I never truly liked my birthday. Every year, without fail, my family tells the story of how I almost killed my mom. Her pregnancy was going well, great even, until she was actually delivering me and there was too much blood everywhere. Hours after a near-miss, I (being the problem child that I am), stopped breathing. I had to be transported to a different hospital for a specialist, which was totally understandable and okay had I been the only one who needed care, but I was not. No, my mom, who hours after a complicated birth and seeing her child stop breathing in her own arms, was kicked out of the hospital when she needed care and rest too. I almost killed my mom, keyword being “almost”, it could have ended very differently. Knowing this happened to my mom, a Latina immigrant, and knowing that the United States has one of the highest maternal mortality rates in the world that disproportionately affects women of color, I’m able to critically think about her experience. I can’t help but question how different her experience would have been had she been a white woman.

Maternal mortality and morbidity is plaguing the United States. Maternal mortality is described as death associated with pregnancy, delivery, and the postpartum period (about 6-8 weeks postpartum).1 Maternal morbidity is described as the health consequences, associated with pregnancy, delivery, and the postpartum period, one lives with. America is the “most dangerous industrialized country in which pregnant women can live and deliver.”2 This issue is very multifaceted. It stems from institutional and structural racism that creates an unsafe environment for pregnant women of color, especially Black non-hispanic women. This unsafe environment now consists of many racial disparities such as lack of access to maternal care as well as lack of quality maternal care. Yes, even when women of color have access to maternal care, their experiences are not amazing. They are subjected to doctors whose care is influenced by implicit (and honestly, sometimes, explicit) bias against them for no reason other than their race and/or ethnicity. Even the bare minimum can be harmful to pregnant women of color. It is terrifying to think about how I can go on and on about the horrors of this.

Before we can delve into solving this problem, we must look at the causes. I spoke briefly about institutional and structural racism, but what does this actually mean? Taking a look at Jim Crow laws, legalized practices and policies that segregated Black people, they affected almost every aspect of life and continue doing so even after they were overturned. The “residential segregation due to long standing systemic racism” can be held accountable for the healthcare disparities that take the lives of pregnant women of color.3 For example, the career opportunities for the Black community were limited due to Jim Crow laws and this affected their socioeconomic status heavily.4 By having a low socioeconomic status, you are more likely to not be able to afford healthcare, maternal or other. While this may seem obvious, the implications may not be so obvious. Being able to pay for insurance allows many people to have access to prenatal care, which is incredibly important in decreasing the risk of maternal mortality and morbidity risks.5 The World Health Organization recently updated their prenatal health recommendations from four prenatal visits to the obstetrician to eight.6 If BIPOC women cannot afford healthcare, what makes you think they are going to be able to access prenatal care at all, let alone eight visits?

My sister always tells me stories about going to the local WIC with my mom while she was pregnant with me to get prenatal vitamins. Trying to understand my feelings about these stories was complicated because being able to get WIC benefits means you are a low-income family, yet despite being low-income, you are able to have access to these crucial vitamins. It’s a part of my family’s life where we were able to benefit from poverty. Living as a low-income family was always taxing, yet it helped my mom gain important vitamins for herself. We were lucky, millions of women of color do not get to just drive down to their local WIC; they do not benefit from their poverty.

Not only is this daunting to think about, it opens more doors to this complex issue. The healthier a woman is at conception, it can be assumed that she will have a healthier pregnancy.7 Keeping this in mind, I’d like to point out that women of color, especially Black women, have significantly higher rates of chronic health conditions.8 Before they are even pregnant, the odds of a healthy pregnancy are against them. Can you imagine wanting nothing more than to bring life into the world but having to think that this might also mean you will no longer grace the earth yourself? And why? Because of conditions that are not in your control. For simply living in the wrong zip code, you can be in a maternity care desert where getting maternal care is nearly impossible.9 Maternity care deserts occur in zones most impacted by redlining, another direct effect of Jim Crow laws and other various racist-based policies and practices. Maternity care ranges from prenatal care to access to abortion and contraceptives to postpartum checkups. Living in a maternity care desert goes beyond vitamins, it goes beyond ultrasound scans to see if the fetus is forming healthily, it is quite literally a matter of life and death.

