Bonus Pod: BMHW21 - Black Maternal Health, Abortion Access, and Reproductive Justice

 April 11 – 17, 2021, marks the fourth annual Black Maternal Health Week. In this bonus episode, Dr. Jamila Perritt, board certified OB/GYN and President and CEO of Physicians for Reproductive Health and Dr. Mishka S. Peart, OB/GYN and fellow with Physicians for Reproductive Health, talk to us about the importance of highlighting and discussing the disparities in abortion, contraception, and maternal health access and outcomes for Black people in the United States 

There are undeniable race- and ethnicity- based disparities in maternal health outcomes in the United States. For example, maternal deaths occur more frequently among Black people than any other race or ethnicity, and the Centers for Disease Control and Prevention (CDC) note that Black people are three to four times more likely to die of pregnancy-related causes than any other racial or ethnic group. Lack of access to quality contraception and abortion care also disproportionately impact Black communities; in fact, a recent study found that barriers to abortion contributed to up to a 38 percent increase in maternal deaths, which has a disparate impact on Black people.

Medical care, access to comprehensive reproductive health services, and maternal health outcomes are certainly impacted by social inequities and racism. “Weathering”, or the phenomenon of the biological impact of stress related to being Black in America, is an effect of the systemic racism faced by the Black community in the medical system and beyond. It is vital that the U.S. medical system recognize this cyclical structure and make long-term changes that address the inherent biases in the healthcare infrastructure.

The reproductive justice framework has four tenets at its core: 1) every person has a human right to determine if they have a child, and to determine the circumstances under which they give birth; 2) every person has a human right to decide if they will not have a child and to have the resources to decide if and how to prevent and end a pregnancy; 3) every person has a human right to parent the children they already have in sustainable and safe communities free from violence; and 4) every person has a human right to bodily autonomy and sexual pleasure. It is far past time that the United States begins to view and provide comprehensive reproductive health care holistically and through the lens of a reproductive justice framework.

Links from this episode

Physicians for Reproductive Health on Twitter
Physicians for Reproductive Health on Facebook
H.R.959 - Black Maternal Health Momnibus Act of 2021
Additional information on Black Maternal Health Week
It’s Black Maternal Health Week. Let’s Talk About Abortion Access.

transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: I’m your host, Jennie Wetter, and my pronouns are she/her. Welcome to a special bonus episode of rePROsFightBack. So, I'm still thinking about last week's episode and all of the attacks that are happening to trans rights in the states. They're still going on. There's been another slew of bills introduced this week or this past week, and it's just unrelenting and I just, it breaks my heart. It makes me so angry and I just feel so terrible for all of those trans kids who deserve our love, who deserve our support. And instead, are having to deal with all of this. It's just so unfathomable to me. They deserve to be living their lives as kids and not having to worry about all of this. And it is just enraging to me that they are having to deal with this day in and day out. Right now, these attacks have to stop. Like it is just the worst y'all, I just, you know, saying that trans kids can't have access to gender affirming care saying they can't play sports that correlate to their gender. Like these…this is just, there's no reason. There is no reason for all of this. I really hope that we start to all speak up and fight back against all of this. It is just terrible. So that's really been weighing heavy on me for the last week. I mean, longer it's been weighing on me as all of these bills have been introduced and it just, it seems relentless. So, and if it seems relentless to me as a cis woman who doesn't, this doesn't affect my life per se, think of the trans people in your life who are having to see all of this hate and all of these lies about them spewed all over. So, make sure you're checking on them and seeing if they're doing okay, because this has been a really hard couple of months for them, I'm sure longer, but particularly these last couple of months where the attacks have just been unrelenting, just know that we see you. We care for, we support you and hopefully the tide will turn soon, and we will be able to push back on all of these attacks. Maybe we'll be able to get the Senate to pass the Equality Act. And that will end all of these attacks. I just, there has to be an end to this soon.

