Sequoi Phipps-Hawkins (left) and Chelsea Watson, both doulas with Birth in Color (Photo by Marcus Ingram)
Since Kenda Sutton-El was a child, she’s known the risks Black women face during pregnancy and childbirth. She was raised in a family of health care workers and attended her first childbirth at age 6. As she entered college and her friends started having children, she realized not everyone was equipped like she was for the toll childbirth takes on Black women.
“They didn’t know anything,” she says. “So I started educating them, like, ʻThis is what you’re supposed to say to your provider,’ and all of the things.”
She became a doula, a trained birth worker providing comfort and assistance to women through pregnancy and immediately after childbirth. As part of a team of health professionals, doulas have been shown to decrease the likelihood of cesarean sections and reduce care costs, among other benefits.
Sutton-El says that too many medical providers ignore Black women’s barriers to equity in maternal health care, continuing to hamper health outcomes in the state. This motivated her to co-found Birth in Color, a Richmond-based nonprofit that trains birth workers and doulas and advocates for policies to address disparities in Virginia. Birth in Color has built a network of nine facilities across the state.
Maternal mortality rates have skyrocketed in Virginia. From 2018 to 2020, the pregnancy-associated death rate increased from 37.1 to 86.6 per 100,000 live births, according to the Virginia Department of Health. The state reports 89.5 pregnancy-associated deaths per 100,000 births in Black women, compared with a rate of 53.5 in white mothers. This disparity, though under-researched, likely stems from the cumulative effects of chronic stress that Black women face at high rates.
According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, in 2021, the maternal death rate for Black women nationwide was 69.9 deaths per 100,000 live births, about 2.6 times greater than the rate in white women (26.6). That same year, the maternal death rate overall was 32.9, more than 80% of which, the CDC estimates, were preventable, owing to a lack of attention or overt and implicit biases of health care providers.
“If you’re already not listening to me, and I haven’t even got to the labor room yet, that’s a problem,” Sutton-El says.
As the organization has expanded its reach, policy supporting its efforts has grown with it. The organization advocated for coverage for its doulas under Medicaid benefits, which the state approved in January 2022. Now, they’re pushing for private insurance coverage and mandated training for medical professionals to address racism in health care.
Birth in Color completes training for 15 to 25 doulas every month, Sutton-El says. They’re able to provide Black mothers with a trusted voice in the health care process. Ashle Page, a medical professional living in Henrico County, used a doula in 2023 for the birth of her daughter.
“It made the process so much easier,” Page says. “It took a lot of weight off my shoulders, and I was like, ‘I have to give the same services to somebody.’”
Shortly after her pregnancy, Page became a doula and took on clients to emphasize the needs of Black women during pregnancy. “There really wasn’t any light shed on the problem, just the sad stories,” Page says. “It’s good now that we’re talking about it.”
This past April, the organization’s facilities held community outreach events, public health screenings and “color carnivals” — cookout-style community baby showers — during Black Maternal Health Week, a federally recognized awareness effort that Birth in Color helped to create.
The events are anchored by the Black Maternal Health Summit in Richmond, where Sutton-El and other maternal health leaders speak with optimism about the future of the commonwealth’s maternal health outcomes. “It’s great to see it flourish,” Page says, “because everybody deserves a doula.”
