I’ve worked in healthcare leadership for 20 years, and I specialize in diversity, equity, and inclusion (DEI). But even with all of that experience, some things still shock me—like when I see the numbers and hear the stories about how our healthcare system continues to fail Black mothers and their children.
The good news is that we already know what health plans and healthcare organizations can do to change the system and improve healthcare and birth equity for people of color. Now what we need is action.
True stories of a real-life Black mother
Before we dive into solutions, let’s consider what it really means to say that the healthcare system is failing Black mothers. First, the numbers: it’s estimated that non-Hispanic Black women are almost four times more likely to die while pregnant, or within a year after childbirth.1 Black mothers are also less likely to receive pain medication during birth, and are more likely to report that their pain wasn’t adequately addressed by their providers during labor and delivery.2
The stress of the lived experiences of racism in our daily lives, and in medical care, add to this burden, especially when it comes to our mental wellbeing. Up to 28% of non-Hispanic Black women experience perinatal depression.3 This problem has grown during the pandemic, with a 10% increase in severe symptoms of depression and a 26% increase in reports of suicidal ideation among BIPOC (Black, Indigenous, people of color) mothers.4
During my first pregnancy, I thought that my academic and professional background would make my experience different, but I was wrong. Early on in the pregnancy, I had some health concerns, so I requested an extra ultrasound. This is how my doctor discovered that I had a short cervix, a condition that can lead to preterm labor and pregnancy loss. To lower my risk, I needed a cervical cerclage, a routine procedure that includes a spinal tap, made even more stressful because I was in the middle of a cross-country move. Now I needed to find a new provider, in a new city, who could manage my condition.
Finding a new doctor can be difficult anytime, and I was fortunate that I knew how to proceed—I needed an in-network provider with a low c-section rate and cervical cerclage experience. I managed to track down the one doctor who fit the bill in my new city. But just imagine trying to find that needle in a haystack—so you can get safe care—without a healthcare background to guide you. The complexities of benefits and navigating the healthcare system are serious barriers to care that we need to address for everyone.
But I was lucky, and I got all of that figured out. Still, my labor was so much more difficult than it should have been. I knew that I’d need my cerclage removed before labor, which is fairly normal and was planned when my doctor scheduled my induction. I arrived on a Tuesday, and didn’t have my baby until 4:00 a.m. on Thursday. During 30 hours of labor, I saw many different care teams—some that were wonderful, and some that treated me with very little respect or compassion. I felt that my care teams weren’t addressing my pain even half as much as I needed, and I kept wondering, ‘Is it me, or is it something else? Is it because I’m Black?’ Even having that thought is traumatic.
When the team switched and my doctor returned for my delivery, I was grateful. I gave birth to a beautiful, healthy daughter. But I also knew that I needed to report the hospital for discrimination. To my surprise, no one at the hospital was surprised—in fact, one particular nurse seemed to have a reputation for poor bedside manner. I wondered how this could be. Why hadn’t the hospital already made moves to address the problem?
The more I thought, the more questions I had. If I, as a well-educated, financially secure woman with a master’s degree in healthcare administration, had such a hard time getting through the system and advocating for myself, how can we expect people without those advantages to make their way? How can we educate women about their health needs and make sure they are able to find the care they deserve? And how can we advocate for safe, respectful care for everyone, especially women of color?
These questions brought me to Ovia Health, where we’re working every day to improve birth equity and help employers and payers support people all along their parenting journeys.
How healthcare organizations can do right by Black moms
The roots of inequity, especially when it comes to maternity care for people of color, run deep in healthcare. That’s why change has to run deep too. Healthcare systems need to take an honest look at their practices and find the places where bias creeps in. From there, they need to train providers on equitable care,set goals for change, and hold themselves accountable to realize that change.
However, healthcare systems need accessible, evidenced-based tools to build this new, intersectional future of maternal care. Ovia partnered with the National Birth Equity Collaborative (NBEC) to create practical tools and supporting infrastructure for better birth outcomes. The core of our project is to elevate Respectful Maternity Care (RMC), a framework built by Black moms, for Black moms, and how healthcare systems can begin to deliver respectful maternity care to their patients. RMC tools help healthcare organizations:
- Critically evaluate their health systems to identify where they are failing women of color, and where changes are needed.
- Recognize implicit bias at all levels of healthcare administration, especially providers, and deliver training to address bias in patient interactions
- Train providers on how to incorporate patients as equal decision makers in their care, restoring power to historically disempowered groups.
- Adopt an equitable, intersectional, and measurable standard of respectful maternity care, create goals for improvement, and track progress through patient feedback loops.
How Ovia is empowering Black mothers
Though top-down, systemic change within healthcare is essential to achieve equitable care, patients too can drive change by demanding the quality care they deserve from their providers.
That’s another way Ovia is helping to make change–we’re empowering our members, particularly Black women, with the information they need to understand what respectful maternity care looks like and how to advocate for it throughout the reproductive health journey.
Ovia’s diverse team of one-on-one health experts and care advocates are the strong support system walking with mothers day in and day out through the entire parenting journey. Our new Empowered Beginnings clinical module magnifies the unique experiences of Black women navigating motherhood. It includes guidance for building a birth team, education on types of care team members like midwives and doulas, and frameworks for building a birth plan. The module also:
- educates members on the importance of a strong support system to advocate for you before, during, and after their pregnancy
- provides information on what to expect during pregnancy and postpartum
- offers detailed physical and mental health screeners tailored to the unique health risks of Black mothers.
Now’s the time to make care equitable for Black mothers
From my personal experiences, and my professional vantage point, I can tell you that the time for change is now. We need to define reproductive justice and respectful maternity care, and begin the work toward deep and lasting change. This means training providers and setting clear goals so we can keep our progress on track. We also need to support Black mothers every step of the way.
Every day, I’m alarmed by disparities in maternity care. But I’m also optimistic. We know how to make change, we know how urgently it’s needed, and together, we have the power to achieve birth equity.
Kami Wigginton is Ovia Health’s Director of Payer Solutions. For 20 years, Kami has been a leader in sales, solutions, and client services in healthcare, wellbeing, and health information technology for some of the industry’s most innovative organizations. Kami holds a bachelor’s degree from the University of Alabama, a master of health administration from Belhaven University, and a certification in Diversity, Equity, and Inclusion from Northwestern University. And she’s the mother of two amazing daughters, 10-year-old Simone and 4-year-old Sutton.
1: Juanita J. Chinn, Iman K. Martin, and Nicole Redmond. Health Equity Among Black Women in the United States. Journal of Women’s Health. Feb 2021: 212-219: http://doi.org/10.1089/jwh.2020.8868.
3: Juanita J. Chinn, Iman K. Martin, and Nicole Redmond. Health Equity Among Black Women in the United States. Journal of Women’s Health. Feb 2021: 212-219: http://doi.org/10.1089/jwh.2020.8868.