When we think of social justice, we often envision images of people marching, carrying signs adorned with phrases meant to challenge the status quo or physical representations of resistance such as the Black power fist or, more recently, kneeling. Social justice, however, extends far beyond activist lines, into a realm that highlights the inequities of lived experiences. Pregnancy and childbirth, in particular, are still unequally lived experiences for Black women.
Half of all maternal deaths in the U.S. are deemed preventable in nature.1 Black women in America are dying at alarmingly disproportionate rates during childbirth when compared to their white counterparts:2 they are three to four times more likely than white women to die from pregnancy-related complications.3 When potential confounders of SES and education level are adjusted for, maternal mortality rates for black women remain at higher rates – a college educated black women with a greater SES will die at a greater rate from pregnancy-related complications compared to white women who did not complete a high school diploma.4 Therefore, the racial divide persists despite the United States’ overall increase in maternal mortality rates across the board.5 While poverty and access to health insurance and health care help explain some of this racial gap, the gap is not yet fully understood.
Literature speculates that chronic stress from racial discrimination experienced throughout lifetime can be the missing factor in explaining the racial gap in maternal mortality.6 While providing a key focus to changing the landscape of Black maternal health and spanning multiple organizations focused on Black mother’s health, these studies fail to grasp the experiences and viewpoints of Black educated women and Black mothers. Kirstie Coxon and colleagues did, in a study of 2015, consider these different experiences in childbirth and concluded women’s perceptions of hospital care during a pregnancy have a great impact on their planning of future pregnancies7. Another study provides the perspective of childbirth preparation from an African American women providers.8 While centering Black women’s voices and testimonies around birth is not new, still missing is the intentional focus on black women and how their experiences in community programs, community, and life shape their birthing options.
Reducing the burden of death for Black pregnant women will improve the health of not only Black women but the Black family. While the school-to-prison pipeline disproportionately disrupts the lives of Black people, already deconstructing the stability and backbone of many Black families, dying mothers provides no extra benefit.10 We need to better understand, through lived experiences within communities, families, and peers, why Black mothers make the decisions they do around birth; those choices are crucial to design adequate programs focused on their health. This could be through including cultural competent components in order to decrease the alarming racial gap in maternal mortality rates in the United States.11
My interest in this topic lies at the intersection of the numerous, heart-wrenching, unfortunate stories of Black women who were close to death or died from pregnancy-related outcomes and my lived experiences of being a Black woman contending with the scary death statistic attached my being.12,13,14 Black women’s bodies can be liberated through a radical transformation of birth; we can only achieve that when we understand how choice and viewpoints are mired in experience in community and community programming.
 

Nchedochukwu Ezeokoli is part of the Students for Social Justice. Students for Social Justice is a student group at Emory University’s Rollins School of Public Health committed to social justice and change within our personal, academic, and professional lives.
Write them at s4sjRollins@gmail.com. 
Facebook page: https://www.facebook.com/S4SJRollins/
 
References:

  1. Maternal mortality and morbidity in the United States of America. (n.d.). Retrieved February 08, 2018, from http://www.who.int/bulletin/volumes/93/3/14-148627/en/
  2. Reproductive Health. (2017, November 22). Retrieved February 08, 2018, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
  3. Flanders-Stepans, M. B. (2000). Birthing Briefs: Alarming Racial Differences in Maternal Mortality. Journal of Perinatal Education,9(2), 50-51. doi:10.1624/105812400×87653
  4. Tucker, M. J., Berg, C. J., Callaghan, W. M., & Hsia, J. (2007). The Black-White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates. Obstetrical & Gynecological Survey,62(7), 426-427. doi:10.1097/01.ogx.0000268653.02125.b9
  5. Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F., & Callaghan, W. (2015). Pregnancy-related Mortality in the United States, 2006-2010. Obstetric Anesthesia Digest,35(4), 195. doi:10.1097/01.aoa.0000472713.19210.f5
  6. Oparah, J. C., & Bonaparte, A. D. (2016). Birthing justice: black women, pregnancy, and childbirth. New York: Routledge.
  7. Coxon, K., Sandall, J., & Fulop, N. J. (2015). How Do Pregnancy and Birth Experiences Influence Planned Place of Birth in Future Pregnancies? Findings from a Longitudinal, Narrative Study. Birth,42(2), 141-148. doi:10.1111/birt.12149
  8. Abbyad, C., & Robertson, T. R. (2011). African American Women’s Preparation for Childbirth From the Perspective of African American Health-Care Providers. The Journal of Perinatal Education,20(1), 45-53. doi:10.1891/1058-1243.20.1.45
  9. Western, B., & Wildeman, C. (2009). The Black Family and Mass Incarceration. The Annals of the American Academy of Political and Social Science, 621, 221-242. Retrieved from http://www.jstor.org/stable/40375840
  10. Taylor, C. N. (n.d.). Exploring African Americans’ High Maternal and Infant Death Rates. Retrieved February 08, 2018
  11. Lockhart, P. (2018, January 10). Too many black women like Erica Garner are dying in America’s maternal mortality crisis. Retrieved February 08, 2018
  12. Lockhart, P. (2018, January 11). What Serena Williams’s scary childbirth story says about medical treatment of black women. Retrieved February 08, 2018, 
  13. Martin, P. N., & Montagne, R. (2017, December 07). Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why. Retrieved February 08, 2018
Nchedochukwu Ezeokoli
Nchedochukwu Ezeokoli
Nchedochukwu Ezeokoli is a Master's of Public Health Student in Global Health. She is studying community health and development has a passion for women's health and development utilizing health equity and social justice framework. She is co-president of Students for Social Justice, an organization at Rollins School of Public Health.

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