Nytasha Stevens (from left), Kenda Sutton-El, Courtney Glenn and Nikiya Ellis are part of the Birth in Color RVA network of practitioners supporting pregnant women and families. (Photo by Sarah King)
“Herein lie buried many things which if read with patience may show the strange meaning of being black here at the dawning of the Twentieth Century. This meaning is not without interest to you, Gentle Reader; for the problem of the Twentieth Century is the problem of the color line.”
Those words open W.E.B. Du Bois’ book “The Souls of Black Folk,” which he dedicated to his daughter, Yolande, and son, Burghardt — the former living at the time, the latter lost to an epidemic that has quietly gripped American communities of color for more than a century before and after Du Bois’ seminal 1903 work was published: the disproportionate infant and maternal mortality rates among black and white mothers.
In response to this quiet epidemic, and in support of the local organizations advocating to change the status quo, Richmond Mayor Levar Stoney proclaimed April 11-17 “RVA Black Maternal Health Week” to highlight the disparities black women face in the health care system at “Blooming Beautifully,” an event hosted by Birth in Color RVA at Lewis Ginter Botanical Garden.
“In recent years, we have determined the rate at which black women are dying perinatally is essentially a public health crisis being ignored,” says Kenda Sutton-El, a birth worker and co-founder of Birth in Color RVA — a network of birth workers focused on providing culturally sensitive support and education to pregnant women and families from the ground up. “We here in RVA are working together to, one, change the narrative, but also encourage and support new mothers as they carry new life into this world.”
The words “public health crisis” are not an overstatement. The United States is the only industrialized nation with an increasing maternal mortality rate — and black women are 243 percent more likely to die from pregnancy or childbirth-related causes than white women. In the commonwealth, black women are over 300 percent more likely to die in childbirth than non-Hispanic white women, according to 2017 data from the Virginia Department of Health.
The trend is inherently intertwined with another stark juxtaposition: The rate of black infant mortality in Virginia is twice the rate of white babies, a wider gap than in 1850, the first year such deaths were recorded by race. More than a decade before slavery ended, 340 black infant-mortalities were recorded per 1,000 births, compared to 217 deaths among white babies.
“Since the time enslaved Africans arrived at this country, black women have been put through so much in the birthing of children, and taking care of other people's children as well, and I think it's about time in 2019 and beyond that we put [at] the forefront health care and particularly maternal care,” Stoney said while announcing his proclamation. “A great thing about being mayor is I can proclaim so much,” he added coyly, to laughs from the attendees, “but this is one I take a particular honor in and it's declaring Black Maternal Health Week in RVA.”
Richmond Mayor Levar Stoney talks with participants at the “Blooming Beautifully” event held by Birth in Color RVA at Lewis Ginter Botanical Garden. (Photo by Sarah King)
Sunday’s lunch-and-learn-style session was part of a series of programs organized by the four friends-turned-organizers in Richmond for Black Maternal Health Week – a nationwide initiative aimed at highlighting the circumstances of minority moms.
“It's a really great thing to know that we are supported not just by the people we see and other women, but men as well, fathers as well, uncles and the mayor — this is huge for us,” Sutton-El said, noting that Stoney also proclaimed RVA Black Breastfeeding week last year.
As families broke bread together in a conference room overlooking gardens on two sides, Stoney chatted with new and expecting moms, dads and kids — quipping with a couple originally from New York over their allegiance to the Jets or Giants — but also sitting quietly with his brow furrowed while women shared snippets of their experiences during pregnancy or postpartum while cutting lunches into bite-size chunks for their children.
“It's time that we actually start listening to black women when they say there's something wrong,” Stoney mused to his staff as they walked back toward the garden atrium adorned with flowers courtesy of Flowers by Bron, installed that morning.
To combat pregnancy-related deaths, the Centers for Disease Control and Prevention recommends that states implement systematic reviews of all maternal deaths to identify prevention and intervention strategies; this legislative session, the Virginia General Assembly passed HB 2546, introduced by Del. Roxann Robinson, R-Chesterfield, which establishes a Maternal Mortality Review Team (MMRT).
Through the new initiative, Virginia’s Department of Health will review the rate of pregnancy-associated and pregnancy-related deaths, identify risk factors and develop recommendations for prevention and intervention programs to reduce the rate of maternal mortality.
State health data indicates that the leading cause of natural death for infants within the first month of birth was “conditions originating in the perinatal period,” which the World Health Organization defines as the period from 22 weeks pregnant through the first week of the newborn’s life. “Perinatal mortality” refers to the number of stillbirths and deaths in the first week of life after birth.
“And during those times, we see higher rates of maternal mortality, meaning black women are dying at higher rates,” explains Courtney Glenn, a birth doula and co-founder of Birth in Color RVA. “Currently the rate is three to four times that of non-Hispanic white women — and we recognize the issue is not race but racism within health care systems in community institutions.”
