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As 2023 dawns, women in the U.S. look back on the last year and see one glaring issue: 2022 was the year their right to have an abortion was severely curtailed.
But many women did not have access to abortions even before the Dobbs decision. Women on Medicaid, in the same states that are outlawing abortion now. Women who live in rural areas. Women who don’t have access to good doctors, and good advice.
One thing the popular press doesn’t seem to talk about is how many women and trans men (anyone with a uterus) want to have children, but find that the systems as they are set up in this country mitigate against them.
You read that right: women want to have children, but don’t because it is so hard to do so.
Chi Chi Okwu (00:00):
Health doesn't start when you walk into a doctor's office or a hospital. It starts with where you lay your
head at night, what resources you have access to, and the environment around you. And so if you're not
able to communicate that to your physician, to your healthcare provider, and if your healthcare provider
is not trained to ask questions about, you know, your environment, the context in which you live, you
will never get high-quality care. It's really based on trust.
Erika Washington (00:28):
That's Chi Chi Okwu. We heard from her in the last episode. She's the executive director of Ever-Thrive Illinois, which succeeded in the last couple of years in getting the state to expand Medicaid to pay for women and pregnant capable people in the 12-month postpartum period. They also got coverage for doulas and midwives, and they're working to get undocumented women covered under Medicaid. All of this is good, but it doesn't change the basic issue: Racism in the medical system.
OPENING MONTAGE:
Tony Bond (01:05):
Black women in black pregnant-capable people's bodies have historically and continued to be under
surveillance and monitored and controlled.
Loretta Ross (01:15):
I wrote a report called Women's Watch that predicted that there would be overlap between the white
supremacist movement and the anti-abortion movement
Chi Chi Okwu (01:24):
The systems that were created that we're fighting against in their current iteration will never take care
of us.
Nina Martin (01:30):
There's a lack of understanding about the continuum of women's health and maternal health in this
period.
Alicia Suarez (01:40):
And we really have to go back to colonial era and this idea of obstetrical hardiness of black women's
bodies.
Wanda Irving (01:48):
So I used to once think that the system failed Shalon, but it didn't. That's the part that I've come to
realize. It didn't fail her. It operated exactly as it was set up to operate.
END OPENING MONTAGE
Erika Washington (02:03):
This is American Dreams, reproductive Justice, and I'm your host Erika Washington. In this episode,
we're exploring medical systems in Black and Brown communities. The maternal mortality rate for
Black women is three times the rate that it is for white women. But more surprisingly, the almost
mortality rate is higher than most of us realize. But as Chi Chi Okwu points out, the likelihood that you will have a healthy pregnancy, which includes the postpartum experience, is embedded in the history of our country.
Chi Chi Okwu (02:34):
Like a lot of things in our country, it was founded on racist ideology. And so, this health care system that we exist in wasn't built for people of color. It exploited people of color really. And a lot of research was done on slaves in ways that was really harmful. We don't have to go that far back to see ways in which people were harmed in a system that was supposedly supposed to care for people. So to think that we are no longer paying the price for that is naive. And that messaging about trust and like who you can trust within the healthcare system, it gets passed down generation to generation. And so there rightly so, there is distrust between black people, people of color and the healthcare. It impacts every level of care. If you walk into a doctor's office, and you immediately feel like, oh, I shouldn't be here, or there's a power dynamic or, or maybe you're in a clinic where you get a new doctor every time you walk in the door. It's hard to build a relationship where you feel like you can actually share what's happening in your body and even beyond that in your life. And for me, you know, I identify as a black woman and I've had a lot of education, but there are times when I go into a doctor's office and they're running through the appointment and I'm like, oh, can I actually ask a question now? And they're like halfway out the door before I'm like, oh, I need to ask you something.
