The number of Black women dying during childbirth didn’t sit right with doula Kristin Mejia-Green. Giving birth is supposed to be one of the most beautiful times in a pregnant woman’s life, but the experience has become synonymous with the looming fear of the reality that a Black woman may go to the hospital to have her baby and never make it out alive. 

So two months before the global pandemic hit, Mejia-Green opened Homeland Heart Birth and Wellness Collective in Nashville, Tennessee. Homeland Heart is Nashville’s first and only perinatal support center that prioritizes families of color. Due to COVID-19 the center was forced to operate remotely for a year, but has been helping pregnant women nonstop ever since. 

“There weren’t a lot of Black doulas in the city that I could refer clients to while I was pregnant with my daughter,” said Mejia-Greene. “That was really disheartening. That was my motivation behind building this table that we all could pull up a chair to.”

Mejia-Greene said she founded the center once she learned about the gaps in care for Black women, the racial disparities in maternal health outcomes, and the limited number of Black doulas in her area.

Unlike midwives, who focus primarily on the safe delivery of a baby, doulas provide educational, physical, and emotional support for pregnant people before, during, and after delivery. At Homeland Heart, 100% of the clients and doulas are Black women, but the center is currently in the process of expanding its staff and clientele to include immigrants and Latinx people. The center has helped about 50 Black families through the childbirth process. 

Black women and medical distrust

Black women know all too well the burden of having to advocate for themselves when they go to the doctor. When it comes to maternal health care, the need for advocacy is even greater. Whether a Black woman advocates for herself or not, things can turn deadly. Black women are up to four times more likely than white women to die from pregnancy-related complications and suffer from childbirth-related disabilities, according to the Center for Disease Control. They’re also significantly more likely to suffer from infertility, have a cesarean section, receive no prenatal care, and be denied medication to manage their pain. 

This year for Black Maternal Health Week, Black women like Mejia-Green, as well as legislators from across the country, are speaking out to uplift their ongoing efforts to eliminate these disparities. Black Maternal Health Week (April 11-17) aims to amplify the voices of Black mothers and raise awareness around maternal health. Until there’s more progress in this space, Black women are continuing to put themselves on the front lines in the fight for safer, healthier pregnancies.

Mejia-Green said one of the main reasons Black women turn to Homeland Heart is because of a distrust in the healthcare system.

“[Doctors] can be so busy trying to be the ones that save people, but they don’t always realize that you can save someone by listening to them,” Mejia-Greene said.

Meejia-Greene’s clients have shared with her that they feel they can’t be fully transparent with their doctor about their lifestyle or health issues. She said many Black women fear honesty could subject them to being profiled or stereotyped, and that many of her clients will reveal information about themselves to doulas that they wouldn’t share with their OB-GYN.

“The problem with being an educated patient is that you deal with stepping on the toes of your healthcare provider,” Mejia-Greene said. “How do you think that makes them feel? Are they proud of you because you research what’s going on with your body? It’s very unlikely. Your doctor thinks they’re the only person who knows and they’re the only person who gets to know.”

Doulas have been proven to improve pregnancy outcomes for all women and those who give birth, but especially people of color. But the cost of a doula can be a barrier for low-income people looking for additional support. Doulas aren’t typically covered by health insurance providers and can cost up to $2,500 out of pocket. Homeland Heart offers free doula services to women of color in seven different zip codes in the Nashville area that either meet or exceed the nation’s infant mortality rates. The free services are made possible by their partnership with the Metro Public Health Department and their grant program, Nashville Strong Babies.

Because doulas can play such a crucial role in ensuring a healthy pregnancy and delivery, Mejia-Greene is constantly working to make sure expecting parents have access to services. She worked with Healthy and Free Tennessee to form legislation that was supported by state Sen. London Lamar. Lamar’s resolution was officially passed in March and recognizes doulas as vital members of the childbirth team. Mejia-Greene played a role in removing the requirement that doulas must be certified in order to eliminate the financial barriers preventing many Black and brown people from getting into the profession.

