Ashlei Spivey, founder of I Be Black Girl, and Elizabeth Barajas-Roman, President & CEO of Women’s Funding Network, share some solutions for Black birthing disparities.
This op-ed was published in Essence Magazine on November 24, 2021.
Earlier this year, the Biden administration proclaimed, “In the United States of America, a person’s race should never determine their health outcomes, and pregnancy and childbirth should be safe for all.”
But it’s not race that determines these outcomes. It’s racism.
The data on Black maternal health outcomes is staggeringly bleak: Black mothers are three times as likely to die from a pregnancy-related issue as white women. As the March of Dimes puts it: “The U.S. is one of the most dangerous places to give birth in the developed world, and there are unacceptable disparities in birth outcomes between women and infants of color and their white peers.”
But if you’ve been following the outrage over Black maternal health disparities, you’ve more than likely read these bleak statistics before. They’re sadly nothing new. However, what’s not reflected in the data is what we can do about it.
The National Strategy on Gender Equity and Equality, released by the Biden-Harris Administration last month, takes note of this. But in the 42-page report, there’s only one paragraph devoted to the changes needed to protect maternal health. While these strategies are laudable, they are still vague, lacking the specifics necessary to combat entrenched racism and patriarchy when Black lives are at stake.
As the leaders of organizations that serve marginalized races and genders, we know what it takes to make lasting change in the communities we seek to serve. We believe change can arise from strong public-private partnerships that transform systems that currently don’t see the humanity of Black birthing people.
But what does it mean to transform a system? It’s about pushing resources at the state level and crafting policies that codify what we know to be true on the ground. It’s about leaning into and making sure that Black women are at the helm of the leadership of this work. We can’t ask folks who don’t share these experiences to fix it. They’ve had their chance, and they haven’t. And so, we have to trust and be committed to Black women to not only share their experiences as the most impacted, but also to lead the conversation about solutions.
One place we’re seeing early success is in Nebraska, both through funding and grassroots partnerships. And what we’ve learned so far sets us on a path to better long-term outcomes that allow Black birthing people to not just live but also thrive.
Build a local ecosystem—with Black women at the helm
Last year, I Be Black Girl (IBBG) started the first and only statewide Black maternal health coalition in Nebraska, working at the systems level with key partner institutions, including Health and Human Services, nonprofits, hospitals, and practitioners to create stronger communication and a shared vision for the future of Black maternal health. Of the committee, 80% of the leadership are Black women or birthing folks providing not only their professional expertise but lived experiences as well.
The coalition started by reviewing available data on childbirth outcomes and death cases of birthing people in Nebraska. What they found: near deaths—including hemorrhaging and emergency hysterectomies—are more common in Nebraska for Black women, but there is still not adequate data being collected on severe maternal morbidity. But instead of mandating through policy and legislation, IBBG is working alongside the state agency responsible for reviewing these cases to create a more racially diverse review committee that is now representative of the folks most impacted, including Black birthing people.
Get the data—and act on it
High-level numbers and stats are helpful, but we can’t stop there. We need to start collectingdata, disaggregated by race and gender—which is not currently available—comprehensively and consistently across all birthing institutions and hospitals in the state. For instance, we’re pushing for severe maternal morbidity (which is labeled as unexpected outcomes of labor and delivery that result in significant consequences to a woman’s health) to be tracked as a standard at all hospitals and birthing centers.
Beyond the insights that data can provide, we are building a comprehensive plan around how practitioners can best support Black birthing people. This will be a best-practice entry guide to support traditional medical practitioners and community-based programs that are still serving a majority of Black birthing people.
Start with community
It is important to transform the medical systems that have been in place to better serve us, but the answer to our livelihood does not live there. We are the ones we have been waiting for. That means we will incubate and create community-based programming that supports the comprehensive experience of Black birthing people, from the time we decide to have a pregnancy to after the child is born.
Some practical solutions include having various Black birth workers that are actually reimbursed for their services through insurance. This would include lactation consultants, doulas, and midwives, among others.
In addition, having community-based birthing centers as well as options for where you can give birth (currently in Nebraska you cannot have home births) is crucial. Many other states have seen success in a community-based birthing and resource center, and IBBG is exploring what that looks like in the major city of Omaha. Lastly, expanding Medicaid coverage to 12 months postpartum can have a drastic impact on the health of a mother and child—right now coverage only applies for three months.
Fund the right partners
Women’s funds, foundations, and gender justice funders often move money faster than traditional philanthropy by getting resources into the hands of smaller, but highly impactful community groups. The Women’s Fund of Omaha is I Be Black Girl’s fiscal sponsor. What that means is that IBBG is able to use their organizational infrastructure to regrant and redistribute resources to community partners that are on the ground doing the work. So far, over three funding cycles, nearly $150,000 has been deployed. One of our grantees this year was the Omaha Black Doula Association (OBDA). The grant allowed the OBDA to host community baby showers for expecting Black birthing people.
Without question, it will take a lot more to close the gaps in Black maternal health, but local community organizations know where to start. Institutional funders might not be aware of the grassroot efforts underway, but when you fund community leaders working to create transformational system change, like local women’s funds and like IBBG, you can really put those resources to work to make lasting change for women, children, and families.
At the core, this is about ensuring Black women and birthing folks don’t just live through their birthing experience, but actually thrive. We deserve power and choice over our birthing experiences. When we center the voices, experiences, leadership, and solutions of Black women in maternal health, all women will benefit.
Ashlei Spivey is the founder of I Be Black Girl, a collective sponsored by the Women’s Fund of Omaha that creates space for Black-identifying women, femmes, and girls to access and reach their full potential to authentically, BE.
Elizabeth Barajas-Román is the President & CEO of the Women’s Funding Network, the largest philanthropic network in the world devoted to gender equity and justice.