Jennie: So those are the main things that I've been thinking about. I know, sorry. It was kind of heavy, nothing else, too exciting. I'm in DC. So, I still haven't been able to get my vaccine yet. I am on the like preregistering to get an appointment list. So hopefully sometime in the near-ish future, I will be able to get one, but it has been so heartening and heartwarming to see so many people I know who've been able to get theirs and it just takes all that like little bits of stress you didn't know you were carrying off your shoulders. Like when my parents got fully vaccinated, I didn't realize how much I was stressed about that until they were fully vaccinated. And I just felt this invisible weight lift. So hopefully I will be able to get mine soon. It would really be nice to be able to, uh, start to see some people more. That would be lovely. So I think I'll leave the intro there. I'm really excited for this week's episode. You know, it is Black Maternal Health Week this week. And so we thought it was really important to do a special episode for Black Maternal Health Week to talk about black maternal health and issues around it. And I couldn't think of two better people to have with me then Dr. Perritt and Dr. Peart with Physicians for Reproductive Health. We had a wonderful conversation, and I can't wait for y'all to listen. So enjoy.

Jennie: Hi, Dr. Perritt and hi, Dr. Peart. Thank you so much for being here today. I'm so excited to talk to both of you.

Dr. Perritt: Thank you so much for having us. We're excited to be here.

Dr. Peart: Thanks, Jennie. Thanks so much.

Jennie: Okay. So do you both want to take a second and introduce yourselves real quick? Tell us a little bit about yourself and include your pronouns. So let's start with Dr. Perritt.

Dr. Perritt: Of course. Hi, my name is Dr. Perritt. I use she/her pronouns. I'm a board-certified OB/GYN, and I have subspecialty training in complex family planning. I'm also the President and CEO of Physicians for Reproductive Health, which is a physician led nonprofit organization that uses medicine and science to advocate for comprehensive person based reproductive health policy.

Jennie: …and Dr. Peart?

Dr. Peart: Hi Jennie, thank you for allowing me to share this space and this important conversation. Um, so I'm Dr. Mishka Peart, and my pronouns are she/her. I'm an OB/GYN, specializing in complex contraception and family planning at the University of North Carolina. And I'm also a fellow with the Physicians for Reproductive Health.

Jennie: Great. I am so excited to have y'all with me today. This episode is coming out for Black Maternal Health Week, and I think one, it's such an important issue and I'm so excited to have both of you here to talk about it. So I guess let's start at the beginning. What is kind of the state of Black maternal health right now? Like what is it look like?

Dr. Peart: Yeah, so I think in answering this question, it's important to highlight the fact that maternal health as a whole in this country, it's not in a great place, but when we look at health outcomes by race and ethnicity, we start to see some major disparities emerge, which is unacceptable. Take for example, Black maternal mortality, maternal deaths occur more frequently among Black people than any other race or ethnicity. And per the CDC are three to four times more likely to die from pregnancy related causes. So these inequities have persistent for decades and they exist across socioeconomic status. We talk about Chaniece Wallace, Shalon Irving, Kira Johnson, and so many other Black people that we have lost due to pregnancy related complications. And when we start to think about how we got here, it's important to really acknowledge racism of all forms and social inequities that the Black community faces and how this permeates every aspect of our lives, including maternal health.

Dr. Perritt: And if I could just add to that, there are two things that Dr. Peart said that I would just love to lift up and make sure that folks really heard; one, this is not a new issue. This is something, the inequitable outcomes for Black women, Black birthing people has been an ongoing issue for quite some time. You mentioned in the introduction that we're going Black Maternal Health Week, and that's a week that was founded and developed by the Black Mamas Matter Alliance to really draw attention to these glaring inequities and outcomes for so many folks.We know Dr. Peart mentioned as well, that it doesn't matter how much education you have, what your income is, where you live, what your socioeconomic status is. We cannot earn our way out. We cannot educate our way out of these inequitable outcomes. And so, we have to look at other root causes and that leads us directly to not just our race, right? It's not the fact that all of the women that Dr. Peart named are Black women that put them at higher risk, but because of the racialized experience of being Black in this country and receiving care and our health systems, we know that racism and bias is a part of our nation's history and medical care is not uniquely excluded from that legacy. And so it's time, it's way past time that we start to really grapple with this history, with this legacy, and really think about meaningful and sustainable and authentic ways to address it.

