- Just ahead on "Black Issues Forum," we're tackling the crisis of Black maternal health.

We break down the disparities, policies shaping maternal care, and the power of community-led solutions coming up next.

Stay with us.

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[upbeat music] ♪ - Welcome to "Black Issues Forum."

I'm Kenia Thompson.

With recent challenges to reproductive rights and ongoing disparities in maternal care, it's become essential to explore how policies, healthcare systems, and community-driven solutions shape the experiences of Black mothers.

Black women face disproportionately higher risks during pregnancy and childbirth, and research points to systemic inequities in healthcare.

More often now, many women find themselves seeking advocates and policies that protect them and their families.

Our two guests today have helped many of these women in this position.

I'd like to welcome Joy Spencer, Executive Director of Equity Before Birth, which is a nonprofit working to address the maternal mortality crisis, and Karida Giddens, Access to Healthcare Program Coordinator with North Carolina Black Alliance.

Thank you both for being here.

- Thank you.

- It's a topic that we've broached before many times on the show, but it's something that continues to be a problem, especially with the current policies that we're facing changes within.

So, Joy, I wanna start with you and I'd love for you to just kind of frame the issue.

What is the problem around maternal health, and then Black maternal health in particular?

- Yeah, so despite the United States having the most well-funded and well-resourced healthcare system in the world, we have the worst birth and maternal health outcomes when compared to similarly developed countries, and then when we zone in and disaggregate that data, and look at the disparities, unfortunately, it's Black and Indigenous women who bear the brunt of that, dying at a rate three to four times higher than our White counterparts.

And then if we zoom in a little further, unfortunately, North Carolina has disparity rates that surpass national averages.

We actually have the 11th-highest maternal mortality rate in the country.

- In North Carolina?

- In North Carolina.

- Why is that?

Do we know?

- Lots of different things.

Access to healthcare is one of them.

Just in the antebellum South, we still are dealing with a lot of racism in our healthcare system.

We see that areas that have more access to midwives, for example, tend to have better birth outcomes and things like that, and we have a lot less access to things like midwifery care.

We have a high rate of what we call maternal healthcare deserts, which means within North Carolina in particular, over a third of our women have to travel more than 30 minutes to get to a medical facility that has, on duty, a birth and labor delivery unit, or an obstetrician that specializes in the labor and delivery process.

So access to care, racism, lack of culturally competent and affirming care, a lot of different things tat lead to us not being up to par in our birth outcomes.

- Yeah, Karida, I wanna bring you in, touch a little bit about the work that you do, why it's important.

I'm guessing it links to a lot of what Joy just shared here.

- Yeah, so a lot of my work with the North Carolina Black Alliance is focused on the policy and the community education aspect of things.

We really want folks to know, one, about the incredible work of organizations like Joy's and what they're doing to really fill gaps in care that we're not necessarily seeing our policies do.

And so that's where I like to see our work meet in the middle right?

We're educating communities about solutions that are working, but we're also letting them know what gaps there are in the role that policies can play in filling those gaps.

So if we see greater investments in infrastructure, so that we have a workforce that is built to really sustain supporting maternal healthcare in North Carolina, we're talking to communities about issues like that and the role really of our elected officials and democracy and engaging in that process in addressing issues like maternal health.

- Yeah.

Let's go back.

I failed to ask about equity before birth specifically, and what is the mission to the organization and what had you started in the first place?

- Yeah our mission is to eliminate those disparities and save the lives of Black and Brown mamas by increasing the access to care.

We take what we call an economic justice approach to birth justice.

And so what it looks like for us specifically is if financial barriers are the thing that is causing people to not have adequate healthcare access, we want to eliminate that.

So we are covering the cost of doulas and access to midwifery care.

We are covering the cost of transportation to doctor and also like essential baby items, making sure people get education.

And we also have a cohort of working moms who don't get paid maternity leave benefits from their employer, and we are able to give paid maternity scholarships.

- Oh, that's great.

- To help them recover and stay at home.

So one in four American moms return to work within two weeks of giving birth.

- I can't imagine that.

- And we just know that's just not nearly enough time to adjust and recover and heal and even- - Bond with your baby.

Yeah.

- Correct.

- Yeah.

Karida, when we hear, you know, I think a lot of people say that the Black community may blame issues on systemic issues, right?

But we know for a fact that some of these issues are due to systemic problems.

Give us an example of what that looks like when it relates to maternal care.

- So I think the first example that comes to mind is bias, right?

And the role that implicit bias plays in, you know, how healthcare providers deliver care, really seeing you as a human right, that needs healthcare and not seeing, you know, maybe you're deserving of less because of the color of your skin.

It's also listening, right?

And kind of taking the time to listen to patients and say, "I hear you."

