When Marna Armstead discovered she was pregnant, she accepted three truths: her baby was unplanned, she would be a single parent, and she was immensely excited to be a mom. Yet, when Armstead went to see her obstetrician, she was shocked to be advised to have an abortion, despite her insistence that she intended to keep her baby.
“It was just pretty devastating because I trusted that provider,” says Armstead, co-founder and Executive Director of SisterWeb, a San Francisco-based doula network providing a wide range of maternal support for individuals before and after birth. “And at a time when I was most vulnerable—when I was pregnant—and had gone to them for years, they told me something absolutely against what I told them that I planned to do.” The doctor’s preconceptions floored her. “I was not treated fairly. They didn’t look at my insurance, didn’t look at anything about who I was, and just saw a Black woman who was pregnant and made assumptions.”
SisterWeb is one of several nonprofits and community-based organizations, mainly in California, that partner with Heluna Health, providing critical maternal health services for Black women and other vulnerable people. Other partners include Happy Mama Healthy Baby Alliance, Expecting Justice, and CinnaMoms. Heluna Health and its partners recognize inequity as a systemic problem in healthcare, and pregnant women of color routinely face inadequate prenatal and postnatal care, often leading to dire consequences.
Heluna Health is focused on building a solid network of maternal health providers and promoting synergy and collaborations among these organizations, which are on the front lines of addressing Black maternal health disparities. This is critically important in California, where more than 50% of all births are covered by Medi-Cal, the health care program for children and adults with limited income and resources. Next year, Medi-Cal will begin to cover doula services, increasing the demand.
Racial inequities in maternal care are a significant reason Black women in the U.S. are four times more likely to die from pregnancy or birth-related incidents and are at twice the risk of preterm births than white women. Black mothers’ physical and life-threatening risks are compounded when trust in the medical provider does not exist. Black mothers frequently report experiences of being disregarded, condescended to, made to feel incompetent, and judged by medical professionals during and after pregnancy and birth.
Many hospitals and healthcare professionals are providing implicit bias training for their staff that raises awareness of unconscious biases and recommends steps that can be taken to prevent these attitudes from affecting medical care. However, many experts don’t believe diversity or cultural competency training works. Dr. Zea Malawa, Director of Expecting Justice, a Black-led collaborative and partner program of Heluna Health that mobilizes leaders across San Francisco to intervene and advocate for healthy Black, Latinx, and Pacific Islander births, says that despite a rise in implicit bias training, Black women continue to be at increased risk of devastating health impacts when pregnant.
“When we think about what we need to do differently to improve Black maternal health, we think about how we can make Black women more educated or more resilient,” says Dr. Malawa. “The reality is that racism is at the root of these birth disparities, and what Black women really need is alleviation from racism. We need to address the different components of racism so that birthing people can have an easier, more satisfying, more healthy experience while they’re pregnant and giving birth.”
Some women, like Marna Armstead, had to experience and navigate Black maternal health disparities hands-on, feel the devastating impacts, and ultimately persevere to make Black motherhood easier for others. Armstead thought, in the middle of birthing her daughter, “I want to help someone else get through this. Because throughout all the craziness that happened, I found joy in my experience, and I wanted other people to have a positive birth experience, too.”
After birthing her daughter, Marna made it her mission to help other Black mothers. She trained to become a doula, a childbirth professional who provides emotional, physical, and educational support during pregnancy and postpartum experience, where she gained the knowledge and connections necessary to organize like-minded peers. Her first-hand experience led her to create SisterWeb, the only nonprofit in San Francisco to offer a community model of doula care—in which clients are matched with doulas from their community and ethnic background. Armstead is helping ensure that clients receive fair and equitable medical care and feel informed and empowered during their birth journeys.
Cordelia Hanna, the founder, Chief Executive Officer, and Executive Director of Happy Mama Healthy Baby Alliance (HMHBA), the first community-based doula program in Los Angeles offering free doula services to low-income families since 2010 with volunteer doulas, says that providing maternal care for Black women and other women of color requires a multi-faceted approach. “What we do is so much more than prenatal care,” says Hanna, whose organization offers doula services and trains doulas from the same communities and backgrounds as the women they serve. “There are unique stressors that Black women experience compounded by the mistreatment and disrespect they receive in maternity care. It could be the neighborhood they live in, their exposure to violence, or their fears that their son will be stopped by police. This could lead to pre-term labor and can even be lethal.”
“Our prenatal care incorporates yoga classes, mindfulness, relationship coaching, and more,” says Hanna. She established the first doula program serving African American and Hispanic families at the Pasadena Public Health Department Black Infant Health Program, which she established in 2002 and managed until her retirement in 2012. HMHBA’s doula support extends until eight weeks after birth when mothers can be susceptible to depression. “We give women confidence in themselves, help them trust their bodies, and trust the process of birth. That’s 90 percent of it.”
Black women have long created their own advocacy groups and safe spaces to support Black mothers due to insufficient care from traditional healthcare settings. CinnaMoms, a direct service program of Heluna Health offered in partnership with Heluna Health’s Women, Infants, and Children program sites in Los Angeles, is a peer support group whose vision is to increase breastfeeding rates among Black women who participate in WIC. Black mothers face disproportionate barriers to breastfeeding and are statistically the least likely to breastfeed their babies than any other race. Given the tremendous health benefits for both mother and child, breastfeeding support is significant for improving health outcomes for Black mothers and their children.
Breastfeeding is a vital part of the spectrum of advancing Black maternal health, according to Toncé Jackson, the founder of CinnaMoms. To leverage CinnaMom’s work, she says that her organization collaborates with healthcare providers, other maternal health nonprofits, and community-based organizations. “The movement of maternal health is so big,” she says. “We’ve been partnering with doulas, and we look forward to continuing to expand CinnaMoms to advance maternal health equity.”
Armstead is adamant that the solutions necessary to resolve health disparities already exist in Black communities. “There are solutions out there, and we need to be able to practice them openly, without restraint and constraint, and without being ostracized or criticized for what we need to do. So listen to us.”