Alicia Suarez (04:13):
My name is Alicia Suarez. I am an associate professor of sociology at DePauw. That's D-E-P-A-U_W
university in Greencastle, Indiana. We really have to go back to colonial era and this idea of
obstetrical hardiness of black women's bodies regarding birth and pregnancy. This is still even implicitly
and occasionally explicitly taught in medical school now. Some of the textbooks still have twinges of
this, but it's still taught culturally, when people are residents doing their obstetrics residency, et
cetera, especially in major urban public hospitals. So this myth continues despite this other discourse
about black bodies as physiologically inferior and inherently diseased. You know, so it's really, it's really
contradictory. But specifically in terms of pregnancy and birth, it was like, well, they used to birth in the
fields. They can handle pain. That's a big thing. So when they are in pain, whether it be just normal pain
and they want an epidural, or when something's wrong, they're often not believed because it's like, oh,
you're a Black woman, you, you can handle this. Or just they're seen as, uh, being complainers. And that
has incredibly deleterious effects.
Erika Washington (05:32):
We need to only look at the legacy of James Marion Sims often referred to as the father of modern
gynecology. Sims developed his expertise by operating on Black women. Wait, let me say this again.
Sims experimented on Black women by operating on them without anesthesia because he thought we
couldn't feel pain, which is still a commonly held bias. This is what Tufts researcher Ndidiamaka Amutah-
Onukagha told a group of journalists in December 2022 about SIM's legacy.
Ndidiamaka Amutah-Onukagha (06:05):
It's no surprise that structural racism is still showing up today because this is how the field of research
and gynecology started through these procedures being done. This is how we know how to do a fistula
repair today. This is how we know how to use a speculum today. This is how so many other cervical and
gynecological procedures were perfected on the bodies of these black enslaved women.
Jollina Simpson (06:27):
My name is Jollina Simpson, and I am a traditional midwife and international board-certified lactation
consultant. Up until, uh, maybe even as few as six years ago, you're not going to see black and brown
bodies represented in the textbook. You're not gonna know what, what a rash looks like on a pregnant
body that's not white. Everything is going to be like the skin pinks up or make sure that the mom is not
pale as opposed to kind of gray and ashen, like, what would look like if you were black. Or if you see a
bruise, it's going to turn these colors. That's not what it looks like on black skin, right? So the education
itself isn't inclusive.
Chi Chi Okwu (07:06):
Most of our medical schools, they train around an ideal patient that is white. And I think it was a couple
maybe last year when, uh, there was a OBGYN who had a picture drawn of a black baby in the womb.
And they were saying that there no textbooks, that's not what they study in school, and l I remember this. It was like, I've never seen this before. So if you think of the history of people learning about bodies and the default body for them is a white body. You know, that has to do something to the way that you look at people who don't look like that.
Jollina Simpson (07:47):
Even through my education, my preceptors were all white, every single one of them. And so I remember
sitting in rooms with my white preceptors and them talking to a black mother going, oh, uh, your, your
nipples are just too big. Black women always have really big nipples and areolas, so you're gonna have
problems feeding your baby. And I'm just like, what? What? Right? Or the whole body mass thing, oh,
your muscles are too tight. You have too much muscle mass, you're gonna have a problem getting
that baby through that perineum. Right? So these are the kinds of things that I experienced as part of
my education, right? And then I had to push back up against that. I'm like, yeah, no, the thing about the
areola, that's not true. I mean, it's the areola, it's not the nipple. So she's gonna be just fine. And why
would that even be an issue?
Erika Washington (08:40):
In the first episode, Dr. Tony Bond mentioned that the idea of reproductive justice encompassed...
Tony Bond (08:45):
The high rates of fibroids, for example, for Black women.
Erika Washington (08:49):
And how women had to help each other and not rely on medical systems. Chi Chi talked about that too.
Chi Chi Okwu (08:55):
Would this look different if, if more white women had this, would there be more information about it?
Would I have more options? Every other day I see a commercial about erectile dysfunction out
there, so I know if we want to put our minds to something, we can figure out tghe solution. But when all ways which racism infiltrates systems, you think about which diseases are we actually trying to find solutions for? Where are we actually investing our research dollars? And more times than not, if it's really only impacting, you know, black women, women of color, people of color, you see the correlation that there isn't as much invested in those spaces.