Jennie: I think that's really important that you bring up the root causes, because I think sometimes when people see the numbers, they assume, you know, it's because often Black people are more low-income, and they assume it's maybe an easier issue to fix and not wanting to focus on kind of this systemic ingrained racism in the system.

Dr. Perritt: I mean, it's hard to talk about racism, right? Um, that's one of the more difficult conversations that we have to have. And I think this last year and a half has shown us that we must figure out a way to begin having these conversations and really start addressing the issues. You know, the risks that Black people, communities of color, Black, indigenous, and other people of color are exposed to, has everything to do with structural inequity, right? And that's part of our legacy in this country. And so, it's easier to say, well, let's throw some money at it, or let's move people out of neighborhoods, let's change school systems, but that doesn't fix any of the real root causes. And certainly, doesn't change outcomes for Black mamas.

Jennie: So, you know, when we talk about Black maternal health, some people might not see a connection to another area that has been under attack for the last, well, for a very long time as well, but really uptake in the last several years. And that's abortion access and people might not see how the two connect, but I know that's something you really wanted to talk about today. Let's touch on that. Like, how does abortion access relate to Black maternal health?

Dr. Peart: Yeah, so restricting access to abortion is another form of reproductive oppression that Black people face-- from forced sterilizations now to forced pregnancy by way of TRAP laws limiting people's access to essential health care, this is another attempt to remove autonomy and decision-making and not respecting and trusting people about the decisions that they make for themselves. A recent study that I saw last year published by Hawkins and colleagues discovered that barriers to abortion contributed up to a 38% increase in maternal deaths. Which we've already discussed, disproportionately affects Black people. So not only are these policies reproductively oppressive, but they're also racially oppressive as well.

Dr. Perritt: I mean, that's wonderful. I agree with Dr. Peart a hundred percent and what we're really talking about. I think it's hard for people to really make that connection between abortion and pregnancy in our mind. And that's because of the politicized way that abortion is approached in this country. Right? But the truth is the decision to have an abortion, the need to have an abortion is always framed by the conditions of your community. We know that most people who have abortions are already parents, and so they know what it is to parent and their ability to parent their children, they already have is a leading reason why they're seeking an abortion in the case of most people who are having one. One of the things that I really love about the reproductive justice framework and for those who aren't familiar with the term reproductive justice, reproductive justice is a term that was coined by 12 Black women in 1994, who were looking at the state of reproductive health in the country, in this country at that time, and saw that as Black women were often left out of conversations about reproductive health policy, have disparate access to reproductive health services. And they wanted to seek a broader way to, uh, define what reproductive health look like for so many communities. And what they did was they blended the term reproductive rights and social justice and human rights to come up with a new phrase called reproductive justice. And a few years later, SisterSong the reproductive justice collective was formed, but reproductive justice holds four tenants at its core 1) that every person has a human right to determine if they have a child and the circumstances under which they give birth, 2) every person has a human right to decide that they will not have a child and to have the resources and information needed to prevent and end the pregnancy, 3) every person has a human right to parent their children they already have in communities that are safe and sustainable with the necessary social supports free from violence from the individual or the government, 4) and every person has a human right to bodily autonomy and sexual pleasure. The thing that's really so critical about the reproductive justice framework is that abortion is not pulled out and treated as a separate thing, right? It is equally as important as the right to parent their children we have. Abortion is equally and as important as the right to become pregnant, should you want to. Abortion is equally as important as the right to agency and autonomy. So we have to think about and talk about and hold abortion and parenting and maternal health and violence in our communities on an equal footing. And when we advocate for one, we must understand that it is deeply connected to the right to access those others.

