Reproductive justice requires countering racism, listening to women

In early 2018, accounts of tennis star Serena Williams’ life-threatening childbirth complications circulated the news.

The famous, wealthy, world-class athlete revealed that when she felt short of breath the day after giving birth to her daughter Alexis, doctors ignored her concerns about an artery blockage in her lungs from blood clots, a condition for which she had previously been treated. 

When doctors finally heeded her requests for testing, they found several blood clots in her lungs. Williams is not alone in feeling unheard and unsafe while giving birth. 

“We know that Black women are three to four times more likely to die of pregnancy-related complications or delivery complications,” said Ndidiamaka Amutah-Onukagha, PhD, MPH, CHES, associate professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine. “That is 243% higher than their white counterparts.”

Amutah-Onukagha and other experts spoke about reproductive health disparities during the second in APHA’s Advancing Racial Equity webinar series, “A Path to Reproductive Justice: Research, Practice and Policies.” 

(From left: APHA's Regina Davis-Moss, webinar presenters Ndidiamaka Amutah-Onukagha, Elizabeth Howell, Joia Crear-Perry and U.S. Rep. Lauren Underwood, and moderator Monica R. McLemore)

Income level, access to care, culture and communication all play a role in maternal health disparities. But factors like poverty and education level are not the sole cause of the problem, as Amutah-Onukagha emphasized, citing results from ProPublica’s Lost Mothers series. 

“Lost Mothers points out that Black women living in the wealthiest neighborhoods have more complications than white, Hispanic and Asian mothers living in poorer neighborhoods,” she said. “The narrative around education as a protective factor does not buffer the case of maternal mortality and morbidity in Black women.”

Amutah-Onukagha also spoke about the problems of limited funding for minority researchers and a lack of diversity among doctors and those who educate them. 

“Overall, there's very limited diversity in the medical field; 6% of MDs are Black, 11% of OBs are Black, 3% of medical school faculty are Black,” Amutah-Onukagha said. 

Panelist Joia Adele Crear-Perry, MD, FACOG, founder and president of the National Birth Equity Collaborative, highlighted the need to recognize disparities in maternal births as an issue of equity and not one of biology. 

“We don't have to believe in a biological basis of race,” Crear-Perry said. “That was something that was brought into the sciences, that's not something that was created by the sciences.”

And while it’s a main tenet of reproductive justice, “We don’t treat patients as if they have personal bodily autonomy,” Crear-Perry said. “We don’t say to them, ‘you have health care choices.’”

Elizabeth Howell, MD, MPP, professor in the Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science departments at the Icahn School of Medicine at Mount Sinai, called for action in the medical and public health communities to address existing racial inequities. 

“We've got to eliminate and do these implicit bias and explicit bias trainings, and do more to counter this culture of racism that we know plays such a role in these deaths,” she said. “We need to engage community, and we really need to work on enhancing our communication between our staff and our clinicians, as well as with our patients.”

Presentation slides, webinar transcript and on-demand recording of “A Path to Reproductive Justice: Research, Practice and Policies” are available. Register now for the third Advancing Racial Equity webinar, “Reborn Not Reformed: Re-imagining Policing for the Public’s Health” hosted live Aug. 11, 12:30-2 pm EDT.