Jollina Simpson (09:34):
These white midwifery communities still bought into the mythology of medical ideology. So more
muscle mass, more disease, uh, will always lie. Can't be trusted, non-compliant. That's my, that's one I
still hear all the time. Non-compliant. I don't understand what you said. I don't know how to do what
you are asking me to do, so I'm just gonna be quiet and not do it. Cuz I didn't understand what you said
because if I ask a question, you're gonna give me a "what this means to you
and your family is", which is just as much of a put-off. Like, I'm not, you can't even talk to me. Right? No,
thank you. No thank you.
Chi Chi Okwu (10:16):
When you add up all these things, all these factors, a history of racism in our country, I think you get
what we have now, which is a really broken relationship between patient and provider. So, really what we are proposing is that we really have to look at implicit bias. We can't act like that doesn't impact how patients are treated, the patient-doctor relationship. We need more doctors of color. We need more doctors that look like the communities that they serve. And there is research that shows that there is greater trust, you know, when you see a doctor that looks like you. And so, those things are important. But we know that's not gonna solve everything. They'll never be only doctors of color. But I think for all of us looking at what does implicit bias look like within these relationships, and then how do we begin to build awareness and then begin to combat that and then start to think about what does it, to actually think about context in which someone shows up in a doctor's office or a hospital and taking all of that into account. Those are things that are, I think, really help to build trust as well as taking the time asking questions. But there's some baseline that we really have to look at how our healthcare providers are trained, what that training looks like, and then how we begin to combat what has been set as the standard, which really excludes so many BIPOC people.
Jollina Simpson (11:45):
Because the communication level often switches to the scolding mindset too often in the medical field.
You know, I don't need that noise. I don't need that noise. You don't know that I just took four buses to
get here. You don't know that I had to pack an entire day's worth of food to get me and my baby here.
And now you are talking down being condescending cuz I'm 20 minutes late, I missed a whole day at
work to be here today. I'm not getting paid for this and I don't need to get that from you and still, you
know, be able to take in all that you're saying to me.
Chi Chi Okwu (12:19):
There's a term that it started to kind of become more popular. It's called weathering. And it's really
exciting. I, when I first heard about it, I was like, oh, I can't, someone finally put some language around
this where, you know, there, there are these macroaggressions, right, that we experience that are, you
know, big racist moments that are like, oh, okay, we, there's no question about it. But then there's these
smaller microaggressions that happen to us on a daily basis, and over time it starts to show up in your
body, you know, as stress or as other symptoms. So there, there's this term now called weathering that
really addresses all of these microaggressions, what it might do to your body, how it builds up. And I
know there's the beginning of some of this research and there's, I know that I'm hopeful that there's
gonna be more coming out because I think these are things that we really have to start talking about as
we're training physicians and training nurses.
Alicia Suarez (13:09):
There's some great research that's been out for about 10 years from a variety of different people that
show that a lifetime of daily stressors of experiencing racial discrimination has long-term effects on the
body that are actually even passed on to children. So the fight or flight instinct is ramped up all the time,
the cortisone levels, because of whether it be macro microaggressions experienced on a daily basis. So
these stress hormones are like ramping up an engine constantly. And this is one of the, you know, many
explanations, but really a pretty big one in terms of rates of preterm labor for black women, is that
because of stress hormones are already amped up all the time, even before pregnancy, that that can
really trigger preterm labor. The research suggests that a lot, even, you know, medical sociological
research, that's just a harder thing to fix. And so a lot of people like to research stuff that's like, has an
easier fix and it's like, okay, well we can just do this, you know, and, and that will help. And a lot of us
are like, actually we just need to dismantle racism in white supremacy. You know, I mean, that's the
truth. And that's, you know, as a sociologist, people are like, well, don't you have grand ideas? And I'm
like, well, kind of. I mean, that is the structure and the cultural patterns that lead to all these myths
about Black women's bodies and mistreatment in healthcare and all these different things. But that's the
larger setting.