One of the most important first steps in combating maternal mortality should be expanding government healthcare. Living in a maternity care desert is dangerous; by giving access to maternal healthcare thousands of lives will be saved. As of now, there is a policy to extend Medicaid, not expand.10 To me, it seems as though our federal government sees the issue

but wants to do as little as possible to help this issue. By extending it, even if a woman does not qualify for Medicaid they will be able to gain access to medical care for the duration of their pregnancy and two months postpartum.11 While this may seem great, it fails to address the fact that 31% of maternal deaths actually occur within a year postpartum.12 So for the other ten months, they are on their own. They are in one of the most vulnerable states of mind any person can even be in, and their government is doing nothing. It makes me wonder if this “expanding” government healthcare would even work. If they are still living in maternity care deserts, they won’t have a facility to go to to use their healthcare service.

Maybe providing more obstetrician and gynecology facilities in predominantly Black and Brown communities would be a better first step. I live in the San Fernando Valley, a predominantly Latino region of Los Angeles. I’ve lived there my entire life; being away at college is the most I’ve ever been out of the Valley. This means nothing to many of those reading but when I tell you I can count the number of obstetrics and gynecology clinics in the Valley on my hand… well that should perk some ears up. My neighbor from three houses down would ask me to babysit her two toddlers while she commuted over an hour (Los Angeles traffic mixed with the unreliable, inefficient public transportation system mixed with the sheer distance) to the nearest obstetrician clinic that approved her non-insurance covered visit. How is it that someone who has already given birth twice, who knows the importance of prenatal care, is still subjected to such a long trek to a clinic? She is doing her part and her government needs to do theirs.

While access to maternal healthcare is difficult to obtain in the United States, it is not impossible. But if and when women of color do get access to maternal healthcare, it’s a question of whether it’s of good quality. That’s another layer to this issue, having maternal healthcare is great but if you are being treated with no respect, it does not seem that great. Studies have shown that Black, Hispanic, Native American, and Asian women experience considerably lower quality maternal care than their white counterparts.13 There are instances of belittling and just blatant disrespect. When my mom was pregnant with my brother, the doctors would talk about her as if she wasn’t there and would only talk amongst themselves. She would hear and understand everything they were saying, but then another person would come in and say everything the doctors were saying but in Spanish. There was not a single document that indicated whether my mom needed or wanted an interpreter; no doctor ever even attempted to talk to her directly. They simply looked at her and disregarded her (she had already been fluent in English for ten years at this point in her life). There was no communication whatsoever between the doctors or my mom until she actually got upset about the entire situation. Every time she tells the story, I get chills. I can only imagine how she and thousands of other women have felt when doctors do not take you seriously or consult you about your own body.

Doctors have a way of either making you feel incredibly safe or entirely isolated in the delivery room. I think that is why many Black pregnant women choose to have a midwife present in the delivery room with them.14 When a midwife has been present for the entire duration of the pregnancy and the delivery, rates of healthy infants and mothers increase.15 There is safety in having someone in the room with you that is more concerned about your wellbeing than the fetus’s. I wish my mom had someone like that. She had my grandmother and dad in the room but they were all worried about me, who was taking care of my mom? I do think she carried that with her. I didn’t understand it then but I saw those memories coming back to her firsthand; one of her cousins was giving birth a few years ago and my mom was one of the first people she called. My aunt needed her so my mom went (she also took me along). In real time, I saw my mom give my aunt every pain-relieving position you can imagine, every word of affirmation, every ounce of support and attention that she needed all those years ago. My mom has absolutely no medical education, but she has real life experience and sometimes that’s all a mother needs in the delivery room, someone who is going to attend to their needs.