Jennie: I think that's so important for so many reasons, but one of them is so often funding and advocacy and all of these for these issues for many issues. But these in particular are really siloed off from each other. Right. You know, like you will often see the abortion rights conversation is a separate conversation from the maternal health conversation. And so often they're not talking with each other, they might sometimes talk across each other. So I think it's really important to have this conversation about how they interrelate.

Dr. Perritt: I agree. I think, you know, we treat them in these false silos, right? These issues are deeply connected in the lives of the patients that I take care of. And so, they must be deeply connected, and we have to understand the way they are tied together in our work. And that includes our work in the advocacy space, our work in the policy space, our work in the public space. One of the things that we really do as an organization, Physicians for Reproductive Health is to really, to lift up those deep connections. Right? So as physicians who hold so much privilege in the healthcare space, we know that it is our obligation and we have the opportunity to make sure that folks who are creating laws, who are creating policies that have direct impacts on the people that we take care of, understand that these things are connected and should not be siloed in the legislation that they're writing. And can't be talked about as separately either.

Jennie: Yeah. It makes me think of like thinking of the whole person, right? You need to be focusing on the whole person and how they access care and how they think about these issues and that we need to shape our conversation to fit that and making sure that we are discussing all of it together.

Dr. Peart: Yeah. And I, a hundred percent agree with that. And just reflecting back to, you know, the famous quote by Audre Lorde, right? “There is no single-issue struggle because we do not lead single-issue lives.” So, whenever we come to a space where we need to advocate, we need to advocate and consider the entire person and everything Dr. Perritt mentioned people-- that seek abortions are more likely to be parents already. So, they're coming from a space where they understand parenthood. They are coming from a place where they know what it takes to be a parent. So just keeping in mind that people do not lead single-issue struggles can, you know, make us understand that we cannot treat these issues siloed.

Jennie: I think another thing that this makes me think of is, you know, there's been a growing and I think more broadly heard conversation around Black maternal health. I think the conversation has been happening for a long time, but I think a broader audience is finally hearing it. But at the same time, we're seeing this attack on abortion rights happening at the state level and not kind of the reckoning about how one impacts the other.

Dr. Perritt: I mean, we have to really be clear that the oppressions that people who are seeking abortion face are the same oppressions that people who don't have access to quality maternity care are facing. Right? These are the same communities, right?

Jennie: Absolutely.

Dr. Perritt: We're talking about the same people. And so we can't allow folks who want to separate out and other abortion care, want to other abortion seekers, want to other abortion providers to control that narrative. Dr. Peart and I both care for folks along there in the entire spectrum of their life. We know that people who are carrying their pregnancies term and people seeking abortions are the same people at different points in their life. Right? And so we must really continue to complicate the conversation as much as we can. One of the things that you mentioned that I thought was really critical, Jennie, is really about treating the whole person, right? Holistic care. And that's something that reproductive justice advocates have really been fighting for a very long time. When you're treating and caring for the entire person, then you aren't able or willing, or even interested in separating out or pulling apart one piece of their identity to treat uniquely or different or separately; you meet people where they are and their community. And then we're also talking about here. This underlying theme that Dr. Peart mentioned a few moments ago is about power, right? This is about power. This is about agency. This is about control. And the United States has a long history of attempts to control what people with the ability to reproduce, can and cannot do with their bodies. And we see this power and control play out in a really racialized way through stratified reproduction, and theories that undergird so much of our healthcare system. So, we have to continue to remind ourselves to remind each other, this is about power and control, and every person should have the right, the fundamental right to control their reproduction. And as healthcare providers, as physicians, it is our obligation to support that and our responsibility in an effort to care for our communities.

