Читать книгу The Movement for Reproductive Justice - Patricia Zavella - Страница 21

Initiated in 2013 and launched publicly in 2016, the Black Mamas Matter Alliance is a Black-women-led cross-sectoral collaboration formed to address the growing rates of Black women’s maternal mortality and morbidity. This collaboration aims to stop the increasing numbers of Black women who are dying at a rate significantly higher than white women and other women because of pregnancy-related complications (see plate 9).⁹⁴ In New York City, Black women are twelve times more likely than white women to die because of pregnancy-related causes.⁹⁵ More worrisome, severe Black maternal morbidity affects approximately sixty thousand women per year in the United States, and that number has been increasing steadily.⁹⁶ These disproportionate rates of Black maternal mortality and morbidity occur across all educational levels and persist even after controlling for differences in socioeconomic status.⁹⁷

The causes of maternal death in the United States are related to the social determinants of health, especially racial discrimination and poor treatment.⁹⁸ Where Black women live and receive health care significantly shapes their health outcomes and access to health care. Most Black women’s deliveries (74 percent) occur in hospitals that are considered high and medium Black serving, many of which are located in the South. Black-serving hospitals provide lower quality of care and have higher severe maternal morbidity rates; these hospitals are also located in states that refused to expand Medicaid after passage of the ACA. In addition, the causes of Black women’s mortality are complex and related to higher maternal age, obesity, rising caesarean delivery rates, and the increased number of pregnant women with preexisting chronic medical conditions. Black women have high rates of unintended pregnancy, more than twice the rate for white women—an indication of lack of access to contraception—and Black women have low rates of health insurance that would enable them to access health care.⁹⁹ Thus, any of women’s preexisting conditions are exacerbated by the lack of access to quality health care.¹⁰⁰ Marsha Jones, executive director of the Afiya Center, summarized the “horrible conditions” of people living in poverty, also including a limited number of physicians who take Medicaid patients, higher unemployment rates, wage differentials, and segregated communities: “We see food deserts; these women are still eating from the corner stores. There is no store where you can get the best food possible. Are they really having those nutrition meetings? Is there any real full follow-through to make sure women have access to quality food care? And living in places where you have to travel on the bus for hours just to make your doctor’s appointment.… We have legislators saying we are not going to expand Medicaid. Sixty days after the baby is born, they lose it [Medicaid].” In a live Facebook presentation that I happened to catch, Deneen Robinson, office manager of the Afiya Center, pointed out that all of these conditions are exacerbated by chronic stress that Black women face. “The stress of walking into a space where we’re the only one. And then I decided I want to take on the stressful task of having a baby. The time of labor is its own stress.”¹⁰¹ Marsha Jones affirmed, “Every time you walk in the room, you expect to be on. And all the time you can’t be on.… There’s a lot of stress attached to being a Black woman.”¹⁰² The human rights scholar-activist Alicia Ely Yamin expresses the outrage that many of us feel about health disparities that produce maternal mortality: “it is primarily a social problem and a problem of political will at both the national and international levels … because [women] are discriminated against and excluded in their homes and communities and by health-care systems that do not prioritize their needs.”¹⁰³ Clearly addressing these contributors to Black maternal mortality and morbidity requires a multifaceted approach.

According to the Black Mamas Matter Alliance, “We envision a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy.”¹⁰⁴ BMMA is led by Black researchers, doctors, midwives, doulas, and advocates, and its aims are fourfold: “1) Change policy: introduce and advance policy grounded in the human rights framework that address Black maternal health inequity and improve maternal health outcomes; 2) Cultivate research: leverage the talent and knowledge that exists in Black communities and cultivate innovative research methods to inform the policy agenda to improve Black maternal health; 3) Advance care for Black mamas: explore, introduce, and enhance holistic and comprehensive approaches to Black mamas’ care; 4) Shift culture: redirect and reframe the conversation on Black maternal health and amplify the voices of Black mamas.”¹⁰⁵ BMMA is staffed by SisterSong in Atlanta.

The BMMA initiative includes policy recommendations at the state level, acknowledging the ways in which different states have particular structural inequalities, racial groups, and political will.¹⁰⁶ BMMA’s state policy framework provides a rationale for the focus on states: “When it comes to maternal health, states are strategically positioned to leverage regional knowledge about community needs and obstacles, build stakeholder networks, and implement targeted solutions. State leaders and lawmakers can take proactive measures to ensure that their states have effective health care systems to treat sickness and prevent disease and injury. They also have the power to design and implement other kinds of systems that create and promote health.”¹⁰⁷ The standard of health that BMMA strives for is defined by the World Health Organization as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”¹⁰⁸ Different organizations are working on grassroots organizing in support of these policy changes and culture shifts. The Afiya Center, for example, based in Dallas, has been organizing Black women about their risk for maternal mortality, infant mortality, and HIV since its founding in 2010. Executive director Marsha Jones points out that Texas has the highest rate of Black infant mortality.¹⁰⁹ Like other partner organizations, the Afiya Center has organized workshops and used social media to educate Black women about their health risks, has issued a report, and is networking with other organizations.

While clearly this initiative includes policy work and grassroots organizing, it also highlights culture shift work. In a webinar, “Reproductive Justice and Black Women’s Maternal Health,” which launched BMMA to the public, SisterSong executive director Monica Simpson explained the organization’s views on Black motherhood: “We wanted to make sure we include all working parents. ‘Mama’ is borrowed from Forward Together and includes cis women, gender-nonconforming and trans people—all that parent, that birth, that serve that role of mamahood.”¹¹⁰ Thus, this alliance’s work echoes the culture shift work of the Strong Families Network, which is inclusive of gender-nonconforming people. Further, Simpson pointed out, “It’s a strategy to actually shift perception, how people see and think, and in connection to those things that are heavier to talk about.… We need to really connect on a personal level and help people see issues from different perspectives. We can use strategies like art activism, like storytelling, to understanding the nuance. We are using it with a very broad scope.” Then she quipped, “I could do culture shift work all day long!”

In 2018 Black Women for Wellness sponsored Black Maternal Health Week, in which the organization screened the documentary film Death by Delivery and sponsored presentations and discussions in Los Angeles. The film includes footage of Monica Simpson, who calls the struggle for Black women’s maternal health the “modern-day civil rights cause.”¹¹¹ There is powerful footage of interviews with Black women who experienced childbirth as traumatizing. Katrina Anderson, formerly a human rights lawyer at the Center for Reproductive Rights, observes, “If the numbers were reversed and white women were dying at the rate that Black women are dying, there would be political will to address this problem. The US is the only country with an advanced economy where the maternal mortality rate has risen in the past decade. So we see this as not a problem of lack of resources but where resources are spent.”¹¹² BMMA’s work is gaining visibility as news outlets pick up the story.¹¹³

SisterSong is taking culture shift work a step forward. In 2017, it issued a call for artists to submit an image for its big conference, “Let’s Talk about Sex,” and started the Artists United for Reproductive Justice (AURJ) program: “Through AURJ, we are working to push communities beyond just telling stories and toward recalibrating reality through artistic mediums that allow for reclamation of space, representation, visuals, narrative, history, and community that is uncensored and fearless. We are also working to cultivate artistic leadership and strategy that can connect uncommon, idealistic, or even radical ideas with everyday life.”¹¹⁴ As BMMA moves toward implementing policy, conducting research, and engaging the other goals, clearly culture shift work is integral to this collaboration.