Almost all maternal deaths are preventable. Most Black maternal deaths are the result of preeclampsia and eclampsia, high blood pressure and seizures caused by the high blood pressure.16 This is yet another example of how doctors do not listen to their patients, even when explicitly told that the mothers feel something wrong, as was the case with Shamony Gibson, a Black woman who died due to medical negligence, as documented in the film Aftershock.17 The documentary tells the story of the families of two Black women who were victims of maternal mortality, and how they found solace in each other while learning about the maternal mortality epidemic. The film used visual and linguistic modes of communication to showcase the severe impact maternal mortality has on families. An especially impactful scene depicts a gynecologist explaining how Shamony Gibson’s painful cry for help being brushed off was a direct result of racist medical tactics; the pain of a black woman in labor has never been taken seriously.18 The

film pans across a photo of a woman screaming in pain as the gynecologist is explaining how the foundation of the medical gynecology field is based on the myth that Black women do not feel pain. I’ve never given birth, nor do I have a medical background, but I am positive that all people actively pushing another body out of their own body definitely feel pain. This “unconscious bias” held by the doctors in the film should have been mitigated, it is through this way that the healthcare inequities can actually be diminished.19 The scene continues to describe how Black women, specifically enslaved people, were used for medical experiments and continue to be the largest population cared for by teaching hospitals (in which people who are still learning are the ones treating patients). Medical racism may look different today, but it still persists. I had to take breaks throughout the film to collect my emotions, even imagining my dad in Shamony’s partner’s shoes made my eyes well up. There are so many ways things could have gone differently that could have resulted in Shamony being alive.

I also wonder how different this issue would be if sex wasn’t held on such a high pedestal. I remember sitting in seventh grade health class when my teacher started to demonstrate how to properly put a condom on via bubble wand. She actually said, “This is just so I can abide by district policy, I know you good girls won’t have sex until you’ve met the perfect guy.” There are many things wrong with her sentence, the first being that we were a coed health class (she didn’t have to single the girls out) and another that she was very heteronormative about it, but the point is, she was supposed to tell us how to practice safe sex. Instead of doing that, she made sex a sort of forbidden fruit. People wanted to try it now since it was something so untouchable. This is very dangerous because people were then not equipped for pregnancy at all. The point of that unit in health class was to give knowledge of safe sex so that teenagers don’t get pregnant; she failed to do so and the teenagers weren’t just pregnant, they were uneducated pregnant people. They were people who had no idea you had to take vitamins for yourself let alone prenatal vitamins. Having “inadequate education” can literally cost someone their life, even though they just wanted to try this one thing.20 Now that I’m really thinking about it, I went to a public school that was so caught up in trying to stop teenagers from having sex and would try to scare us with the fear of pregnancy, that they never equipped anyone with knowledge on what to expect if you were to actually get pregnant. The public school system let people (that I had known my whole life) fend for themselves unknowledgeable and vulnerable.

I’m terrified of giving birth in America. I wish I could say I was scared in a regular, teenage girl way, but I’m scared in a “what if I feel something is wrong with me but no one takes me seriously” way. Everything from my zip code to my skin color, my social determinants of health (those aspects of my life that can give many people a clear picture of how hard it can be for me to be healthy), is telling me that never getting pregnant is the way to go about my life. I don’t want to get ahead of myself and say that I’ll never birth a child, but right now it’s looking that way. But I do see how I get the privilege of being able to have a choice in the matter. Even if I were to get pregnant right now, I could (with some difficulty but nonetheless I would be able to) get access to an abortion. This would actually be my safest option. Contraception is actually one of the best prenatal care options in reducing maternal morbidity and mortality rates.21 Planning your parenthood is important! While I’m important by myself, the effects that can present themselves if I were to have a complicated pregnancy and/or delivery can lead to “potentially lasting effects on women’s health over a life course or along family lines across generations.”22 So not only would I be putting myself in danger, the family that I was attempting to grow would also be put in danger. There is no winning, no fear subdued until the government pays attention to the fact that I, a nineteen year old Latina with no immediate urgency to start a family, is terrified to her bones of giving birth and being pregnant in America. When will my fear end?

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