- Olympic medalist Allyson Felix is advocating for Black moms everywhere.
- Every 12 hours someone dies from pregnancy-related causes, and 60 percent of these deaths are preventable.
- People of color are also up to 50 percent more likely to give birth prematurely, and their children can face a 130 percent higher infant death rate.
Motherhood brought sprinter and nine-time Olympic medalist Allyson Felix all the good feelings: love, joy, awe, and pride. It also inspired her to advocate for moms and babies across the country.
After preeclampsia threatened the lives of her and her baby at 32 weeks pregnant, Felix had an emergency cesarean delivery on Nov. 28, 2018.
Because her daughter, Camryn Grace, was born prematurely, she started life in the neonatal intensive care unit (NICU).
“I’m so grateful and fortunate that she got out of the NICU a strong baby and that things went well for her, but it also just opened my eyes to a whole new world — the risk associated with pregnancy, the limited access that some women have to maternal care, especially from the complications and facing death for Black women… and I felt compelled to do work around that,” Felix told Healthline.
She teamed up with Better Starts for All, a partnership with March of Dimes and RB’s Enfa portfolio of brands, which offers on-the-ground and virtual interventions to bring support, education, and clinical care to communities in need.
“Currently more than 2.2 million women of childbearing age live in maternity care deserts (rural and urban) that have no hospital offering obstetric care, no birth center and no obstetric provider. Approximately, 150,000 infants are born in these maternity care deserts each year,” Dr. Rahul Gupta, chief medical and health officer, senior vice president, and interim chief scientific officer at March of Dimes, told Healthline.
In 3 years, Better Starts for All aims to improve the lives of more than 7,000 pregnant people in pilot markets in Southeast Ohio and Washington, D.C., by providing the following:
- a mobile health vehicle that brings prenatal care and related maternal health services
- a group prenatal care model that provides clinical care, education, and support in a group setting
- online prenatal education for moderated groups and telemedicine to provide OB care
- community providers to develop and implement strategies to increase access to care in maternity care deserts
“The health of mothers and children is widely viewed as an important indicator of the health and well-being of a nation. Yet, the U.S. remains among the most dangerous developed nations in the world for childbirth,” Gupta said.
March of Dimes reports that every 12 hours someone dies from pregnancy-related causes, and 60 percent of these deaths are preventable.
“It is even more dangerous for moms and babies of color as Black women are over three times more likely than white women to die from pregnancy-related complications,” Gupta said.
“Women of color are also up to 50 percent more likely to give birth prematurely, and their children can face a 130 percent higher infant death rate,” he said.
Why maternal care disparities exist
While the reasons for disparities in maternal care for Black people are complex, racism is at the root, said Dr. Leslie Farrington, a retired obstetrician and co-founder of the Black Coalition for Safe Motherhood.
She points out that racism affects the body and uterus, and can result in preterm delivery.
“There are many ways in which racism shows up biologically. The stress on Black women from dealing with the overall overarching effects of being devalued in society, being punished more, not being supported as much when children or encouraged as much in schools,” Farrington told Healthline.
She added that this stress increases the risk of preterm birth.
“When I was in the middle of my career, they were saying preterm birth is related to inflammation, but they did not see a correlation to infection, so they kept trying to say that Black women had more infections,” Farrington said.
“But that’s not the case. They just had more inflammation, and this inflammation — the medical term being higher levels of leukotrienes — results in preterm birth,” she said.
Moreover, more stress means more inflammation.
“It’s been shown discrimination increases all of these factors,” Farrington added.
Lack of insurance coverage is another reason for maternal health disparities.
Since the Affordable Care Act (ACA) core coverage provision came into effect in 2014, Gupta said uninsured rates fell across all racial and ethnic groups, with the biggest gains among Black and Hispanic people.
“Still, 30 million people remain uninsured. About half of those 30 million are people of color. Fourteen states have refused to expand Medicaid under the ACA, which is one of the reasons why people of color are disproportionately likely to be uninsured today. This includes some of the states with the largest populations of Black Americans,” he said.