And so we have a healthcare system that's not necessarily built right now on the needs of those that it serves and responding to the needs that are emerging with issues like Black maternal health.

And so because we're not necessarily listen to communities, we see that lack of investment reflected in our systems, and we continue to see that these structures of inequality are maintained, because we don't have a system that's responsive to the needs of our communities.

- Right, are there any specific North Carolina policies that are helping or hindering the progress in this space?

I can pivot to either, but I'll start with you Joy.

- Yeah, I mean, we recently saw an expansion to Medicaid and that really, really helped.

Most importantly, it helped for postpartum care to be covered up to one year after giving birth.

Before that expansion, people got that one six week postpartum checkup and that was kind of it.

- Wow.

- So we have really seen that be very, very helpful.

I would say a policy that I would love for us to pass is something I just mentioned, paid leave, to allow folks the time that they need to heal.

It's actually been directly associated with improved postpartum health outcomes and improved brain development and development outcomes for the infant.

Actually, about 2/3 of maternal mortality occurs in that period after giving birth and up to one year.

So we really need to get more intentional about how we care for moms, even after the baby has landed Earth side.

- And even spousal support, right?

- Absolutely, absolutely.

- Having paternity care too would be, I mean, that's a family unit.

And so when we talk about some of the systemic barriers that exist is that division within households, right?

- Absolutely.

- And we see fathers maybe not having the opportunity to be there, and that creates even further division.

Mombibus Act, let's talk about that.

Some people may not know what it is.

Carita, could you share?

And then is that something that is able, I guess, to be upheld here in North Carolina?

- Yeah, so I can start with like the big Momnibus, I think that people are a little more familiar with, which is the one that takes place at the federal level.

And it really seeks to tackle maternal health as an issue, as a crisis that it is, from all different angles, right?

You're talking about investments in a workforce that is aimed to deliver perinatal healthcare, right?

I'm getting you at the beginning of your pregnancy, during your pregnancy and after your pregnancy, right?

So filling those gaps.

You're also talking about addressing overlooked populations, right?

I don't know how many people are thinking about veterans and who need maternity care, incarcerated women who also need maternity care.

And it's also looking at the data portion of things, right?

Because how can we grow and improve if we don't know what's working by looking at the numbers?

And so it's really taking this approach to invest in maternal healthcare, so we know it's working, where we can improve, and we're adding funding, investment to folks that are doing this incredible work, like Equity Before Birth, and so many other community-based organizations who really are stepping in, providing necessary healthcare, but they haven't necessarily been able to have the funding that they should, which makes their work unsustainable.

North Carolina has a version of Momnibus as well.

It's introduced every year.

That's a bill I would love to see us pass into law because it's not a partisan issue.

And-- - What's part of the bill?

What makes up the bill here in North Carolina?

- So I think of it kind of like in three parts.

So it does address implicit bias, really kind of holding providers accountable with kind of seeing the role that their viewpoints and their beliefs play in how they deliver care to patients.

The other investment is really looking at our HBCUs as a critical pipeline for adding a workforce that is diverse in the field of maternal health.

And so North Carolina A&T and Johnson C. Smith are two HBCUs that have the Pathway to Lactation program- - Oh wow.

- which really seeks to provide greater diversity and support and lactation support.

So again, it's not really just looking at one part of your journey with pregnancy and motherhood, but it's like, trying to cover all of those different parts.

And that's where this investment with lactation support and investing in a diverse workforce comes from with that bill as well.

- That's great, I didn't know that about those schools.

Part of the problem too a lot is perspective of what Black motherhood looks like.

Do you do any work towards that in Equity Before Birth and kind of shifting community understanding of what motherhood looks like for us?

- Yeah, call us a boots on the ground organization we do a lot to center and prioritize lived experience.

We even have what we call listening sessions.

We have group chat with moms.

We're always trying to like feel that experience and feed it up to our elected officials, people who make decisions.

Very happy that Senator Natalie Murdock has like us at the table in the creation of the mom to bus for this year.

That'll be introduced so that we are able to infuse that lived experience into common sense policy that will actually help us.

But I think that it is ever changing in ways, especially since COVID, we were able to talk about the impacts of like the social distancing and the telehealth, which doesn't work too well with maternal health.

We are able to talk about the impact of not having support to either continue in the workforce, like not having appropriate pregnancy accommodations.

I don't know if folks have ever had a baby that got comfortable like in their back and then, you know, you can't stand at a cash register for eight hours or needing to take those extra breaks to pump when you are lactating or breastfeeding mom.

And so yeah, that lived experience piece, to me, is extremely important.

And I enjoy bringing that to decision-making bodies so that we can make sure we're not, our intent is matching our impact, that we're not causing harm when we're making decisions without the people impacted by those decisions.

