BMHW25 – Black Maternal Health, Medicaid Cuts, and Community-Based Care

April 11th- 17th officially marks Black Maternal Health Week—a week-long campaign centered on activism, awareness, and community-building for Black mamas and Black birthing people. Elizabeth Dawes, Director of Maternal and Reproductive Health and Senior Fellow at the Century Foundation and Co-Founder of the Black Mamas Matter Alliance, sits down to talk with us about the status of the Black maternal health crisis in the U.S. and the myriad, ongoing attacks to the Black community’s health, rights, and wellbeing from the new administration.

The U.S. maternal mortality crisis has seen an overall reduction in maternal death rates in every racial group except for Black birthing people-- due to racism and inequity at institutional, systemic, and interpersonal levels. This is despite continuous, targeted, and hard-fought advocacy since 2014. Solidifying key actors, distributing resources and funding, and amplifying direct, local care and Black-led initiatives can make a sizeable change and help tackle the persistent, systemic oppressions and health injustices disproportionately felt by Black individuals.

Links from this episode

Century Foundation on Facebook
Century Foundation on X
Black Maternal Health Week
Black Mamas Matter Alliance

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hey rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I was recently doing some purging. I mean, I've just decided I've accumulated too many things that I just, I need to clean out a bunch of storage places and why am I holding onto these things? And I just, it, it, it's having to happen. So, I'm trying to not be my usual chaotic self when I do it and just like, dump everything out and, like, do it all at once and then it feels overwhelming and it doesn't happen. So, I was trying to do, like, small, like, every day, do one small thing to just kind of go through everything and just get rid of all of these things I don't need. Anyway, I was going through a storage box and I ran across a bunch of things I ordered from Liberal Jane and hadn't used, and it was so exciting. I think it was, like, two pieces of artwork and then like a ton of stickers. I love having the stickers that Liberal Jane designs. They decorate all my notebooks and things. And so, I was so excited to find y'all. Seriously. It was, like, 20 stickers. I don't, I don't know why they were in this box instead of where I keep all of the other ones that I have saved up to use, but it was delightful to find them. So, I am enjoying this purging and trying to get rid of all of the things. But it's still just like so much stuff. Why, why do I hold onto it? It is so unnecessary. So, it's feeling good, like, freeing to get rid of it all. But it is still a process. It's gonna be an ongoing process to get rid of it. I wanna go through, like, my clothes and just all the things. So it's, I'm trying, like I said, trying to not be chaotic and do it all at once, just trying to do it in small bites. So, I'm excited to get rid of a bunch of stuff. So that's, that's what I've been up to lately is really just like going through all the things and all of the little fun things you find. Like, all of these cards I've set aside that friends have sent me, that I've held onto for forever, I'm trying to, like, whittle those down and not save all of them. But I don't know, for some reason I have a really hard time letting go of those sweet cards your friends send you with like special handwritten notes in 'em 'cause they all evoke like a special memory. So, I have a hard time letting those ones go, but I'm trying to maybe just get rid of some of the ones that are, like, a funny card with a signature that I don't need to save. Right? I, what can I say? I just, I hold onto things for sentimental reasons that I really don't need to and I need to be better about it. So that is, that's my goal right now is just to get rid of the things. I don't need the clothes, I don't wear the shoes I don't wear. I just need to get rid of some things and just do major housekeeping. That's all. No big deal, right? Just go through all my stuff. Yeah. Anyhow, that's what's new and exciting with me. I'm really excited for this week's episode.

Jennie: Coming up later this week kicks off Black Maternal Health Week. So, I was very excited to have on Elizabeth Dawes at the Century Foundation to talk about Black maternal health and Black Maternal Health Week and what y'all can do to get involved. So, definitely also make sure to check out our show notes because we will have a link to all of the things that are happening during Black Maternal Health Week. So, you can find if there's a webinar you want to attend or ways to engage on social ways that you can get involved. So make sure to check out our show notes so that you can find all of those, take action things and get involved this Black Maternal Health Week. Okay. With that, let's go to my interview with Elizabeth.

Jennie: Hi Elizabeth. Thank you so much for being here.

Elizabeth: Hi. Thank you so much for having me.

Jennie: I am so excited to talk to you this Black Maternal Health Week about everything that's going on. But I thought maybe we should start real quick with would you like to introduce yourself and include your pronouns?

Elizabeth: Awesome. I'm Elizabeth Dawes. I use she/her pronouns. I'm based in Washington DC and I'm Director of Maternal and Reproductive Health at the Century Foundation.