Social determinants of health, such as access to care and poverty, environmental conditions, housing, transportation, and social economic status, also contribute to the disparities.
“I see ‘social determinants of health’ as a euphemism for environmental racism: redlining, gerrymandering, controlling the budget of predominantly Black-serving hospitals,” Farrington said.
Breaking the disparities
As a Black mother, Felix said her role feels heavier in recent times.
“It’s a really sobering responsibility, and I think a lot about my daughter and how I’ll have to give her the tools to navigate through this world, but it’s also this beautiful privilege that I get to do that and teach her,” Felix said.
“So, a lot of these issues that I want to champion are motivated by her,” she said, “and I don’t want her generation to grow up and for these statistics to still be the same.”
Felix is hopeful that more conversations about maternal care disparities are occurring in mainstream media, and that more research is dedicated to the subject.
“[We] are moving in the right direction, but I’d love to see policies change and more support to be provided. But we are seeing programs like Better Starts for All where we are trying to address issues in a very real way, and so I’m excited that we are helping women in these communities with access to care,” Felix said.
Policy actions and solutions can create positive change, noted Gupta.
“We are demanding policymakers to take action to better serve the women and children in our country. While no single solution exists to address limited access to care and improve health equity, there are key policy actions that can create positive change,” he said.
Those policies involve:
- improving access to quality and affordable preconception, prenatal, and postpartum care (e.g., expand Medicaid, provide coverage to telehealth services, expand access to midwifery care, support care quality improvement efforts)
- focusing on prevention and treatment (e.g., create paid family leave systems and address social determinants of health)
- expanding research and collection of surveillance data on maternal death and disease
“Our hope is that by addressing the issue and creating solutions, other local community leaders and policymakers will follow suit so we can all address this national issue together,” Gupta said.
How Black people can find the best care
In 2020, March of Dimes launched implicit bias training for healthcare professionals to uncover institutionalized racism in the healthcare system and to not perpetuate the cycles of discrimination.
But bias among physicians exists. Farrington recommends that Black people seek out treatment from trusted Black obstetricians, midwives, or doulas.
The National Perinatal Task Force, a grassroots movement that aims to start and grow Perinatal Safe Spots (PSS) in areas where it’s not safe or conducive to being pregnant or parenting young children, is another resource.
Additionally, Farrington said you need to advocate for yourself.
“Our ACTT acronym is a reminder to moms and their supporters of what they can do in the medical setting to get the care they need,” she said.
ACTT stands for:
- Ask questions until you understand the answers.
- Claim your physical and mental space.
- Trust your body.
- Tell your story.
Felix shared a similar sentiment: She promotes building a relationship with your doctor.
“It is so important, and you can’t be intimidated to ask the questions, whether you think it’s something minor or something huge or something silly,” she said.
Felix also recommends having a support system and someone else to advocate for you, as she did with her husband, Kenneth Ferguson.
“I know in my situation, things went south very quickly, and I had to have a partner who was able to make some decisions and speak on my behalf and advocate for me… Really think about that beforehand, and put those things in place,” she said.
And once a mom, give yourself some grace, added Felix.
“There is so much — especially now with the pandemic going on, it’s just another layer of unpredictability and stress added to it — but really be kind to yourself, and know that it’s OK for everything not to be in control,” she said.
The one thing that is in your control, though, is keeping a little bit of your pre-mom self in sight.
“I do believe that some of your best performances and best work can be done after you become a mother, and we can’t put these limitations that society kind of forces on us,” Felix said.
“I would encourage women to be strong, still have their same passions, and there’s no reason to shrink yourself at all because you’re in this new role. I think if anything, it motivates you and drives you to be even greater than before and to have a different perspective,” she said.
Felix’s advocacy work is certainly proving this to be true.
By Cathy Cassata