Understanding Black Women’s Birth Experiences So We Can Improve Outcomes and Equity
If anything, the last few years proved that when the need is urgent, organizations can move mountains to improve health and safety with unprecedented speed. Now that we’ve discovered what payers and employers are capable of, it’s time to pool our collective power, as communities, health experts, and corporations, to make birth safe, respectful, equitable, and inclusive for everyone.
That’s why we recently joined forces with the National Birth Equity Collaborative (NBEC) for their Justice & Joy Holiday Event, an event that raised, celebrated, and supported the voices and experiences of Black mothers and birthing families in response to the Black maternal health crisis and blatant lack of birth equity. At the event, speakers and attendees discussed birth experiences, deep and persistent barriers to respectful and quality care, and tools to help improve birth equity. Events such as this are important because they help to identify some of the most important steps employers and payers can take right now to address birth inequities, and provide a safe space for Black mothers to examine and explore shared experiences.
“It’s important that birthing people are armed with tools and information that supports their health and wellbeing,” says Joia Crear-Perry, MD, FACOG and the founder and president of NBEC. “With Justice & Joy, we wanted to create space for our audience to share their experiences and hear from others. The liberating nature of these events is essential if we want the community to truly absorb the information and share it with others.”
Confronting health disparities for mothers of color and their babies
There is a crisis in maternal and infant health in the U.S. Black and AIAN (American Indian/Alaskan Native) women are two to three times more likely to die from pregnancy-related complications compared to their white counterparts1, and most of those deaths are preventable.2 The crisis impacts children, too—Black and AIAN babies are twice as likely to die during their first year of life compared to white babies.3
These disparities persist, regardless of income or education. In fact, a college-educated Black mother is at 60 percent higher risk for maternal death compared to a white or Latina woman with less than a high school education.4
Beyond birth outcomes, women of color often receive a different quality of maternity care. For example, recent research found that Black and Hispanic women are given less pain medication after labor compared to white women, even though they rate their pain higher. Women of color are also less likely to receive a prescription for pain medication when they leave the hospital.5
So what’s at the root of these disparities?
Many researchers and healthcare providers agree that high maternal mortality and morbidity rates among women of color are a result of structural racism within the healthcare system.6 Hearing from and addressing the disparities for those with the worst health and birth outcomes will ultimately help improve access to birth equity for all mother and birthing families.
But what are the experiences and access issues women face today? And how can organizations identify where they can help? The experiences shared at the event made some of the most pressing issues, and opportunities for improvement, more than evident.
The Black birthing experience: A tale of two deliveries
To move toward birth equity, we need to understand the numbers and listen to the lived experiences—positive and negative—of real people. That was one of the goals of Justice & Joy.
“As a result of the trauma Black birthing folks and families endured in 2020 and 2021—the pandemic, social unrest and police brutality, and numerous viral Black maternal mortality incidents—we wanted to create an event to celebrate, inform, and educate Black birthing families across the country. We wanted a space where folks could breathe and feel free to release the heaviness of it all,” explains Kiley Mayfield, Director of Community Power Building and State/Local Policy for NBEC. “Justice & Joy truly sums up one of our main goals—to achieve justice in Black maternal and infant health while simultaneously cultivating the spirit of joy.”
During the event, speakers shared stories of respectful, well-supported births as well as traumatic ones.
A mother of four described her planned home birth, where she was surrounded by family (including her older children) and her care team: a Black midwife, doula, and obstetrician. She spoke of the love, empowerment, and genuine care she felt with the support of people who understood the cultural nuances and needs of her family. She was proud of her decisions, and grateful for the opportunity to trust her body and her team throughout the birth and recovery process.