Jennie: I'm so excited to have you on. I feel like there has been so much going on that is impacting Black maternal health. So it feels like a really good time to have a check-in on: where are we at currently? Like what, we know there's a maternal mortality crisis, but is it getting better? Is it getting worse? Like, what is happening?

Elizabeth: It's really interesting what's happening, and I can, I can share with you what's happening now but guaranteed that's gonna change in the future given our political context. So, right now we've seen an overall reduction in the numbers of maternal deaths. In particular, rates have declined for every other racial group except Black women. We have to ask ourselves: how did that happen? Right. We've been doing advocacy on Black maternal health since at least 2014. So, it's been over a decade and a lot of people have spent a lot of time and energy and money in improving Black maternal health outcomes. And we're not seeing that across the board. We're not seeing it in the ways that we want to. So, something is happening where Black birthing people are not benefiting the same way that other groups are from changes that have happened. It's, I, you know, I have a lot of ideas about why that is. You know, the first thing that comes to mind is racism, inequity at institutional levels, at systemic levels, and certainly at the interpersonal level. So, there's still quite a bit of work to be done, but I think we can be hopeful because we have seen some reductions, right? For if we can reduce maternal mortality in other groups, then we can certainly reduce maternal mortality for Black birthing people.

Jennie: I have found hope in this steady drumbeat of attention being drawn to black maternal health.

Elizabeth: Mm-hmm.

Jennie: Like, you have really felt it grow over that decade. Where it is getting, has been getting more and more attention. It's tragic and frustrating and all the things that we haven't seen that kind, the kind of movement that we have seen in other groups. But there is still hope in that the conversation is getting louder and hopefully people are gonna start making those changes that are systemic and big and will help make this movement actually happen.

Elizabeth: Yeah, I think one of the things that happens in movement building and getting the broad level change that we actually need is people have to wake up and realize what's happening. And there are key points in history where that happens, where things get really difficult and people can see how it affects their family, their community, how it affects themselves, and then we get the attention that we need, the engagement that we need. So, for example, 2014, when I co-founded Black Mamas Matter Alliance, that was at the same time or shortly after the Black Lives Matter movement had built momentum, and we were seeing, you know, chronic mistreatment, targeting, policing of Black people overall and, you know, untimely deaths of Black people overall. And so, that kind of national conversation helped spark this conversation on Black maternal health. I think we're seeing the same thing now. This is another point in history where there's a critical moment where we have a really conservative administration that intentionally seeks to harm certain communities, and people will feel that. They will see that, they've already seen it. You know, I've heard firsthand stories of people witnessing ICE raids, and that's just, that's just one of the…you know, that's just, I know people who have friends in the government who lost their jobs. So, it's getting close to home. It's very close to home. I of course know people who are working in abortion advocacy, who are seeing cuts and protests and attacks and all kinds of things that directly affect their work as well as the people they care for. So, it's gonna get so bad that it then has to get better. It- we're, we're at that point.

Jennie: Yeah. One of the things I've been thinking about is one of the big things that the previous administration did was expanding Medicaid for maternal healthcare, for what, one year postpartum and that's huge. But now we're talking about possible huge cuts to the Medicaid program, and that is just gonna be devastating if that happens.

Elizabeth: It is, it is. There's going to be a lot of devastation if they continue to do what we see them doing and what they say they're going to do, right? Project 2025 is scary, but as someone mentioned to me, they said, well, they've laid it all out for you, so you know, how, how are we gonna fight that? We know what they want to do, we know what they're trying to do, what they are doing. So, at least we have that kind of information to then combat it. So there, there's a lot of devastation, but there is also a lot that can be done to correct things. If we know what the problem is, we have a better chance of correcting it. And improving people's lives. So I'm, I'm hopeful in that regard, that there are key places where people can make decisions, can take action, can make changes, can do things differently to improve access to healthcare, access to resources that Black people need to stay healthy and that Black birthing people need and want to have healthy pregnancies and their ideal labor and delivery experience, as well as the postpartum care and support they need. So, one of the things I want to get more into in my advocacy is helping people see and understand that there are decision makers at key points, and that one person can change the lives of thousands, hundreds of thousands, millions with one action. And we've seen that. We're seeing it now. One person can either cause massive destruction and one person can also cause a lot of positive change. So I would love for more people to think about how them as individuals and their positions, whatever that may be, one decision, you know, at, at a moment where you either go left or right and that decision can make, you know, it can make the difference for, for somebody for a whole community, for a whole family, and for society, you know, at large.