Jennie: Okay. So, we have a good grasp of the issues now. So, let's talk about some of the solutions, what are some things that need to be done to address both of these issues?

Dr. Perritt: One of the solutions I would offer is one that we're doing now-- to have more conversations that really blend these two seemingly disparate, but deeply connected topics. So, when we're talking about abortion, we must also talk about maternal health. When we're talking about maternal health, we also have to talk about abortion and contraception, right? And so, I think really lifting up those conversations together is a really good start. And the other thing that we need to do is to shine a light on what's happening. That's one of the reasons why we at Physicians for Reproductive Health and me as an individual healthcare provider is deeply involved in Black Maternal Health Week. It's an opportunity to talk about this in a dedicated way, in an intentional way, and to really name what's happening and really to name what the unique opportunity is for physicians to enter this space and to help to write some of these historical, for sure, and ongoing definitely harms to our communities.

Dr. Peart: Yeah. And I would say coming from a policy standpoint as well and being unable to kind of separate out abortion care from the overall maternal health, we need to start attacking these policies that are restricting access to comprehensive reproductive healthcare, including abortion care. People need to be able to choose the optimal time in their lives if, and when they want to become pregnant and carry a pregnancy to term. Something else that I find important as well is when we look at these policies surrounding, you know, public assistance and who is eligible or who is deemed worthy of this public assistance, usually it's a pregnant person, right? So, I think policies that support expanding access to healthcare pre-pregnancy really puts the emphasis on the individual's life and signals to the community that we are upholding this individual within our society, that yes, you are worthy of essential health care outside of your pregnancy. So, separating access to health care from pregnancy will place that emphasis on the individual's lives.

Dr. Perritt: That's so true. And the truth is that pregnancy outcomes, poor or negative pregnancy outcomes, don't just magically occur when you become pregnant. And so, you know, one of the really critical things that Dr. Peart has said is that, you know, your health going into your pregnancy, these pre-pregnancy access to healthcare services is really critical if we have any hope of impacting inequitable access to maternal health care for impacting and inequitable maternal health outcomes. So that means we have to look at yes, access to care in our community, but access is so much bigger than just brick and mortar, right? Or the presence of, or absence of a healthcare facility, a clinic, or a doctor's office. What we're really talking about when we're talking about equitable access to pre-pregnancy care is community-based culturally responsive healthcare, right? So, we want to make sure that we're able to meet people with the care that they need when they need it. We found, you know, studies are showing time and time again, that folks who are deeply grounded in their community, that they serve, they often do a better job, right? And so, health outcomes for those communities are much, much better when you have folks who are informed by what the needs of the community is, right? And that can't be done from a grass tops level, right? So, we, as healthcare providers must be deeply embedded and responsive to the communities that we serve. And that's a huge part of ensuring equitable access to healthcare reproductive healthcare prior to pregnancy, and then ultimately improving maternal and infant health outcomes during pregnancy as well. And we see a lot of energy around that with perinatal health workers and doula support folks and the supportive midwives. And we see that folks who have historically had disparate outcomes are seeing improved outcomes. And it's not because doulas and midwives are magic. They are often fantastic and seem to be magical people, but because they are engaged in a different way often with their community. And this is especially true when we're talking about Black midwives and midwives of color, right? And so that legacy, the legacy of midwifery in BIPOC communities is a really deep enrich one. And it's time that we really start paying attention to them.

Jennie: So, all of this also makes me think of some of the other research I've seen. So, you talk about the importance of the health going into the pregnancy and having access to healthcare and a support system before. But this plays into the racism inherent in the system, but also that people experience day-to-day and the stress and toll that takes on people's bodies and then affecting health outcomes later. So, this all comes together, and all interrelates and all needs to be tackled.

