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Not only has maternal and infant health mortality rates increased in the U.S. but these rates are double for black women compared to their white counterparts–no matter what their education or income level. Community Doulas and midwives think they have part of the solution

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TAYA GRAHAM America is the wealthiest country in the world. And yet for some women living here, it is as risky as residing in countries with extreme poverty. I’m talking about our abysmal maternal mortality rate which is particularly terrifying— black women and their children who die during childbirth at alarming rates. In fact, a recent CDC report reveals black mothers and their children are more than twice as likely to die from birth complications compared to their white counterparts. And all this come amid efforts in states like Alabama and Ohio to roll back reproductive rights for women in general. So what can be done? Well, one community activist in Baltimore has some solutions to address the problem and she’s going to share them with us today.

To discuss and hopefully understand the future of reproductive rights and the impact on communities of color, I’m speaking with Andrea Williams-Muhammad, a doula and reproductive justice advocate. She is a Baltimore native and she has dedicated her life in grassroots efforts centered on social justice. Andrea, I thank you so much for joining me.

ANDREA WILLIAMS Thank you for having me.

TAYA GRAHAM So first, just tell me a little bit about your work as a doula. For those who don’t know, what is it doula and what do you do?

ANDREA WILLIAMS A doula is a nonmedical birth assistant who aids moms and birthing persons on their birth journey. Most times, we are most involved during the actual birth— supporting her, providing her comfort measures, explaining medical terms and terminology or procedures that are happening. As my role as a doula under our program, I’m more so an advocate and policy person. In our program, we advocate the use of community. Our acronym that we use all the time is HOME, and that means to honor, observe, mentor, and empower all of our families.

TAYA GRAHAM That’s lovely. That’s really lovely. Now, can you talk a little bit about the restrictions on reproductive care in a state like Maryland because we know, for example, access to abortion is being restricted in Ohio and Alabama and several other states, so how do we compare Maryland to these other states that are just pulling back on reproductive rights for women?

ANDREA WILLIAMS Maryland—You know, I had an interesting conversation over the weekend where another reproductive justice advocate mentioned that, you know, Maryland and Baltimore in particular isn’t really a hotbed of issues and dramas centered around abortion and maternal care. But what I shared with her was the fact that we have two large international, you know, medical institutions, so you would think that Maryland, particularly Baltimore City, would be the last place you would still see these numbers where—

TAYA GRAHAM Excellent point.

ANDREA WILLIAMS In comparison to our white counterparts that, you know, we’re dying and are living with severe morbidity issues and that means any kind of medical condition that arises during pregnancy and lasts well after pregnancy. But we have issues here in Maryland, particularly in Western Maryland and on the Eastern Shore where we’re talking about access to care. I mean, literal access to care where there are women and families who live in Western Maryland who may have to travel up to an hour or two just to get prenatal care. Some are choosing to go out of state. It is easier to go to West Virginia than it is to go to Maryland, in some areas. And then there is the Eastern Shore where there’s only one, you know, one facility to cover, you know—

TAYA GRAHAM And the Eastern Shore is also a Republican stronghold, as well.

ANDREA WILLIAMS Correct. Correct. Fortunately for us, our governor has said that, you know, he was not going to raise the issue of abortion and abortion rights. It’s already been settled here in Maryland, but what we see across the country is this overlapping of abortion and its ties to reproductive access to care. We’re not just talking about abortion. We’re talking about contraceptive care, preventive care— what do we do if a woman who has been deemed high-risk or the pregnancy is not viable? What do we do for her? Those are the issues that most frighten me when I look at what’s happening in other states, especially the fact that, you know, I generally believe that every person should have the right to determine what happens with their body. So, you know, my overarching theme is hands off.

TAYA GRAHAM Fair enough. Fair enough. And let me see if I can ask you a question that hopefully doesn’t get you to step on some toes, but you mentioned that we have some incredible medical systems here. We’ve got Johns Hopkins, which is world-renowned for its ability to research and create cures and vaccines, but we also still have the same incredibly high rates of maternal death and infant death right outside their door when it comes to black women. Do you have any idea why that’s the case? Can you maybe speculate on that?

