New story in Health from Time: Amid Social Upheaval and Covid-19, Black Women Create Their Own Health Care Support Networks

In early May, a group of 20 Black mothers in rural Mississippi logged onto a virtual group therapy session to discuss the immense, compounding pressures of providing for their families and caring for their children during a global pandemic and historic unemployment crisis. It was the first time any of them had talked to a traditional mental health counselor, and the results were cathartic.

“It’s important that we refuel — to be able to be better parents, to be able to be better daughters, to be better sisters and mothers,” says Dr. Erica Thompson, the executive director of Magnolia Medical Foundation, the community health nonprofit that ran the program.

Magnolia Medical Foundation’s pilot series was designed to address the unique challenges facing Black mothers in recent months as they navigate a pandemic that has disproportionately claimed Black lives, an unemployment crisis that has exposed the failures of the American social safety net, and the explosion of a national movement combatting the systemic violence perpetrated against Black people.

Magnolia Medical Foundation’s program invited mothers to participate in therapy sessions virtually, via computers or phones, and then stop at a drive-through to pick up information about mindfulness and coping mechanisms, as well as other more tangible resources, like food, cleaning supplies and face masks. “This allowed them to place those questions that they had, and to be able to pick up resources and information that they could carry with them to build out their recovery and their resilience and sustainability,” said Thompson, who returned to her native Mississippi after medical school to address the stark health disparities that faced Black people like herself.

But the Magnolia Medical Foundation is hardly alone in using this moment to find new ways to support Black mothers. In recent months, community leaders have rallied to offer Black women access to mental health care, counseling and information regarding their unique health challenges. Doula groups from Brooklyn to New Mexico have led online trainings on how to handle stress and trauma, and midwives in rural counties across the South taught clients how to take their own blood pressure and how to advocate for themselves in a hospital setting. Organizations like Black Mamas Matter Alliance and Black Women’s Health Imperative have published guidance and held webinars addressing topics targeted at Black moms, including navigating health insurance, accessing telehealth, and to how to give birth safely during the pandemic.

The focus on Black mothers is not incidental. Even before the pandemic, many Black women faced outsized barriers to health care. They are less likely as a group to be insured than their white counterparts, more likely to suffer from maternal health complications, and three to four times more likely to die from causes relating to pregnancy. Black mothers are also more likely to see their babies die, particularly in rural areas, where the mortality rate for infants born to Black women is at 11.8 deaths per 1,000 live births.

Enduring racism can also be a significant factor for Black women’s health, says Monica McLemore, a family health care nursing professor at the University of California, San Francisco. She and several colleagues recently published a study finding that Black mothers who reported high levels of racial discrimination may be at risk for preterm births and other negative birth outcomes. Other studies have shown that racism among medical practitioners affects the quality of care Black mothers receive, the amount of time doctors spend with Black patients, the way providers view Black patients’ pain and evaluate their complaints. Black mothers’ experiences with racism have also been associated with delays in seeking prenatal care.

Those stresses are perhaps compounded in the wake of George Floyd’s killing, when millions of people have shared violent videos on social media. “We are very worried and concerned about people’s exposure to repeated videos of the murders and shootings of unarmed black people,” McLemore says. “We also worry about the fact that many people who would have social support, currently don’t have that in the context of physical distancing.”

COVID-19 exacerbates negative health trends, in part because it fuels people’s fears of seeking out medical care, experts say. As hospitals reassign doctors and nurses to handle a surge in COVID-19 patients, other parts of the hospital — like maternity floors and family health wards — are understaffed and restricting outside visitors. “On-the-ground community based organizations have already been the safety net for so many of our communities, for folks who have historically not been able to access care,” says Dr. Jamila Perritt, an OB/GYN who works in community health centers in Washington, D.C. “So those networks are really critical in this time.”

Partly as a result of these factors, more Black women in recent months have expressed interest in giving birthing outside of hospitals, says Angela Doyinsola Aina, interim executive director of Black Mamas Matter Alliance, a group that brings together community organizations working on Black maternal health around the country. Laboring at home or in a birthing center can have upsides, research shows; home births can be associated with fewer interventions such as induced labor or cesarean sections. But they also carry significant risks, doctors warn, particularly for Black women who are more likely than their white counterparts to have serious, and potentially fatal, pregnancy complications such as fibroids and preeclampsia.

The apparent growing interest in giving birth outside of hospitals is a trend that worries many mainstream health care providers. In April, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, which do not recommend home births, addressed the issue. The AAP published new guidance, while ACOG put out a statement on birth settings emphasizing the need for “patient-centered, respectful care” while reiterating that hospitals and accredited birth centers are the safest options.

Still, midwives say their services have been in high demand. Nikia Grayson, a certified nurse midwife at Choices, a reproductive health care center in Memphis, has been flooded with calls and social media messages every day for months. “Any means they can reach me they’re gonna do it,” she says. She is the only midwife in Memphis that can do both hospital and home births, and until recently, she was the primary provider at the center’s midwifery clinic and its wellness clinic for transgender patients. As a Black midwife operating in a city whose population is 64% Black, Grayson says she intentionally focused her practice on making sure families of color have safe birth options. Choices is set to open a birth center in August, which will be the first one in Memphis, and it has added three other midwives on staff so that it can ramp up its load from the 15 births per month it was handling in the first part of the pandemic to 30 births per month.

The large caseloads are not ideal for pregnant people or midwives, Grayson says. But they are a direct result of the restrictive way that midwives are regulated, particularly in the South. The midwives that do practice in the U.S. are often limited in where they can deliver babies and cannot always get their services reimbursed by private insurance or Medicaid.

Legislation related to the pandemic response may address some of these problems. In March, the Black Maternal Health Caucus in Congress introduced a package of legislation they called the “Black Maternal Health Momnibus Act,” and some ideas included there, such as allowing providers to offer telehealth services across state lines and extending Medicaid postpartum coverage, are inching forward.

But even as midwives, doulas and community health groups are seeing demand increase, many are struggling amid the ongoing economic crisis. Small health centers operate on shoestring budgets in the best of times, and an increase in total demand does not change the economic picture if patients can’t pay for the services. “A lot of these organizations are really trying to figure out if they’re going to stay in business,” says Linda Goler Blount, president and CEO of Black Women’s Health Imperative, which provides health information to women, advocates for policy change and funds federally qualified health centers. “We’ve seen organizations have to lay staff off, so even if they don’t close the doors, at what level will they be functioning in the next six months?”

Back in Mississippi, Dr. Thompson of the Magnolia Medical Foundation is working with Nakeitra Burse, a public health educator and consultant, to build a new program that will pair Black women in Jackson, Mississippi with doulas and create a registry of doulas in the state. The goal is to establish a more sustainable network of trusted, community providers who can address high maternal mortality rates and help Black women safely get the care they need.

“We have to do what we have to do for our community and not wait for someone else to do it,” Burse says. “We are still holding the system accountable. But until then, we have to create and do for ourselves at this moment.”