Chi Chi Okwu (14:42):
The systems that were created that we're, we're fighting against in their current iteration will never take
care of us. So it, it's got to be about how do we dismantle this and create something new. And I
see like these conversations starting to like percolate and bubble up. And I really hope that there is
some momentum of saying, okay, what we've been doing is not working. We're in a moment, I think
where we have to reimagine what radical care in our communities and for our families looks like.
Because there are people that actively believe in freedom, but only for a small group of people. But I
think if we are actually going to experience that freedom and that ability to flourish and thrive, that we
have to create new systems of care for one another.
Erika Washington (15:33):
Chi Chi also talked about how Illinois moved forward on allowing Medicaid to cover more varieties of
care, including before, during, and after pregnancy.
Chi Chi Okwu (15:41):
We've just, in the last couple years, were successful in advocating for Medicaid to be expanded to cover
the 12 months postpartum, which is a very important period in a childbearing person's life in a family's
life. That was where we see a lot of incidents of maternal mortality and morbidity during that period.
OMINOUS MUSIC
Erika Washington (16:09):
You're listening to American Dreams, reproductive Justice. We're gonna focus now on how weathering
what you just heard. Chichi Okwu will talk about affects women after they give birth. Now, we don't put a
lot of emphasis on postpartum, but according to a report by the CDC that was put out in September of
2022, most maternal deaths happened after birth. Two-thirds as many, and most of those are at least a
week after birth. In 2017, NPR and ProPublica did a story on Shalon Irving, who was a CDC maternal
health researcher who died from postpartum hypertension, or eclampsia. This is what her mother told
ProPublica, journalist Nina Martin and NPR journalist were Renee Montagne in December of that year.
Wanda Irving (16:54):
It was a great birth, it was just, just a beautiful time. So the problem didn't come in until after the birth
and she didn't have an afterbirth plan.
Erika Washington (17:08):
We talked to Wanda Irving about what happened to her daughter and the foundation she's established
in her honor.
Wanda Irving (17:14):
My name is Wanda Irving and I am forever the mother of Dr. Shalon Irving. I currently am co-founder
and acting president of Dr. Shalon's maternal action project.
Erika Washington (17:29):
Wanda, as you might have noted from that introduction, does not talk about herself without talking
about her daughter. They were best friends in life. And Wanda is, at the age of 70, raising her five-year old granddaughter.
Wanda Irving (17:41):
Her name is Somina, and her mommy called her Sunny.
Erika Washington (17:46):
Shalon Irving only had three weeks with her daughter Sunny.
Wanda Irving (17:49):
She was so excited to be a mother and so ready. She just, she loved that baby to... so, so much. And she wanted the opportunity to raise her. And she would have been an incredible mother. Just totally
incredible. My daughter was an amazing woman. She had a dual PhD in sociology and gerontology. She
had two master's degrees. One from the premier public health school in America, in the country, in the
world, Johns Hopkins. She was a lieutenant commander in the US Public Health Service. She was a
brilliant writer, researcher, epidemiologist at the Center for Disease Control, certified health education
specialist. But none of those degrees experience, awards protected her. She died three weeks after
giving birth to her daughter, her only child, because she wasn't listened to, she wasn't valued by her
providers and she wasn't given the care that she kept coming in requesting.
Wanda Irving (19:06):
Shalon was, she was always so giving, so just so brilliant. She knew when things weren't right. She knew
how to express herself. She was very, very articulate. But yet and still the fact that she was a Black
woman kept that from coming through. It kept her doctors from seeing her, from realizing that there
was impending doom sitting right in their waiting room or right in their examination room. And they just
didn't pay any attention. She was dismissed and sent home with platitudes, like, oh, don't worry, you
just had a baby give it time. And on that last visit, she pleaded with them to do something to help her.
She presented with swollen limbs. She wasn't voiding. She had gained nine pounds in seven days and
she wasn't feeling right, but yet and still what they did was tell her, don't worry, give it time. She
collapsed five hours after coming back that last time, cuz her blood pressure was through the roof and it
was high - stroke high - when she was in the doctor's office. The nurse practitioner was there, took it twice because she thought there was something wrong with the machine. But yet, and still they sent her
home.
