a young woman posing for a portrait by a window

American women are still dying at alarming rates while giving birth

Advocates across the U.S. are working to reduce the number of maternal deaths

Brittany Ferrell, 29, is a community activist and high-risk obstetrics nurse from St. Louis, Missouri who was prominently featured in the 2017 Netflix documentary “Whose Streets?” about the 2014 protests that erupted in Ferguson, Missouri after the police-related shooting death of teenager Michael Brown. Ferrell co-founded Millennial Activists United, "an activist collective created by queer black women," and is pursuing a Masters of Public Health degree at Washington University’s Brown School.
Photograph by Lynsey Addario

When Brittany Ferrell earned her pediatric nursing degree from the University of Missouri St. Louis in May of 2014, she’d already had lots of experience as a community activist.

During two years as president of the Black Students’ Nursing Association, Ferrell helped develop community outreach programs and workshops about sexual, mental and nutritional health, and used social media to publicize them widely.

Ferrell’s desire to link activism with neighborhoods came to an explosive head in August of 2014, after an unarmed 18-year-old black youth named Michael Brown was shot and killed by police in the St. Louis suburb of Ferguson, Missouri.

During nationally-televised protests, advocacy moved from the academic to the neighborhoods for Ferrell. She says she participated in the outcry about Brown’s death for 100 straight nights. Her vocal, prominent presence led to her being one of the central subjects of the 2017 Netflix documentary about the Ferguson uprising entitled “Whose Streets?”

Ferrell is known throughout Missouri and the Midwest for her community organizing and activism. She’s most passionate about the challenges for pregnant women of color in St. Louis and beyond.

“There’s absolutely no reason why black women should be dying at the rate we’re dying,” Ferrell says. “Just like state violence is allowing black folks to be shot dead in the street, and no one’s being held accountable or even having to atone for the death of black bodies, the same thing is happening in these medical institutions.”

That Ferrell’s reproductive health activism is unfolding in a town that made international headlines for social justice is no coincidence.

Missouri’s status as the state with one of the highest maternal mortality rates in the U.S. makes it a prime stage for America’s burgeoning “birth equity movement,” which suggest that factors like poverty, racism, social and economic policy impact African American mothers and babies from the moment they’re born.

More than 700 women die each year in the U.S. from causes related to pregnancy or childbirth. Black women have a maternal mortality rate three times higher than that of white women. At least 60 percent of maternal deaths are preventable.

The House of Representatives unanimously approved a bill this week, the Preventing Maternal Deaths Act, to fund state committees to review and investigate deaths of expectant and new mothers, to train providers to improve the quality of care and to make a summary of each maternal death available to the public. The bipartisan legislation, which authorizes $12 million a year in new funds for five years, would pay for research that would yield more accurate data and identify the specific factors fueling the death of mothers, enabling states local and state governments to develop more effective strategies to address the issue. The bill still must be approved by the U.S. Senate.

In fact, the past few years have yielded an unprecedented focus on the issue of maternal health—and death—for black American women. At the forefront of this movement are organizations like the National Birth Equity Collaborative, and the group Black Mamas Matter, both comprised of academicians, medical professionals and community health activists who have collaborated to develop compelling personal stories, research and policy strategies to reinforce the message that black women face serious, quantifiable risk of death or major disability related to pregnancy. The crisis is so real that a coalition of black women mayors from across the nation have formed a coalition intended to direct policies and resources to address the problem, without waiting for federal intervention.

“We can’t just talk about our reproductive health and rights from a single issue lens. Our lives are much more complex than that,” says Monica Simpson, executive director of the Sister Song Women of Color Reproductive Justice Collective based in Atlanta, GA. “The way that the multiple layers of oppression show up in our world is not the same way that privileged communities get to experience these issues. This is why black women came up with the term ‘reproductive justice,’ which is looking at connection between the very real social justice issues that come into our lives every single day.”

The irrefutable data around black women and maternal death is so negative, that black women are far from the only stakeholders who are alarmed by the issue.

“What we see in maternal mortality is what we see everywhere else,” says Dr. William Callaghan, Chief of the Maternal and Infant Health Branch in the Division of Reproductive Health at the Centers for Disease Control and Prevention. “Black men are twice as likely to die from prostate cancer as white men. There’s a litany of that type of disparity. It’s certainly highlighted in maternal mortality, because you’re talking in most instances about otherwise healthy people with families, and oftentimes orphaned babies. "

Callaghan agrees with reproductive health activists that the ways race and ethnicity are encountered and processed in the medical setting directly impacts the issue.

"There’s all kinds of implicit bias, racial and unconscious bias about somebody who presents with a condition or symptoms that look a lot like something ordinary but isn’t. These judgement calls can occur around race. What they say is judged in a way that is based on their racial background.