Jennie: Yeah, I think there's, like, many ways this feels like such a big problem that it's hard to tackle and seeing that, you know, you talk about other maternal mortality rates coming down, but for Black people it's staying the same, so people can start to feel disempowered and a little hopeless in how to take action. So what do you see as: what do we need to do? So, finding key actors is so important. What else are you thinking about?

Elizabeth: I'm thinking about how resources are distributed, how funding either does or does not make it to community-based organizations that are leading the work, that are providing direct service, that are ensuring that their clients have holistic, comprehensive care. Again, this is historically and still the case that a lot of black led organizations are underfunded, under-resourced and trying to do a lot with a little. And I always wonder: how much more could we do with ample resources? I think maybe that's why we've seen these reductions in certain racial groups and not in others. Those groups, when you think about it, have resources, they have more access to resources. They have white privilege or being adjacent to whiteness that is a privilege for them. And they basically got the roadmap right, from Black maternal health advocates: here's what you need to do. And so they're doing it for themselves with the resources that they've been privileged enough to have. So, for me, it's really about redistribution of finances at the end of the day. We need to pour more money into Black-led efforts and initiatives that are actually supporting black people because then they can scale, then they can reach more people, they can have a greater impact, they can do more advocacy. They have more power to leverage at certain, you know, in certain rooms, at certain seats at the table and can create that change that we're all looking for.

Jennie: I think another, like, really important thing is making sure you're listening to the people on the ground for what they need and what they want to make sure the investments are going into the services that they think and know will benefit their community.

Elizabeth: Yeah. The grassroots organizations, community-based organizations and initiatives, they're, like you said, they're listening to their community. They know what works. They have the lived experience, they have those one-on-one interactions, that close touch that a lot of policy makers, or let's say hospital directors or other types of folks are at a distance and they don't experience that. They don't see how people are affected. Hearing numbers and seeing things and understanding people's lives—those are all different things. So, I think what we have right now is a lot of people are hearing numbers and they're not connecting to that. They don't see the people behind those numbers. They don't see the experience that inequity causes. They don't see exactly how they get treated versus how, you know a Black woman on Medicaid might get treated. And we have stories, we have enough stories that show that a Black woman on Medicaid is gonna be treated differently than a white woman who has a million dollars or more. Yeah. You know, a million these days is not actually a lot, you know, like, there are billions of dollars and we see that with the hoarding at the, the highest levels of, of government and wealth that people hoard resources for some strange reason. But ultimately, again, people play into those dynamics and they value those people more than others for some reason. So I think again, there are key points where those things can change.

Jennie: I, so, I recently did an episode talking about Medicaid and the proposed cuts to Medicaid and had very similar conversation of, like, you hear they're talking about cutting $800 billion and not understanding what that means in terms of people on the ground who are gonna lose access to services, hospitals that are gonna close that then people will not have access to. It's so easy to get caught up in just the number and forget the person behind that and the person whose life is impacted behind all of these things. And storytelling and, and getting people's stories out is such an important part of that. But it is always just so important to keep the people front and center.

Elizabeth: For sure. And once you hear those stories to then, you know, go and do something about it. Don't forget about it. Like, oh, that's so sad. And then move on to the next thing. Yes. There's a lot of distracting news these days, so people are putting out fires in every direction.

Jennie: Yeah. And like even forgetting that some of, of, so many of these stories are linked, right? Like thinking about people, Black maternal health doesn't just start and stop with labor and delivery, right? We're talking about the Medicaid cuts are gonna impact them because health beyond maternal health is important in this conversation. Access to abortion care or family planning services or just having on the ground support. Like, all of these factors are interrelated, but talked about so often in silos.

