From Jim Crow to a Changing Zip Code — The Impact of Weathering on Black Families
By Marianne Fray, Chief Executive Officer, Maternity Care Coalition
No matter where we live, how we work, or who we are, having a baby is a big deal. When a baby enters our lives, we take on additional identities — as caretakers, teachers, and advocates. Birthing is beautiful and exhausting but too often life-threatening, especially for Black, Indigenous, and People of Color (BIPOC).
The United States has the highest maternal and infant mortality rates among comparable nations, and mothers of color are at a far greater risk. Nationally, Black women are dying at 3 to 4 times the rate of white women from complications related to childbirth and experience the highest rate of infant mortality among all racial and ethnic groups[1].
In a recent article by HealthSpark Foundation, Maternity Care Coalition’s (MCC) Early Head Start Senior Director Toscha Blalock, M.S. explains why these disparities exist, “People think disparities are driven by behavior, by health, by other individual factors, but it has really become clear- and research has shown- that it’s not individual behaviors, it’s social determinants of health. It’s the environment, where we work, our neighborhoods, and a number of different things that are impacting these outcomes.”[2]
The impact of social determinants of health[i] on families transcends race. Due to structural racism[ii] and social injustice, these factors have a greater impact on Black and Brown families and families living in poverty.
For example, when access to high-quality services and choices are systematically denied to parents, it disproportionately affects their children’s development, making them more likely to experience developmental delays and less likely to reach early learning milestones.[3] Additionally, one in four Pennsylvania households lack enough income to cover the necessities, such as food, shelter, healthcare and childcare. Due to official poverty measures (OPM), only two-fifths of those households are officially designated as “poor”, particularly as living costs rise faster than their wages and the Consumer Price Index.[4] The path to health access and equity has been intentionally obstructed for BIPOC families.
Consider the two pictures shown above. The first picture shows the Helping Hand Rescue Mission, circa 1965, located in North Philadelphia. This was my childhood home. My parents, who immigrated to America from Jamaica, raised our family at the Mission, and for 34 years we fed and clothed the poor and homeless in Philadelphia. The Mission remains a vital resource to low-income families in the community, but developers have long desired to gentrify[iii] this area since it’s within walking distance to Center City. The second rendering shows plans to transform this same block into a multi-million-dollar mixed-use area later this year, with a ‘promise’ to keep the Mission intact. But where will the families who live in the neighborhood go?
BIPOC families have been displaced and marginalized for hundreds of years. Arline Geronimus, a public health researcher and professor at the University of Michigan’s Population Studies Center, found that “the stressors that impact people of color are chronic and repeated through their whole life course, and in fact may even be at their height in the young adult-through-middle-adult ages rather than in early life. And that increases a general health vulnerability — which is what weathering is[5]. I, like so many other Black people, have experienced the impact of weathering in my life.
In August of 1955, my mother was pregnant with my older sister. She and my father were living in rural Alabama during the time of Jim Crow segregation. They had to choose between driving 100 miles to the nearest integrated hospital to give birth or stay closer to home and give birth in a nearby doctor’s office. In the end, they decided to stay close to home and my mother delivered my oldest sister on an exam table, rested for a couple of hours on a waiting room sofa, then went home.
Fortunately, the birth was an uneventful one, my mother did not hemorrhage, and my sister was healthy. But that absolute lack of access to quality healthcare and blatant racism were major risk factors in the health and well-being of my mother and sister. My mother, one of the hardest working women I knew, died unexpectedly at 75.
Although my parents sacrificed so much to ensure my siblings and I had the best educational opportunities, I learned that there is an inextricable connection between weathering and the realities of Black Maternal Mortality — the story of Allyson Felix, U.S. Olympian. According to a 2016 New York City Department of Health and Mental Hygiene’s Severe Maternal Morbidity Report, a college-educated Black woman is three times more likely to experience severe maternal complications than a white woman without a high school education.[6] While attending an elite Boarding High School on Philadelphia’s exclusive Main Line, I had an unplanned pregnancy that ended in a stillbirth. I recall my fear, shame and loneliness as the doctors refused to allow anyone to be with me during the ‘birth’, nor offered any comfort or explanations. Today, I am blessed with three smart, strong, healthy sons. Although I had three complicated pregnancies, all by C-Section, I cannot help but wonder if my mother’s early death and my birth experiences were related to weathering and the color of our skin.