“The other layer of fragmentation is the experience of being a black woman in America, and the intergenerational effects of racism and segregation. It all plays out through biology."

Pamela Merritt wasn’t raised to be a reproductive justice activist. Though her solid middle class upbringing in St. Louis, Missouri was fueled by parents who helped register neighbors to vote and espoused civil rights, they also worked hard to ensure that their children attended the best schools, wore the best clothes, spoke with clear, precise English.

The “payoff for respectability,” as Merritt put it, came in the form of a six-figure job selling radio advertising in Dallas. While there, two things happened to spark her activism. The first occurred when a high-end retail client submitted a written request that their product not be advertised on “urban radio.” Merritt knew what that meant—they had no interest in black customers.

The next epiphany occurred when, at age 28, Merritt developed a severe case of uterine fibroids, along with endometriosis. She sought recommendations for an OB/GYN from her white work colleagues.

“There I sat with my perfect English, wearing my expensive suits and my expensive handbag, and I walked into that office and got treated like shit.,” Merritt says. “I was told that I needed to have a baby as soon as possible, because ‘most of you have had kids by now.’ I was spoken to like a piece of meat by specialists who never once asked me if I was in pain.”

When Merritt shared her story with her African American female friends, she discovered she wasn’t alone. “So many of them had experiences like mine and worse. And we were all what you would consider upper middle class. That’s when I drew the line from where I stood to where a young, lower-income black woman would probably go through in that same setting. And that’s when I couldn’t just turn my back.”

Today, Merritt is to co-founder and executive director of Reproaction, self-described as an advocacy group “upholding abortion rights and advancing reproductive justice as a matter of human dignity.” The group also monitors reproductive health spending in the Missouri, organizes rallies and demonstrations against “fake clinics,” and liaises with state legislators to make sure that reproductive health issues stay on the radar.

Reproaction seeks to amplify the work of activists like 31-year-old Brittany “Tru” Kellman, who’s on track to become the one of the first fully-licensed African American professional midwives in Missouri’s history in 2019. Kellman founded the Jamaa Birth Village, a support group in Ferguson.

Raised in Ferguson from the age of five, Kellman was pregnant by age 13 and in an abusive relationship. By age 17, Kellman was pregnant again, with no support and in yet another abusive relationship. So she saved up for an abortion.

Just days before the scheduled procedure, Kellman says she was contacted by the Ferguson police department about some past due traffic tickets. To avoid jail, she used her abortion money.

“I tried to kill myself multiple times after I had my second son,” Kellman explains. “I spiraled so far down, I just didn’t see any reason to keep going.” Three books helped save her life: “Sacred Pampering Principles: An African American Woman’s Guide to Self-Care and Inner Renewal,” a book about yoga, and another about spiritual midwifery.

“I went on a path of self-discovery starting in 2007. I realized I deserved to be treated with respect. I needed to treat myself with respect. It really laid the foundation for my midwifery training.” Kellman even traveled to Ghana to study traditional midwifery and birth support.

Kellman founded Jamaa in October of 2015, and began her formal midwifery apprenticeship in January of 2016, offering pregnancy support from her home at the same time.

That training also helped her realize how far too many women in North St. Louis are often completely isolated and lacking information, guidance and support as they consider getting pregnant, during those nine months and after birth.

Which is ironic, many birth equity advocates say, considering the role African American women have played in America’s reproductive health history. Throughout the slavery era and into the early 20th century, African American “granny midwives,” were unofficially charged with overseeing the majority of births in many southern and rural settings, for black and white women alike. Only the advent of modern medical organizations and policies that outlawed non-hospital based deliveries fueled the demise of home deliveries—and with it the reverence for granny midwives.

But in the 21st century, African American women are once again taking the lead in the effort to ensure equitable access to care and support for women of color. In September of 2018, Washington DC Mayor Muriel Bowser convened a Maternal and Infant Health summit featuring African American female mayors of Flint Michigan, Gary Indiana, Baltimore, Maryland and Hartford, Connecticut. An audience of nearly 1,500 gleaned information about the latest research, policies and community health initiatives aimed at supporting better maternal and reproductive health for black women.

And in August of 2018, Bowser signed an agreement with George Washington University Hospital that would create a state of the art hospital and trauma center--and a full-fledged maternity ward—in Ward 8, one of the poorest, mostly minority areas of Washington, DC. Construction is slated to begin in 2020, with a goal of opening in 2023.

“Big city mayors recognize this problem, and we are acting on what we know works to solve it,” Bowser says. “Too often, any maternal death in our communities is outsized, in terms of the impact it has on families. Mayors are being forced to extend our reach to do things we used to rely on the federal government to provide. With this issue, we have to call on the knowledge, and the voices and the energy of our communities to save lives. We can’t wait for the next study or report.”

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