present - we can find solutions to combat it. If we can take the time to listen and believe black women we can improve outcomes. It is possible. It is doable! In the book Battling Over Birth8, the authors list seven recommendations for improving outcomes for black and other non-white populations. The first recommendation is for hospitals and care providers to offer prenatal care that is based on cultural humility, empowerment, with a holistic social justice lens. Each of the seven recommendations focuses on a difference segment of the community. Because it is not enough to know, we must act just as Ms. Williams did. We must demand to be heard. Demand to be treated when we know something is wrong. Without action there is no change. And things must change.

This is the reason we must sit at the feet of those who are practicing the art and science of Midwifery. Those who have gone back into the knowledge of the past and have sought wisdom from Indigenous Midwives from around the world. We must relearn the ways of the past to compliment the science of today. Listening to those standing up and speaking out, allows new learners to rise and resist the biases that harm. It provides a space for dialogue and learning, language for that dialogue, and others to stand with you as you rise to the challenge.

1. World Health Organization. (2015). Global Heath Observational (GHO) Data. Retrieved from:

2. Center for Disease Control (2015) Pregnancy mortality surveillance system. Retrieved from: surveillancesystem.htm? ctivehealth%2Fmaternalinfanthealth%2Fpmss.html#

3. Salam, M. (2018) For Serena Williams, childbirth was a harrowing ordeal. She’s not alone. New York Times. (January 11, 2018) Retrieved from:

4. New York City Department of Health and Mental Hygiene (2016).

Severe maternal morbidity in New York City, 2008–2012. New York, NY.

5. Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, Kalauokalani DA, Lasch KE, Myers C, Tait RC, Todd KH, Vallerand AH. (2003) The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine. 2003 Sep;4(3):277- 94. Retrieved from:

6. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296-301. doi: 10.1073/pnas.1516047113

7. Martin, A. E., D'Agostino, J. A., Passarella, M., & Lorch, S. A. (2016). Racial differences in parental satisfaction with neonatal intensive care unit nursing care. Journal of perinatology : official journal of the California Perinatal Association, 36(11), 1001-1007.

8. Oparah, C., Jones, L., Hudson, D, Oseguera, T., & Arega, H. (2017). Battling over birth: Black women & the maternal health care crisis in California. Praeclarus Press. 2018.

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