Elizabeth: Mmm. Yeah, definitely. One of the things I...actually, this is one of the ways that my career started was with a focus on social determinants of health. You know, people are moving on to structural determinants of health, but essentially a variety of factors influence health and wellbeing. And stress is a huge influence on health and can set you up for failure if you're stressed out, if you're worried about your job, if you don't have a job, if you're unemployed, if you don't have access to transportation to get around or childcare if you don't have access to healthy food. So I'm thinking about people that use WIC and SNAP and rely on that kind of public assistance to eat and to feed their families. And you have a government that's saying: we're gonna cut all that, we're gonna take away your right to food, your right to housing, to jobs. You don't, your job is insecure at this point. We can only, you know, you can only imagine what kind of effect that has on mental health, on the body. We know the mind and body are connected. They're one, we are not...you know, we're, we're one person, a whole person. And when you start to attack any aspect of that person, you put that whole person at risk and it shows up. It starts to appear, you know, in heart disease, in obesity, in mental health crises, which we don't talk about enough either as a community, as a country, we have a lot of strides to make in that area. But what I, my point here is I want people to understand that yeah, it's not just healthcare. It's not just health insurance, those things, that's just the end of the line, right? That's where everything falls apart. It's like you've built a house on a shaky foundation, Medicaid cuts are the heavy wind that comes through and blows everything down. And I question, you know, how people will be able to survive that.

Jennie: Yeah, it is definitely something that has been on my mind a lot. I'm from southern Wisconsin and I know the local public hospital where I live is one of the very few in southern Wisconsin, Northern Illinois. And hearing what the Medicaid cuts could do and close that hospital, like, where are these people gonna go? And stories like that are gonna be repeated across the country. And there's just so much, like I said, kind of this devastation all around. But again, trying to find hope in all of the things where we are seeing other maternal health numbers coming down, like we know it can be done. We just need to find ways to make it happen to bring the Black maternal health numbers down as well.

Elizabeth: No, it was, no, it's a, it's a good point. Where are those people gonna go for care? Is a good question. And the initial, my initial sort of internal reaction was, okay, we need more community-based efforts. We need more homegrown efforts. But at the same time, you then run into this same resourcing question. I'm also a business owner and that has really taught me how much of a difference money makes and resourcing makes. And if you don't have the capital in a capitalist society, which we're not changing anytime soon, it's hard. It's very hard to do what you want to do and what you need to do for your community if you don't have the money to do it. So I'm like, yeah, there are any number of things that could be done. There are any number of things that could be done. What's missing is the will and the desire and the compassion to invest in the health and wellbeing of people. It's absurd to me. It's absurd to me that-

Jennie: That this is the conversation we're having.

Elizabeth: Yeah.

Jennie: Like that...

Elizabeth: Yeah, there's no, I don't, I don't know, I don't wanna say that, but that's, there's no way to address these issues without funding. And government has been responsible and should be responsible for funding services for its people. That's why we have government, that's why we pay taxes. That's why we elect them into office is to make choices that benefit people. And when you have a government that the leadership is only making choices to benefit themselves, their pockets and the corporations that they're tied to, there's nothing to be done. We need a new government.

Jennie: I know. It just feels so heavy right now.

Elizabeth: I don't know if I can say that.

Jennie: Oh, all of it just feels so heavy.

Elizabeth: We need leaders who are committed to doing what's in the best interest of the people. I won't even call it the right thing, you know? 'Cause right and wrong, you get into morals and values.

Jennie: Yeah.

Elizabeth: But there are clear things that data and evidence show and that we can see with our own eyes that help, there are clear things that harm. And so again, going back to that point of making a decision, is this decision gonna help or harm somebody? If we can help a black birthing person that's the right decision to make, or that's a good decision to make, if we're going to end up harming a Black person or a Black family, that's the wrong decision to make. That's not a, that's not the best choice at the time. I think what we have is people who are saying they're seeing the best decision as the one that works for white privilege and for their economic benefit.

Jennie: Or staying in office.

Elizabeth: At the expense of everyone else. I, so I've had this just random, random thoughts. I've had this thing, I'm like, what do they want? What does staying in office benefit you? You've got billions of dollars.

Jennie: If you're not using your power for good. Like, what are we doing?

Elizabeth: Why are you there? Just go enjoy your life with your billions of dollars. Go enjoy your life. Nobody asked you. I watched a movie recently, a documentary on the religious right. That's a whole nother conversation to get into. And you know how they bought into Trump as the one who was gonna get their agenda done for them. And we're seeing that right now. But again, I question: to what end?

Jennie: Ugh. Again, it's like the...everything is so dark and heavy at the moment. Ugh. Okay. Let's think through, okay, it's Black Maternal Health Week. Yeah. What, what can the audience do? What actions should the audience think about taking this week to make a difference?