Our second community member shared a story of loss. At 28 weeks pregnant, she woke up with sharp stomach pains. She had to visit multiple hospitals before she received care, only to learn that she had pre-eclampsia (a condition she’d never heard of) and that her baby boy’s heart had stopped beating. With her own body in distress, she endured the vaginal birth of her stillborn son. She described chaos at the hospital, and feeling deeply violated as she was strapped to a bed during delivery. While she plans on a future pregnancy, she plans to find a Black care team that will give her compassionate care, as a direct result of the unfortunate and traumatic experience she had during her previous pregnancy.
Though the outcomes of these stories are dramatically different, one theme unites them—Respectful Maternity Care is essential for positive maternal outcomes.
What health plans and employers can do to promote birth equity
These numbers and personal stories show us that improving birth equity is the right thing to do. If you’re a payer, whether you have a commercial or Medicaid plan, working toward birth equity should be central to your population health strategy. And if you’re an employer, you know that diversity, equity, and inclusion (DEI) are increasingly important for employee retention and success, so it makes sense to create benefits—including those for birth and parenting—that are inclusive and equitable for diverse employees.
The good news is that there are clear, concrete steps you can take to make birth more inclusive, equitable, and safe for all mothers and babies.
Here’s how payers can improve birth equity and take important steps toward improving outcomes, which may also help with various equity program accreditations:
- Cover doula services. Doulas are non-clinical professionals who provide physical, emotional, and informational support to mothers before, during, and after childbirth. The mothers who may benefit most from doula care are often the least able to access it, both financially and culturally. But increasing doula access in under-resourced communities, or communities of color, can improve birth experiences and outcomes, and lower costs by reducing unnecessary medical interventions. One study found that doula-assisted mothers were four times less likely to have babies with low birth weight, two times less likely to have birth complications, and more likely to breastfeed their babies. Working with a doula also increased mothers’ feelings of self-efficacy around pregnancy.7
- Make sure your preferred healthcare partners follow a framework for respectful maternity care, such as NBEC’s Cycle to Respectful Care, an actionable tool designed to support healthcare quality with an anti-racist lens.
- Invest in partnerships and digital health tools (like Ovia) that focus on improving health for BIPOC (Black, Indigenous, People of Color) mothers and their families through clinical programming and intervention services. These resources allow members and employees to:
- Track their health.
- Learn what to expect, and how to stay healthy, during each stage of family building.
- Understand how to self-advocate with healthcare providers.
- Catch health issues early through predictive, data-driven clinical intervention programs developed specifically for BIPOC women based on their experiences and risks.
- Take classes on important skills, such as infant care, breastfeeding, or postpartum depression.
- Monitor mental health and get treatment if needed.
- Talk to a benefits and health coach 24/7.
- Easily understand benefits—and use them.
And here are simple steps employers can take to improve birth equity:
- Review your existing benefits and plans to ensure that language, policies, and programs are inclusive of all families.
- Provide adequate parental leave benefits. Research shows that every extra week of parental leave reduces the risk of adverse maternal and child health outcomes, including infant mortality.8
- Create employee resource groups (ERGs) or other open communications forums for mothers to build community, share information and experiences, and know that they are heard.
Toward a healthier, more equitable future
There’s so much we can do to help babies and their mothers begin their lives together in a more just and joyful way. By working toward birth equity, we strengthen DEI initiatives, lower healthcare costs, and build healthier families and communities for a brighter future.
Have questions about how your organization can improve birth equity? Reach out to NBEC, a team of advocates for change in the Black maternal health and infant mortality crises. And get in touch with Ovia to learn about data-driven solutions for reproductive health, family building, pregnancy, and parenting
2: Centers for Disease Control (CDC): https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm
6: Center on Budget and Policy Priorities (CBPP): https://www.cbpp.org/research/health/closing-the-coverage-gap-would-improve-black-maternal-health
7: Gruber, Kenneth J., et al. The impact of doulas on healthy birth outcomes. The Journal of Perinatal Education. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/.
8: Ruhm C.J. Parental leave and child health. J. Health Econ. 2000; 19:931–960: https://pubmed.ncbi.nlm.nih.gov/11186852/.