Erika Washington (20:40):
Wanda Irving ended up suing the doctor so that Solei would be taken care of. She didn't care about the
money. She wanted her daughter back, and she wanted the doctors to be held accountable. That didn't
happen.
Wanda Irving (20:53):
After my daughter died. I was in the doctor's office the next day and he refused to see me and the
nurses, no one would come out and see me. They just wouldn't face me. There were no people of color
in that office. So I used to once think that the system failed Shalon, but it didn't. That's the part that I've
come to realize. It didn't fail her. It operated exactly as it was set up to operate. And she was just one
more victim of a system that does not value women and especially does not value Black women.
Erika Washington (21:41):
Nina Martin, who was the women's health reporter at ProPublica at the time, says she came to Shalon
Irving's story, and the realization that the system doesn't value women, through data.
Nina Martin (21:53):
There was data on maternal deaths that was collected by the CDC and honestly, there weren't that
many of them. Every year it appeared, you know, maybe 700, 800, 900. The numbers weren't great, but
they weren't... I mean, those were the number of people who get, you know, shot in Chicago in three
months or something like that. Or the number of people who die from smoking-related causes in a day
in the US or something like that. So if you think about all the public health issues and numbers, you
know, terrible numbers. I mean, covid, right? 700 to 900 women dying a year just as a number all by
itself didn't seem like that many. But what really got my attention was another number that nobody was
really talking about at that point, and that was the number of women who nearly die. At the time the
CDC was saying that the number of women who nearly die from pregnancy-related causes every year
was over 60,000. So these are women who have terrible infections. These are women who have blood
clots that progress to the point of near catastrophe. These are women who have eclampsia or renal
failure or hemorrhaging bad enough to warrant infusions of blood. And that's a lot of people.
Erika Washington (23:11):
According to the CDC, roughly 60% of women die after they give birth, and 30% of women die more
than two months and up to a year after they give birth. And the numbers have risen steeply in the last few decades. In 1987, 7 women per 100,000 died of maternal complications. We are now at 17 deaths per 100,000. Over 80% of them are preventable. Of course, a hundred years ago, more than 600 women per 100,000 died in childbirth each year. But that was right at the beginning of modern medicine. For
Nina, it was a family experience she had, and oddly what her editors had that led her to be interested in
maternal mortality.
Nina Martin (23:56):
My sister had given birth in 20, in 2000 actually. In Texas, and she had nearly died. She
had, she developed two postpartum infections, one in the hospital, one after she went home. And I, I
remember kind of going and trying to talk to doctors and everybody sort of said, well, this is the only
time this has ever happened. We have no idea what's going on. She's fine. She'll get, you know, it, it was
just this thing. It was if this had never happened. And my sister was the only person that this had ever
happened to, and was the only time these doctors - she's lived in Austin - that you know, that they'd
ever encountered anything like this. And then luckily they found the right combination of antibiotics and
she got better. And suddenly it was like a switch had turned and suddenly it went from being, we don't
know what happened to her to, well, we don't know what happened to her and it doesn't matter
because she's fine and her baby's fine, and you should just enjoy your baby and be thankful.
Nina Martin (24:54):
And my sister, who had been through this horrible trauma, just felt so silenced and so ignored and so
suppressed. This thing that had happened to her, that was a huge trauma for her and for her whole
family. What I've since learned about maternal complications is that they're rare enough so that unless
you are a very particular kind of practitioner, you may not see this happen very often in your life.
The really important thing though is that our system is so, um, fragmented. Our healthcare system is so
fragmented and our maternal care system is so fragmented that the doctors who take care of a woman
while she's pregnant are very often not the doctors who deliver her. And then if she develops a
complication, she doesn't go back to the doctors who delivered her. She's in a whole new setting. So
there's a lack of understanding about the continuum of women's health and maternal health in this
period.
Erika Washington (26:12):
Not only was Nina a sister treated in a fragmented system, she wasn't counted by the CDC in those
60,000 per year near death because she had already left the hospital and developed her infection at
home.
Nina Martin (26:24):
That showed me that my sister was not a fluke. My sister was a trend, and I really wanted to understand
that trend.