New maternal legislation by Black lawmakers

In addition to Lamar, an increasing number of Black lawmakers are recognizing the importance of doulas, and are actively working to uplift the maternal health crisis affecting Black families. At the federal level, members of the Black Maternal Health Caucus have introduced the Black Maternal Momnibus Act of 2021, which would build on existing legislation to address the nation’s maternal health crisis. At the state level there are several Black lawmakers making strides of their own.

Massachusetts state Rep. Liz Miranda co-authored a bill aimed at addressing racial inequities in maternal health care, maternal morbidity, and maternal mortality. The bill establishes a commission to investigate the numerous causes of Black mortality and morbidity and tasks them with proposing policy changes based on their findings. The bill was unanimously passed by the state House of Representatives last year and was signed into law by the governor in January. Since the bill was signed into law, Miranda has reintroduced additional legislation around maternal health: one to provide Medicaid coverage for doula services and another to conduct a review on fetal and infant mortality.

Miranda said she wants people to know that it’s okay to demand more and fight for what they need—even when they’re scared.

“I am in a job where I get to help my community and do well for me and my family, yet I’m still afraid,” Miranda said. “I heard doctors who were Black women say that they’re afraid. I’ve heard CEOs of companies say that they’re afraid. It’s okay to be afraid, but we’re going to do something about this.”

Michigan state Sen. Erika Geiss introduced legislation last year to expand doula services to expectant mothers on Medicaid before, during, and after childbirth. Geiss continues to work with doulas and various stakeholder groups to strengthen the bill and says she plans to reintroduce it at some point this year.

“It’s very necessary to be able to utilize all the tools to improve health outcomes, especially when we’re talking specifically about a population that statistically has lower positive maternal outcomes, both prenatally and in that first year postpartum,” Geiss said. “Racism is a public health crisis. It’s because of the institutionalized and systemic issues Black mothers have experienced in traditional healthcare settings that the health outcomes have not been good.”

Geiss was the first person in the state legislature to introduce a resolution recognizing Black Maternal Health Week. She is currently working on additional legislation to help pregnant people and families with newborns. Last year she introduced a bill that would provide humane treatment for incarcerated pregnant people. She’s also working on legislation to give equitable breast milk access to parents who don’t have the option to breastfeed.

“When we address these issues and these systemic inequities that have been present for generations, it doesn’t take anything away from others,” Geiss said. “It improves things for everybody.”

Nevada Assemblywoman Clara Thomas is also involved in the fight for better Black maternal health outcomes. She is the lead sponsor of a bill that would strengthen the state’s Maternal Mortality Review Committee. The committee was formed during the 2019 legislative session and was intended to investigate some of the state’s pregnancy-related deaths and other systemic health care problems. Thomas’ bill would revise the committee to mention racial disparities, age, and geographic location in these health outcomes. The bill has received bipartisan support from the state’s legislature, a majority of which is made up of women. 

Black maternal health is a personal issue for Thomas. Her daughter dealt with some serious health issues that went ignored by doctors while pregnant, she said.

“As Black women we aren’t taken seriously with our health needs, especially when it comes to babies,” Thomas said. “They lump us all together because they feel like our anatomies are the same, but there are life issues that are different. We come from different backgrounds, and when you come from different backgrounds that should be taken into consideration in your health care.”

Thomas said she plans to introduce additional legislation later this year aimed at addressing the causes of infant mortality in the state. According to Nevada’s Maternal Mortality Review Committee, Black women make up only 11% of the state’s population, but account for 33% of pregnancy-related deaths.

“We have women out there who are leaving their children behind after giving birth,” Thomas said. “There’s no reason for a woman in the 21st century to go in to the hospital and not come back out with her baby, but it’s happening, and it’s happening way more often than we would like to admit.”