Elizabeth: I think individuals can do quite a few things. They can certainly educate themselves on the topic, participate in the black Maternal Health Week events and webinars and gatherings that a lot of organizations, advocacy organizations are putting on. Those are great ways to learn more about these topics, learn more about how they can help and also offer support to these organizations. So make a donation that's helpful for sure. But also get involved, you know, donations work, but you also need to know why you're donating, what you're donating to. You need to, you know, see how the money's being used to really believe in it. And I think when you connect with these groups as a volunteer or just showing up when they ask, you know, going to march with them, if they're doing that, then you can see, hey, this is actually really important work. These are people that want the best for their community and so I'm gonna do what I can to support them. So, that's one thing. I think another thing that people can do is have conversations with people in their lives that don't necessarily know that this kind of thing is happening. I know a lot of people are politically unaware, right? We're, we are here, we know what's happening, we're having these conversations, we live and breathe this work. You'd be surprised how many people just choose to ignore it, choose not to engage with it. So I think we need some political activation and awareness amongst the broader American society. Again, people are gonna see how it's gonna affect them and that's when they'll pay attention. But we don't want them to have to experience really negative consequences to then take action. So, I think there are critical conversations that individuals can have with their families, with their friends. I've had conversations about maternal health at brunch, you know, with the sorority sisters. So, there are any number of places where these things might come up or you can bring them up. It's like, hey, did you hear that this is happening? Like, sparking dialogue can actually do quite a bit. And I would say post Black Maternal Health Week, don't just go back to, you know, whatever you would.

Jennie: It doesn't end there, right?

Elizabeth: Yes. So yeah, Black Maternal Health Week does not end on April 17th. The same energy we have during that week is the same energy we need to have throughout the entire year. It's the same energy we need to bring to the voting booth when it's time to reelect or make another choice about who gets to take office, who gets to represent us who we think is gonna work for our best interest. So yeah, don't stop there. So that's, we've got education, conversation, donating, and voting accordingly. And I guess the fifth thing would be at any point in time where you are, again, going left or right, asking yourself: how is this going to help? Or how is this going to harm? And choosing accordingly.

Jennie: And then I'll just give my usual flag. I always give, when we talk about donating, if you are able, it makes a huge difference if you can be a monthly donor because then those groups know that they can consistently count on that money as they're budgeting and making their plans versus a one-off. And that's not saying if you were gonna do like a hundred dollars donation, you need, you'd be like a hundred dollars a month donor, but, like, $10 a month, $5 a month, they know they're getting that every month, and it can really make a huge difference.

Elizabeth: Yeah. And I think people also don't realize, like, even the small amounts, right? They're also able to go to their funders and say, you know, they count as a person. Yeah. It's not necessarily that it's a dollar or $5, it's like, hey, one more person believes in us. 10 more people believe in this work and they're giving. So, that's some, that's another way that the funding helps is by this group being able to show these, this number of people cares about our work and they're in it with us.

Jennie: Elizabeth, thank you so much for being here. I had so much fun talking to you.

Elizabeth: Thank you so much for having me. It was a good conversation, and you know, these are tough times, but I think we will get through it with very dedicated, smart, resilient action and with building power amongst ourselves and our communities and bringing whoever we can along.

Jennie: Yeah. And I just have to say like, it is dark and, but I couldn't do this work if I didn't actually have hope or believe we couldn't win, right? Like, so it may feel really dark right now, and yes, there devastating things are gonna happen, but I firmly believe we will get to that better place where people have access to the healthcare they need, the Black maternal mortality rate comes crashing down. We will have reproductive autonomy. We'll have all these things. I couldn't do my job if I didn't actually believe that.

Elizabeth: And guess what, now is the time to step up more than ever. That's something I've been reminding myself that now's the time for me to deepen my advocacy, for me to deepen my work, for me to dig into the ancestral power that I have, knowing that generations before me went through a lot worse and were able to find their own way to thrive and to make progress for us. So I can be here today on a pod, you know, on a podcast, at the Century Foundation.

Jennie: Yeah.

Elizabeth: Walking on the Hill talking to Congressional members, right? That's a place of power and that's an opportunity that I have to do, do the right thing. So now's the time to step up, whatever in whatever way you can.

Jennie: Oh, thanks Elizabeth. Okay, y'all, I hope you enjoyed my conversation with Elizabeth. Like I said, things are feeling a little heavy right now. There's a lot going on and a lot that we are worrying about that is gonna impact Black maternal health, but there is hope. We know what needs to be done and we will keep fighting. And yeah, it was a good conversation. Take action in the myriad of ways Elizabeth suggested. Definitely check out the Black Maternal Health Week website so that you can find and participate in all of the activities that are happening this week. And I will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!