Black Lives Matter

In the 1990’s I worked at a premier birth center in NYC. A core tenet of what was believed about Maternal Child Health then was that access to healthcare was what made the difference between good and bad outcomes. A lot of emphasis was placed on the equal access to prenatal care and safe delivery. While it remains true to a large extent that the care you get is important towards a good outcome what we saw happening in the 90’s contradicted our common (medical/scientific) belief of espousing access to healthcare as the answer.

Working at the birth center felt great because I loved that we served all of New York City with clinical and social equity in mind. 40% of our client base received public health insurance -either Medicaid or PCAP (NYS’ healthcare for pregnant women). But unlike many of the other hospitals I worked in, the PCAP/Medicaid clients got the exact same attention, care and providers as privately insured patients. It was an economic melting pot yet everyone had equitable access to the clinicians, the educators and psychosocial support services. A momentary nirvana for any one geeked out on maternal care--but our outcomes belied this so called “what should have worked “ model.

As we were dealing with the changing landscape of managed healthcare, Insurance companies bargained for all-inclusive prices. The private companies would low ball what they would pay for the total prenatal care and delivery. At one point in this process the neediest and poorest populations had the best insurance; the publicly funded programs still paid a fee that would actually cover the costs while private companies were often paying thousands less thus requiring an increase in patient numbers versus quality of care. This has been the burden of managed care from the beginning. The irony was the client that turned their nose up at wanting to be in a premium birthing center but were appalled that “Medicaid “ clients could also utilize the facility. Little did they know that their privately paid insurance paid less than the tax payer supported state programs to catch the most in need. In theory, the change in managed care would make healthcare more affordable and accessible. The reality is, it did not. Ultimately even the publicly funded programs were handed over to privately managed companies who took a percentage to squeeze ever more “efficiency” and reducing what providers and facilities were reimbursed for prenatal care and delivery (still happening to this day just fyi). What promised to be an economic improvement increasing access, became just another money laundering cycle between for profit healthcare entities and the public paying for it out of their own pocket and/or taxes. The amount of money wasted in the current bloated silo care system is astonishing if looked at objectively.

But an even more critical human reality that became clear is that the increased access to healthcare didn’t seem to change the outcomes for specific groups of people- namely black mothers and babies.

This was an ugly secret that was brewing. Some mothers and babies across the country were still dying at even higher rates than others, and as maternal morbidity and mortality was increasing no one could explain why. I remember a conversation with a NYC Department of Health employee as I uploaded birth certificate data and her almost whispered comment that “yes, maternal health had been deteriorating for years and it was unclear why”.

We know what is happening. There is a reason maternal child health is considered a marker as to the very soul of insight as to a societies well being. Underlying environmental factors such as poverty, pollution, nutrition, stress, impact health. We’ve known for decades now. Doctors, doulas, health educators, midwives, hospitals, birth centers, departments of health, academic institutions have all known as this part of this story unfolded: racism harms mothers and infants. Environmental stressors and realities have a very real physiological impact on us. If you are black woman who has literally worked twice as hard to get half as much while enduring endless microaggression, blatant aggression, and racism (and possibly resulting in needing a RX of phucemol ! ) this plays out in the physiological toll the body weathers. This impacts health. This is a fact, with extensive data to back it up.

The "victory" of having the phrase “systemic racism” become part of the national dialogue due to the murder of George Floyd and the Black Lives Matter movement is a long overdue step to try to begin to recognize that we as civilized humans cannot allow one group of mothers/people to be harmed or die disproportionately. Whether or not you think the BLM movement or phrase Black Lives Matter is “okay” the synchronicity of its founding, the capture of Derek Chauvin murdering a man on the ground, and a pause long enough in the onslaught of daily life that it finally caught on fire in the publics psyche, allows us an opportunity that has been desperately needed for decades. Will we listen now to midwives, doctors, doulas, public health experts, departments of health, the health scientists? Can we make the health of our people a priority? Or will we run like a chicken with its head cut off to the next explosion?