State figures also account for a higher mortality rate in Richmond than in the surrounding localities in the Central Virginia region — which has seen a 62.3 percent rise in non-natural infant deaths since 2013, second only to Southwest Virginia’s 130.5 percent rise in such deaths. In Richmond, 22 of the 30 infants who died in 2017 were black; eight were white. Among the deceased, more than 53 percent of infants died within two days of birth.
Chesterfield County recorded 25 infant deaths at a rate of 6.6 per 100,000 live births in 2017, but two thirds of deaths affected black children and families, despite African-Americans only accounting for one-fifth of the locality’s population. In Goochland County — where 80 percent of the population is white and only 16 percent is black, according to census data — four infant deaths were reported to Department of Health in 2017; each of the infants was black.
The phenomenon transcends time, class, status and ZIP code, the organizers of Birth in Color RVA point out. Black mothers with an advanced college degree are more likely to lose their child in the first year of life than white mothers without a high school diploma, according to a 2018 study from the Brookings Institution.
Stoney shared an anecdote of his own that illustrates some of the challenges families face.
“I always talk about how my parents were very young when they had me — my mother was 16, my father was 19 when I was born — but it was actually my brother where [my mom] faced some complications … before he was even a year old, my brother contracted meningitis,” Stoney told the “Blooming Beautifully” attendees.
“I remember being a kid and seeing my father, he would come home from work — he worked in a butchery – he'd take those clothes off, jump in the car and go see my brother in the hospital, with my mother,” Stoney said as some of the mothers and fathers in attendance nodded soberly as he spoke. “She wasn't educated, she didn't have the information — and a number of families face those same sort of struggles, yearly, in the United States of America.”
Nine state and local Maternal Mortality Review Committees were recently tasked by the CDC with analyzing the underlying causes of death among new mothers, and among them is one particularly salient finding: “The nine committees estimated that over 60 percent of pregnancy-related deaths were preventable,” the CDC report states.
“When we say 'racism' not 'race,' it’s because black women are not being heard; their concerns are being ignored,” says Sutton-El. “So a lot of times our common refrain is, ‘Listen to black women!' We know our bodies, we know ourselves and we know our babies — so listen to us when we have concerns — they are not unremarkable or to be dismissed; they are valid and we deserve to be heard and acknowledged.”
The CDC committee findings also note the most common contributing factors to causes of death among infants analyzed in the nine committees were: “patient/family factors” such as lack of knowledge on warning signs or when to seek care; followed by “provider” factors accounting for instances of misdiagnosis or ineffective treatments; and lastly “systems of care” factors, which include lack of coordination or communication between providers.
"It's an issue that affects all black women, no matter where you are in the spectrum," says Nytasha Stevens, a birth doula and co-founder of Birth in Color RVA. "Black women who birth and get perinatal care in predominantly white spaces fare far worse, so it's really not an issue of health care access."
Walking alongside Stoney after Sunday’s proclamation was Osita Iroegbu, a native Richmonder and the mayor’s senior policy advisor for diversity, equity and inclusion, who recently became a mother herself.
“We know that when you control for education and income, black women are still disproportionately represented in maternal death numbers, which conveys that it truly is a racialized problem,” Iroegbu writes in an email, noting this paradigm is also associated with the inequities around black women and breastfeeding.
“The racial disparities that exist in the level of breastfeeding support and resources for black women are alarming, including how health professionals communicate, or don’t communicate, the importance and possibilities of breastfeeding to black women compared to white women,” Iroegbu writes. “We know that there are many health benefits of breastfeeding to both mother and baby, and it’s reasonable to deduce that the adverse health outcomes that we see for black mothers and babies correlate, at some level, with low breastfeeding rates for black women.”
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of an infant’s life because of the protection breastfeeding provides against adverse health outcomes for both mother and child, but a report published by the Virginia Department of Health examining statewide infant mortality trends from 2014 to 2016 notes that while roughly 60 percent of new moms breastfeed for their newborn’s first meal, in cases of infant mortality, the child’s last meal contained breast milk in fewer than 20 percent of cases, suggesting an overall “short duration” of breastfeeding in more than half of the cases.
“That is why the Mayor’s Office supports the Black Breastfeeding Week RVA and Black Maternal Health initiatives and the various community programs,” Iroegbu says, noting that in addition to Birth in Color RVA, the administration has also been supportive of Healthy Hearts Plus, Mommies, Bellies, Babies and Daddies and other organizations tackling the issue locally.
“As both a black woman born and raised in Richmond and as a new mom, I have firsthand experience with the structural challenges and barriers that exist as well as with the opportunities that we can be intentional about creating,” Iroegbu says. “Opportunities that center black and brown women and our experiences, disrupt dangerous and harmful systems and practices and reclaim the freedom and beauty of motherhood for black women that are embedded in our cultural heritage and that we have always known to be true.”