ANDREA WILLIAMS Recent research has shown that the use of doulas and access to midwifery care drastically reduce those numbers because what we’re talking about with the disparity is not just the access to care because we have access to high-quality care here in Maryland, especially Baltimore City with these two institutions, but the idea is we don’t really have a choice. For instance, there are no free-standing birth centers here in Baltimore City. So your choice is really by default and that default is whatever hospital your insurance is connected to that’s typically your choice, so you really have no say. Access to midwifery care, a lot of midwifery care services aren’t covered under insurance and they’re not covered under Medicaid. And by midwifery, we have nurse midwives who work inside the hospital, but we’re talking about home-based midwives, midwives who will typically come to your home to offer care, and that does not necessarily mean that you want a home birth. They, some have access to or privileges at other hospitals where you can choose to deliver at that hospital, and they can support you in that. So by care here we have really no choice. So everyone is made to go to these two institutions.

And that being said, we also believe in the Baltimore Doula Program that pregnancy is not a medical condition. It is a life event that happens whether or not you’re in the hospital or not. It is not something that you can cure. [laughs] Once a woman is pregnant, she’s pregnant unless she chooses to terminate the pregnancy. So the whole medical concept of pregnancy sometimes places an added stress on women, especially black women who have historically have, you know, this love-hate relationship with medical institutions, particularly here in Baltimore.

TAYA GRAHAM Yes, understandably.

ANDREA WILLIAMS Because we still live under the stigma of Henrietta Lacks.


ANDREA WILLIAMS So. And historically, we just, you know, black people as a whole never really—You go to the hospital because you’re sick, and you only go if you’re sick-sick. [laughs]

TAYA GRAHAM Right. Otherwise, you avoid it like the plague.

ANDREA WILLIAMS So and that is another issue that we address in the community doula program is that a lot of women don’t seek prenatal care because they’re not sick.

TAYA GRAHAM Okay. I see what you’re saying.

ANDREA WILLIAMS So, you know, we lay the blame on, why aren’t they coming? I’m like, well, in our minds— meaning black women— you go to the hospital because you’re sick.


ANDREA WILLIAMS Pregnancy is not an illness. it just happens. So unless, you know, they are told otherwise, you know, they just go on with life until you get to, you know—Most women typically will probably seek medical intervention in their second trimester, but because of the medical model, they think that is late prenatal care. Even though we do advocate for care early on, but, you know, we also have to put in place people’s behavior and why that behavior exists.

TAYA GRAHAM You know, I think it makes sense that black women are reluctant to go into hospitals. You mentioned Henrietta Lacks and her cells being stolen. We remember the Tuskegee Experiments where people were not being given proper care for syphilis. We remember the words “Mississippi hysterectomy.” Meaning, you go into the hospital to have a baby, and you come out and you find out that you were sterilized against your will, against your consent. So I think the concern in the black community is definitely rooted in a very valid history there. I think it’s understandable. So is part of what you’re doing educating black women to let them know that it is safe, and it is actually good for them to go to the hospital to get this prenatal care?

ANDREA WILLIAMS Yes. We are, and we advocate that they be able to choose what kind of care. You can get prenatal care from a midwife, which is perfectly fine. We advocate that anything and everything that can be done to have a successful and positive birth outcome. We are 100% behind the mom and her family. A lot of people think that doulas and midwives are, you know, these proverbial tree huggers that don’t want any kind of medical intervention or, you know—

TAYA GRAHAM That it’s all birthing tanks and sage. [laughs]

ANDREA WILLIAMS Right. [laughs] And water, right, and sage, and all of that. But, no. We advocate for whatever that family is comfortable with. If that family is the proverbial tree hugger and the sage burner, okay, we can go with that. But if we also have the mom who, she wants the full hospital experience, we also go for that because no matter what, we believe it is a person’s choice. And it is not a matter of what our personal beliefs or personal choices are. And even in whatever setting that the mom and the family have chosen, there are still opportunities for them to ask, to have questions answered, or to have their needs met, or to understand what is happening.