- Yeah.

Earlier on you mentioned, I forget the word that you used, but I'm gonna call it like dry deserts essentially, of areas that lack healthcare, access to healthcare.

Karida, last time you were on, we talked about Anson County and some of those surrounding areas being part of that.

How are women impacted in those spaces?

And is that, I guess, is that being looked at as a space for increased need and attention?

- Yeah, so I mean, if you can't get to the doctor, whether you're pregnant or not, you are not getting the care that you need.

Right?

And you are, I think from a survival perspective, thinking about, "Okay, I can't get there.

"What can I do with what I have here?"

And that may not be enough, right?

And that's where we start to get into a conversation of, you know, if people have access to care, how does that play a role in, you know, addressing those pregnancy related complications that are preventable?

You know, just by people having access to the doctor.

I know when I've talked to some of the folks down in Anson County and we ask like, you know, where do folks go for a doctor?

They do have a clinic, but it's not always all inclusive.

Meaning if you need specialty care or if something comes up that they can't address, like at the clinic, at the local hospital, you have to go to Charlotte, which is easily two hours from Anson County.

And so if you don't have a car how are you gonna get to Charlotte?

- That's hard.

- And so it's barriers like that, that are standing in the way of addressing maternal healthcare and the disparities that we see in folks that, you know, shouldn't have the outcomes that they're having if we just had proper infrastructure and investments in communities.

So they had healthcare close by.

- Yeah, I was gonna say a two hour trip is not uncommon in North Carolina, unfortunately, to get to your nearest obstetrician.

Can you imagine being in labor and in motion for those two hours?

- I cannot.

- March at dawn finds that a third of US counties are considered maternity care deserts.

And by us being a very rural state, again, that disparity becomes more prevalent in our lives and so-- - You mentioned the expansion of Medicaid earlier and you know, what was it, over 600,000 North Carolinians were now able to gain health coverage, which is great, but does that ensure that the health coverage is adequate?

- They have been making a lot of improvements.

And I think it goes back down to talking to people, seeing the impact that it has in their lives.

We are now having conversations through Medicaid about how to cover things like doula support services.

How to address more social determinants of health, making sure that people, you know, have nutritious food and things like that, have transportation to their doctor appointments and things of that nature.

And so that expansion has been more important in more ways than one, I think, in more ways than those who are impacted have realized.

- So currently in the Senate there is a proposal that's pending approval for cutting Medicaid spending.

Excuse me.

Does that impact North Carolina and if so, is that going to eradicate what you just shared?

- It does impacts North Carolina, yeah.

- So when they wrote into law Medicaid expansion last year, what was on the table was if the federal government stopped supporting it at 90%, which is what happened with expansion, it would go back to the lay of the land before December 1st, 2023.

- Mm.

- Which meant that all that hard work that we've done to get those 600,000 people who didn't have care before, right, probably weren't going to a primary care doctor, probably had a higher utilization rate of emergency departments because they would go when they needed it, because they didn't have healthcare that they could afford on a regular basis.

They will go back to how their life was before expansion.

And so the work that we've seen, you know, that Joy mentioned, how gaps were kind of being addressed and we're trying to work and build off of Medicaid expansion just getting people health insurance to say like, Hey, I have this copay, I don't have to come out of pocket today and that makes a huge difference.

Now those folks are gonna have to go back to making a decision between can I afford this right now.

There may be these other things that I have to take account for and pay for.

And so yes, it absolutely does affect North Carolina and it's most absolutely gonna hit hardest in our Black and brown communities.

- Yeah and when we look at like federally funded dollars being taken that way, how do you feel as an organization that's doing this work?

I'm not saying that you depend on federally funded dollars, but if we think federal dollars can impact state dollars inadvertently, does that impact your organization?

- Absolutely does.

It has a definite trickle down effect.

It most heartbreakingly goes right into impacting individuals and individual families and individual households.

And it kind of sends this message of, we don't care if you have access to lifesaving healthcare interventions and providers that can really help you live and thrive in a healthy way.

And that is hard on our mental health and it's hard on how motivated folks feel to live their best life, quite frankly.

- Yeah, any success stories that either of you could share?

I see you smile.

- Yeah, because we have so many success stories.

In fact, we have never lost a mom or baby that has gone through our programs and come to us for additional support and assistance.

And I think that speaks towards the power of just having community support, having people around you that care about you.

But unfortunately, we have seen, I'm living in Durham, North Carolina and since I started this work four years ago, we've lost two moms just in the city of Durham in our very community, so this issue is very real.