At MCC, where I serve as CEO, we are doing the work to ensure that parents in Southeastern Pennsylvania, impacted by racial and social inequities, can birth with dignity, parent with autonomy, and raise babies who are healthy, growing and thriving. We work at the family, community, and policy levels to bring about an equitable and just future.
MCC is part of the Pennsylvania Prenatal-to-Three Collaborative who are advocating to:
· Expand access to critical services, such as health care while pregnant and the first year following birth
· Increase postpartum depression and anxiety screenings,
· Provide reimbursed access to doula services
We are encouraged by the recent Medicaid and CHIP Payment and Access Commission (MACPAC) recommendation to guarantee 12 months of postpartum coverage for pregnant individuals.
We are also encouraged with the introduction of the Black Maternal Health Momnibus Act of 2021.
This legislation will comprehensively address every dimension of the maternal health crisis in the United States and will:
1. Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.
2. Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity.
3. Comprehensively study the unique maternal health risks facing pregnant and postpartum veterans and support VA maternity care coordination programs.
4. Grow and diversify the perinatal workforce to ensure that every mom in America receives culturally congruent maternity care and support.
5. Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it.
6. Support moms with maternal mental health conditions and substance use disorders.
7. Improve maternal health care and support for incarcerated moms.
8. Invest in digital tools like telehealth to improve maternal health outcomes in underserved areas.
9. Promote innovative payment models to incentivize high-quality maternity care and continuity of insurance coverage from pregnancy through labor and delivery and up to 1 year postpartum.
10. Invest in federal programs to address the unique risks for and effects of COVID-19 during and after pregnancy and to advance respectful maternity care in future public health emergencies.
11. Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies.
12. Promote maternal vaccinations to protect the health and safety of moms and babies.
While these are promising steps forward, our work cannot stop here. We must fully confront and address the systemic barriers to care that BIPOC families face. No one should ever wonder if their health and well-being is dependent upon their zip code or the color of their skin. We must dismantle the Jim Crow practices that continue to plague us and ensure true justice for all.
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Bio:
Marianne A. Fray is Chief Executive Officer with Maternity Care Coalition (MCC). Marianne leads the day-to-day affairs of MCC. With the Board, Marianne provides leadership in setting and pursuing MCC’s vision and direction, and interprets that vision and direction to the staff for implementation.
MCC is a 40 year old community-based nonprofit organization serving pregnant and postpartum women and parenting families who live in communities impacted by structural racism throughout Southeastern Pennsylvania. MCC’s mission is to improve our families’ health and well-being, while enhancing the school readiness o their children ages 0-3. We are working towards a future where all parents can birth with dignity, parent with autonomy and raise babies who are healthy, growing and thriving. We provide direct services, perform advocacy and research, while collaborating with individuals, families, providers and communities. MCC operates 6 major programs throughout Philadelphia, Montgomery, Delaware and Bucks counties, including running an Early Head Start Childcare Center in South Philadelphia.
References
1Martin, N., & Montagne, R. (December 7, 2017). Black Mothers Keep Dying After Giving Birth. NPR All Things Considered. Available at https://www.npr. org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why
[2] HealthSpark Foundation Grantee Spotlight: Montco Mamas Seeks to Improve Birth Outcomes Among Black and Brown Women and Babies, February 9, 2021
[3] Bishop, G. (2006). Childbirth at a crossroads in Southeastern Pennsylvania. Maternity Care Coalition. Available at https://maternitycarecoalition.org/wp-content/uploads/2018/10/MCC_Childbirth-at-a-Crossroads.pdf
[4] Diana M. Pearce, PhD, October 2019, https://pathwayspa.org/wp-content/uploads/2020/01/PA2019_OverlookedUndercounted_Web.pdf
[5] Gene Demby, Arline Geronimus, 2018 https://www.npr.org/sections/codeswitch/2018/01/14/577664626/making-the-case-that-discrimination-is-bad-for-your-health
[6] Patia Braithwaite, SELF magazine, September 20, 2019 Biological Weathering and Its Deadly Effect on Black Mothers — https://www.self.com/story/weathering-and-its-deadly-effect-on-black-mothers
[i] Social determinants of health are the conditions and environments that affect a wide range of health, functioning, and quality-of-life outcomes and risks, such as economic stability, access to and quality of health care and education, neighborhood, and social context.
[ii] Structural racism is a system where public policies, institutional practices, and cultural representations work to reinforce and perpetuate racial inequity.
[iii] Gentrify, change the character of (a poor urban area) through wealthier people moving in, improving housing, and attracting new businesses, typically displacing current inhabitants in the process.