Dr. Peart: Yeah. And just lifting up what you said, Jennie, I, a hundred percent agree with that. Just looking at the chronic stress of being Black in America, dealing with overt discrimination, implicit bias, explicit biases, facing microaggressions. It does take a biological toll on an individual. It leads to a biologic response in Black bodies that will lead to these negative health outcomes for an entire community. So, yes, I agree dealing with all of the different forms of racisms and -isms that the Black community faces will be one way to help improve the community.

Dr. Perritt: And this is really hard, right? For healthcare providers. This is a new way of thinking. You know, we were trained to believe that we were objective, and our care was free from bias. And to be honest, I mean, that's a diluted approach, right? How could we, who have been cultured in this system that is steeped in the legacies of genocide, steeped in colonialism, steeped in the legacy of slavery and oppression, right? And we've only recently come out of that. My mother grew up in the Jim Crow south in a place that is still deeply segregated. And so, to believe that we, as physicians, would be magically above that kind of culturation is not just misleading, but also doesn't allow us to really address the things that we need and ourselves and our community and our care to be able to improve outcomes. And, you know, the weathering that Dr. Peart is talking about that’s that phenomenon of biological impact of experiencing racism throughout, not just your lifecycle as an individual, but also we have more and more evidence that this trauma is intergenerational, that it's passed along to our children, even during our pregnancy. And this is no way to lean into a deficit narrative. This is not to suggest that Black women are broken or that we need to be fixed, but really, to be very clear in saying it is the system that needs to be fixed. And it is us as healthcare providers, as folks that are working to write policy, to shape policy, to influence policy, to do that work, to create better circumstances for folks who need care, the care that we're delivering. And so, we're seeing calls for things like implicit bias training pop up in health systems around the country. We're hearing organizations, you know, thinking about ways to grapple with it. And we have to be clear, a day long implicit bias training is not going to do the trick, right. There is so much deeper and deeper work to be done to really address these issues. And this is just, we are just at the start of it.

Jennie: Okay. So I always like to wrap up by focusing on actions. So, what actions can the audience take? What can they do to help move, address these issues? Dr. Peart: Yeah. So if you're a healthcare worker, it starts with the basics, right? Respecting and actively listening to your patients, being cognizant of your own biases, validate your patient's concerns and take them seriously. If you're a current or future patient within the health care system, do not hesitate to advocate for yourself. Ask questions. If something does not make sense to you. If you are interacting within a healthcare system, bring someone with you that you're trustful of, that can be a partner, a spouse, parent, friend, someone that will advocate with you, who can hear and listen with you as well and actively discuss some of your concerns. And collectively, I think something that we can do is to also support policies that expand, not restrict, access to comprehensive reproductive health care, giving people the confidence to choose if and when they want to become pregnant. And one thing that we did not touch on that I wanted to discuss was the Black Maternal Health Momnibus Act of 2021.

Jennie: That, yeah!

Dr. Peart: so that was introduced in the house back in February. And basically, what Momnibus is, is it’s a collection of bills, it's 12 bills. And it really takes this multifaceted approach to improving maternal health, not only by proposing new innovations within the healthcare system, but also utilizing that socioecological framework that we've mentioned to really invest in other areas such as housing, transportation, nutrition. So, it takes an all-encompassing look at everything that we've talked about outside of the brick and mortar hospital or office buildings, that's going to help improve health care. But write to your Congress people, let them know that you support this act. I do believe that this is something that has a tremendous opportunity to make such a great impact.

Dr. Perritt: I agree. That was fantastic. I have nothing to add to that. Very comprehensive and the Momnibus is a wonderful set of bills and I encourage all of you who are listening to write to support it. Absolutely.

Jennie: well, Dr. Perritt, Dr. Peart, thank you both for being here today. I had a great time talking to you and it was just a joy to have you on.

Dr. Peart: This is great. Thank you so much for having us, Jennie.

Dr. Perritt: Thank you for having us. It was a pleasure.

Jennie: Okay. Y'all I hoped you enjoyed my conversation with Dr. Perrit and Dr. Peart. It was wonderful talking to them and as always, I learned a lot. Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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