TAYA GRAHAM Now, since Trump’s inauguration, I think it’s been six other states— Georgia, Kentucky, Ohio, Iowa, Mississippi, North Dakota— that have passed the heartbeat bill, which essentially means that they’re going to be able to seek criminal charges against any woman or doctor who has an abortion performed. And I believe in Alabama this could be six months? It will be enforceable in six months and the doctors could face up to 99 years in prison. When you hear about this criminalization, when you hear about prison time, who do you envision being impacted by it? Who do you see? Do you see black women being impacted by this kind of criminalization?

ANDREA WILLIAMS Yes. We see it all the time, just like the case down South where the mom was shot and then she was charged and arrested for child endangerment because she was shot while she was pregnant. So the whole criminalization of women’s bodies is concerning to me and concerning to other reproductive justice advocates across the country. I don’t—I’m just—It’s surprising to me that it is just now that those who are fighting for choice, are now reaching out to black women and black advocates like myself because without them, without us, they can’t succeed in this effort.

TAYA GRAHAM Very true.

ANDREA WILLIAMS Yes. We— when I say, “we,” black women— are going to be mostly impacted by these laws. Mainly, because it becomes a snowball effect. If we have lack of access, and we are traditionally hesitant to go to doctors, so we’re not going to seek care until well after six weeks. So, you know, now you have a mom who has a baby, who may not want that baby. I mean, let’s be real. All pregnancies are not wanted and not welcome. She’s now going to be forced to carry that baby to term. It’s most likely that, you know, she will be on the care of the state, so will that child, so now we have a broken family because of this bill. And people, when we look at the abortion issue, are not looking at those circumstances.

TAYA GRAHAM Right. They’re talking about the life of the fetus, but they’re not talking about the life of the mother and child who need care, who need housing, who need health care afterwards. I think you make an excellent point. A question I have, and you might not be able to answer this, but it’s a question that kind of bugs me. When it comes to maternal health care and infant mortality in this country for black women, it doesn’t matter how educated you are, and it doesn’t matter how much money you have in the bank. The outcomes are still same, that you still have a risk of dying during childbirth or afterwards because of infection or your child dying, and money in the bank doesn’t change it. Why is this?

ANDREA WILLIAMS As we saw with Serena Williams when she was in the hospital, and she literally had to, you know, walk herself to the nurse’s station and demand a certain test. We see that, once again, money was not the issue. The issue is not necessarily access to care or quality of care. The issue is race and racism, and institutional racism that a lot of families face, especially black women. The issue is not really our social-economic status or our health status. It’s how we are treated when we present in certain places as black women. So the treatment that we receive is across the board, and that treatment is often subpar when it comes to race. We are, you know, we have a lot of women—There’s a recent article of women suffering, literally suffering doing labor because the medical field or those professionals feel as though black women can withstand the pain—

TAYA GRAHAM That they can take it. That they can handle it.

ANDREA WILLIAMS Right. Or that they are, you know, trying to get access to drugs.

TAYA GRAHAM Oh, they’re doing that drug-seeking behavior, that they’re all actually secretly junkies, and that they’re using it as an excuse.

ANDREA WILLIAMS Right. So it is not about care. It’s not about, you know, the health status of the woman. It is really about race and racism, and how she presents. And the factors of how that plays into her health, factors into her pregnancy and that outcome when we talk about disparities. The term that is being used now is “weathering”— the perpetual interaction with racist policy, racist behavior, of racist speech, or just the fact that you know as a black woman when you walk into certain places, that you have to have this wall and wear this mask, and that becomes stressful. So if you’re pregnant, that stress is only augmented because now you’re not only advocating for yourself, you’re advocating for your child. And what happens to you, is going to happen to your child. And if you’re mistreated, your child is going to be mistreated.