It is coming and these are stories that, you know, we don't know if we would've been the life changing factor, but we really, we wish that we could have, you know, wrapped those mothers around, whatever additional support it was that they needed or wished that those healthcare institutions were able to do, whatever lifesaving interventions were needed for us not to experience that tragedy, it has a definite ripple effect through our community, but I know moms who, you know, come to us kind of in crisis and they got the support and some of the resources they need, and now they're able to like secure childcare and return back to work.

And because they got a paid leave scholarship, you know, their car didn't get repossessed and they didn't get evicted.

And all of these things that the impact just can't be neatly measured.

It is truly like life changing and life saving.

And then when they are over that hump, they always come and want to give back, hey, what's the next event?

What's the next volunteer opportunity?

Hey, I don't need these baby clothes anymore or this breast pump anymore.

Who can I, you know, pay it forward to?

And things of that nature.

- And what I'm hearing too is that it's not just this care, it's this care.

It's the whole self-care, right?

And I think that that's such a beautiful mission of the organization and obviously the work that you do.

But you know, some people may say, how do we advocate in community?

Like if Medicaid goes back to what it was, how do healthcare providers locally advocate or support the cause if they can, even without the state funding or federal funding created?

- I think the first thing that comes to mind, we have to keep telling our stories, right?

I think that is what helped us to see the progress that we not only saw in people taking like maternal healthcare seriously for what it is, but also Medicaid expansion.

I mean, telling these compelling stories of I was making $7 too much to qualify for Medicaid.

Can you imagine $7 is standing in the way of you being able to have consistent, adequate healthcare?

And so I think it starts with telling stories, but I also think we have to take those stories to the people that make decisions.

I don't like to believe that, you know, if the federal government cuts Medicaid and that takes away North Carolina's ability to fund it at the rate that it currently is with expansion, that our hands are tied, right?

I think that there's a way for our legislators to really see the impact that this policy, this care has had on our communities to figure out how we can come to a solution so that folks are not getting sick, they're not making critical decisions between do I get food, do I pay the light bill?

Do I go see the doctor and I need to go see the doctor, but do I need to if I also have these other competing things that are also important?

- [Speaker] Right?

- And so I think that storytelling and then advocating by way of your stories, right?

Not only to providers to say like, hey, I had this bad experience, I'm trying to be proactive and so I'm here with you having this conversation right now because I wanna make sure I'm getting the best care possible.

But I think also calling your legislators, having those conversations with them to say, this is happening to me now because I don't have Medicaid.

Because we did not sustain the coverage that happened through expansion.

- Yeah, and you know, outside of that too, I think every provider, every person who's not in this situation, checking your own biases, right?

Because just because we didn't experience difficulties around maternal health doesn't mean that someone else's experience isn't valid.

- Yeah, I agree with that.

I agree with everything Karida said, and that's compassion at work to me, caring about other people suffering and doing something to alleviate their suffering, there's a common experience that every human being on earth shares and that is that we got here by way of being born.

And so we should all care that every baby is able to be born and every birthing person and mom is able to recover from that experience and live through that experience.

Totally agree with telling our stories.

And speaking of compassion, getting back to taking care of one another, getting back to checking on the people that you know just had a baby in your neighborhood, at your workplace, in your family.

Making sure, do I need to sit with the baby so you could wash your hair or shower.

- [Kenia] Or sleep - Or eat, or take a nap.

And sometimes not even asking, hey, I know it's probably been a rough week, you have a one week old at home, here's a meal.

[Joy chuckling] Do you need a ride to the doctor?

Do you need help getting this baby dressed?

So leaning back into the ways that we can be self-reliant as a community and just never stop fighting, never stop speaking up, never stop speaking out for what is needed.

Like you said, not only what you need, but what your loved ones need, what the people around you need.

If you see something, say something so we can get it done.

- Well, Joy, if somebody out there is like, hey, I wanna get on this equity before birth bandwagon, how do they find out more about the organization?

- Yeah, please follow us on social media @equitybeforebirth, spelled out how it sounds.

Visit our website.

You can there find our volunteer interest form if you wanna volunteer with us, or if you just wanna drop some general inquiries.

We have community engagement events all the time.

We'll be celebrating Black Maternal Health Week April 11th through 17th.

We have a annual dance party, which I think is so important this year.

- Yay, send me an invite.

- Yes.

- Awesome.

- Definitely.

We gotta celebrate and dance and be merry.

- That's right, Joy Spencer, Greta [indistinct], thank you so much for being here and doing the work that you do.

- Thank you for having us.

- Appreciate - And I thank you for watching.

If you want more content like this, we invite you to engage with us on Instagram using the #BlackIssuesForum.

You can also find our full episodes on pbsnc.org/blackissuesforum and on the PBS video app.

I'm Kenia Thompson, I'll see you next time.

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