Erika Washington (26:31):
When Nina went to the researchers to find out how many people almost died after they went home, the
researchers didn't have those numbers.
Nina Martin (26:38):
What was really interesting about what the experts were telling me at that point was that they had
these raw numbers and that's pretty much all they had. They would analyze their numbers and then
they would figure out how many of those women were Black and how many of them had had prior C-sections and how many of them are obese or something. And so you would come up with this, like these
theories about all of this and, and because if you only know things like how old somebody is and how
many c-sections they've had and what their body mass index is and what their race is, then you make
assumptions that are all about, well, those must be the things that this is all about because that's what
you know, right? As a researcher. And they didn't ever talk to women. They didn't talk to women
because they were researchers who don't talk to people they talk to data or because they were under really strict institutional review board protocols and so forth. It really kind of restricted how
they're allowed to do research. And so, so you had these people and they actually never talked to
women. And so I thought, well, I'm gonna talk to women. And so that's what we started to do.
Wanda Irving (27:51):
Shalon was a fierce, a fierce equity champion. She had a motto, um, I see inequity wherever it exists.
I'm not afraid to call it by name and I work hard to eliminate it. I vow to create a better earth. She
lived that motto, both personally and professionally. She worked her entire professional life trying to
bring health equity and health equality to Black women and to underserved communities. So to have her
die by the same inequities that she fought so hard to eliminate, it just has a particular kind of sad irony
to it.
Nina Martin (28:42):
And the big thing is that when it comes to maternal health and maternal complications and the, the
systemic problems that we're talking about, it's about gender. Primarily. It's about women being treated
as if they are less than - less than men, less than doctors and nurses, less than babies. Women of color,
and particularlyBlack women and Indigenous women, it's so much worse for so many reasons that
you've already heard about. But it's true that for all women, this is a baseline experience. And that
helped us really think about how to do our reporting and to sort of have the first parts of our reporting
try to focus on the gender issues, and the way that women were not valued, were valued less than their,
their babies and their fetuses. Not just by evil lawmakers trying to push abortion bans in the South, but
by their own doctors and their own federal government that didn't pay for Medicaid for new moms after
two months, but funded the care for babies for a year to five years. It was, you know, by researchers
who put all of their attention on trying to save babies and almost no attention on the kinds of
complications and the kinds of, uh, healthcare system reasons that those complications very frequently
turned deadly or nearly deadly. And so for me, that was the place to start, was that this is a gender issue and then on top of it, in that intersectional way that's really real, there's also really profound disparities around race and class. But it, it's, for me, really, it starts as a, as a gender issue.
Erika Washington (31:00):
We're going to explore how women's bodies are not just ignored, but criminalized from slavery to our
current climate, in the next episode of American Dreams Reproductive Justice.
The voices you heard on today's program are Chi Chi Okwu from EverThrive, Illinois, Las Vegas midwife, Jollina Simpson, historian Alicia Suarez, Dr. Tony Bond, who was one of the founders of the reproductive justice movement, journalist Nina Martin and Wanda Irving, who lost her daughter Shalon to a postpartum infection that was preventable.
Erika Washington (31:41):
American Dreams: Reproductive Justice is produced by Carrie Kaufman with Overthinking Media, LLC
and Erika Washington, powered by the donations to Make It Work Nevada. Music by Wil Black for Black
Gypsy Music. Artwork by Brent Holmes. I'm your host and Make It Work Nevada executive director Erika
Washington.
We also want to pay homage to the 12 women who were in the room in 1994. Dr. Tony
Bond, Reverend Alma Crawford, the late Evelyn s Field, Terry James Bela, me Nay, Cassandra McConnell, Cynthia Newble, Loretta Ross, Elizabeth Terry, representative Abel Mabel, Thomas Wynette p Willis, and Kim Youngblood.
We also want to note that Loretta Ross is one of the 2022 recipients of the MacArthur Foundation Genius Award for shaping a visionary paradigm linking social justice, human rights, and
reproductive justice.
This is American Dreams, reproductive Justice.