TAYA GRAHAM Oh. That’s such a good point and so sad, as well. You know, you brought up something to me while we were talking earlier that I want to give you a chance to elaborate on. There is another group of women of color that are also experiencing hardships when trying to access fair health care for them and their children, and that is immigrants and undocumented people. What is happening to Latinos and other immigrants and other undocumented people who actually need this kind of health care, who actually could benefit from a doula, or benefit from OBGYN care or prenatal care. What’s happening to them?

ANDREA WILLIAMS Well, what’s happening is that they’re not seeking care, or they’re not seeking treatment. The presence of ICE within certain pockets of Baltimore City is very troubling to myself and to those families that are involved. You know, restrictions have come up on access to insurance, who can have insurance, you know, subtle rules. Even though we don’t see the violent interactions with ICE here in Baltimore as we see in other parts of the country, we do see a systematic, kind of, policy abuse. Meaning, you can’t get medical insurance, Medicaid, if you don’t have a Social Security number. So, if you don’t have a Social Security number, then you can’t get care. If you can’t get care, you know, the only time that you can get care is in the emergency room.


ANDREA WILLIAMS So it’s like—Okay, so we are not only burdening the system that way, but we’re doing a disservice to those families who are here and safeguarding their health and the status, you know, of the family as a whole really.

TAYA GRAHAM You know, and you make an interesting point because we have heard again and again from conservatives, those in the Republican Party, of how much life matters and how much they value life. And at the same time, they’re putting women and children in this position of having to hide their pregnancy to the very last moment to try to get any sort of health care, which means they’re putting their pregnancy at risk, which means they are putting that life at risk unnecessarily.


TAYA GRAHAM Let me ask you one last quick question. Are immigrant women who come into our hospitals, undocumented women, are they safe to do so? Or should they fear being deported?

ANDREA WILLIAMS I wish I could say that they’re safe, but I really can’t because I don’t know. Sometimes it may not be the written policy of the hospital. It could be the policy of a particular nurse.

TAYA GRAHAM Exactly, exactly.

ANDREA WILLIAMS I don’t—I don’t judge the women that I come in contact with that are undocumented because I know that it’s always that one off. There are certain hospitals that I feel may be a little bit safer.

TAYA GRAHAM Okay. And you direct women towards those hospitals that you know to be safer?

ANDREA WILLIAMS Yes. Correct. And especially those who are seeking alternative solutions to their pregnancy— meaning, abortion services. You’re not going to get that kind of conversation with a health care provider at a Catholic hospital.

TAYA GRAHAM Good point. Very good point.

ANDREA WILLIAMS [laughs] You know, so there’s these whole lot of caveats and things that we have to maneuver through in this system here.

TAYA GRAHAM Okay. Well, thank you. This was a really wide-ranging discussion. And I appreciate you being so flexible with me. And I also appreciate the fact that you help bring little people into the world.

ANDREA WILLIAMS [laughs] Yes, I do.

TAYA GRAHAM So thank you so much for doing that good work.


TAYA GRAHAM We really appreciate you. We hope to have you back soon.


TAYA GRAHAM I want to thank my guest, Andrea Williams-Muhammad, for joining me. My name is Taya Graham. And I want to thank you for joining me at The Real News Network.

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Host & Producer
Taya Graham is an award-winning investigative reporter who has covered U.S. politics, local government, and the criminal justice system. She is the host of TRNN's "Police Accountability Report," and producer and co-creator of the award-winning podcast "Truth and Reconciliation" on Baltimore's NPR affiliate WYPR. She has written extensively for a variety of publications including the Afro American Newspaper, the oldest black-owned publication in the country, and was a frequent contributor to Morgan State Radio at a historic HBCU. She has also produced two documentaries, including the feature-length film "The Friendliest Town." Although her reporting focuses on the criminal justice system and government accountability, she has provided on the ground coverage of presidential primaries and elections as well as local and state campaigns. Follow her on Twitter.