Combating Maternal Mortality in the Black Community

After experiencing hemorrhaging and nearly miscarrying during her first two pregnancies, Jessica Davenport-Williams could only imagine the barriers faced by pregnant people who are poor and uninsured.

“On paper, I checked off all the boxes that society tells you to: private insurance, high household income, highly educated, etc. And still, I was a near miss,” said Davenport-Williams, who is Black.

In Cook County, Black women face the largest disparities in maternal mortality in the country. According to the Centers for Disease Control and Prevention (CDC), pregnancy-related deaths are 2.6 times higher among Black women than white women.

Experiences during maternity also vary by race. According to the CDC, 40 percent of Black women report mistreatment such as being threatened with withholding treatment and not having their concerns taken seriously by healthcare providers. In its position paper on reducing Black maternal mortality the CDC calls on healthcare providers to “recognize and work to eliminate unconscious bias in themselves and in their office on an ongoing basis.”

“The U.S. is the only global north country that has had escalating rates of maternal mortality for three decades, and it’s Black women. It’s across all economics,” said Jennifer Dohrn, a midwife and professor of nursing at Columbia University in New York City. “You could be Tori Bowie or you could be Serena Williams. There’s more to it than just money. It’s so embedded in the structures of how this system works, and it’s unacceptable.”

In 2016, Davenport-Williams, Jazzy Davenport-Russ and Khadija Warfield decided to address the problem by creating Black Girls Break Bread. The nonprofit was created with the “goal of empowering, uplifting and inspiring Black women and girls through the creation of safe spaces for intergenerational discourse and engagement,” as stated on their website. 

Part of that work focuses on maternal health. They set their sights on working with public health systems at the local, state, and federal levels to develop solutions to address racial disparities. Since then, they’ve not only worked with existing healthcare operations, but also opened a maternal health center in a place that desperately needed one. In 2021, they co-led the development of The Family Christian Health Center in Harvey, IL.

Black Girls Break Bread also successfully advocated for the passage of Illinois House Bill 5013, a 2022 law that ensures pregnant patients have the freedom to choose any qualified provider for pregnancy-related care, regardless of whether the provider has an active contract with their specific Medicaid health plan.

This is especially important for pregnant people who don’t live near an in-network provider. “[Limited transportation] has created these huge travel times for patients to be able to receive medical services,” Davenport-Williams said. “So being able to help to enact a house bill to pass that allows for perinatal health services to be covered, regardless of the insurance type for Medicaid members, was something we were extremely proud of.” 

In addition to working with policymakers, Black Girls Break Bread helps connect Black women and girls, creating a supportive community.

“We want to be able to create safe spaces for Black women because we had experience navigating through the segregation that exists in Chicago,” Davenport-Williams said. “There was a need to be able to come together and take off the many hats that we wear as Black women, leave it at the door and be able to sit, commune and break bread with other women across the city.”

Maternal health is just one of the pillars of Black Girls Break Bread. The organization also serves other community needs, like mutual aid. At the start of the pandemic, when communities on the South and West sides disproportionately suffered from a lack of resources, Black Girls Break Bread distributed food and clothing for more than 2,000 people. And it engages the community in supporting Black women and girls, such as by donating items like diapers, wipes, formula and menstrual products.

Black Girls Break Bread also addresses the mental health issues among Black women, who have higher rates of chronic stress, anxiety, postpartum depression and post-traumatic stress disorder when compared with other women. Since 2020, Black Girls Break Bread has sponsored over 500 free therapy sessions by partnering with Black mental health professionals.

“At the heart of maternal and mental health, there’s a lot of overlap,” Davenport-Williams said. “Raising more awareness around mental health, to be able to delineate the nuances specific to that demographic, has been very important.”

Maternal death rates are increasing in the United States, surpassing those of other high-income countries. Deaths caused by medical complications are largely preventable with proper prenatal care. According to the CDC, more than 80 percent of pregnancy-related deaths in the U.S. are preventable.

This is especially true for those with preexisting conditions. “The best time to manage a preexisting condition is before pregnancy,” said Jacqueline Hairston, an assistant professor specializing in maternal-fetal medicine at Northwestern Medicine.

For Black women, the most frequent underlying medical issues leading to death during pregnancy and delivery are cardiac and coronary conditions. According to research published in the Journal of the American Heart Association, Black women of childbearing age are twice as likely to have uncontrolled high blood pressure, increasing the risk of heart-related complications during pregnancy like preeclampsia. This condition can affect kidney and liver function and lead to birth anomalies.

Prenatal care can make all the difference in maternal outcomes. “We often encourage patients to do a preconception consultation where they meet with a physician to talk about where we would like their numbers to be before pregnancy to make sure their medications aren’t contraindicated or harmful to pregnancy,” Hairston said.

But research gathered by Pubic Health Reviews in 2022 found that Black women are less likely than women of other races to receive prenatal care, particularly in the first trimester.

“Prenatal care is evidence-based,” said Pamela Pearson, the director of nurse midwifery at the University of Illinois at Chicago and a researcher at Melanted Group Midwifery Care, which is investigating whether wraparound care from a team of Black midwives, nurses, and doulas can improve pregnancy outcomes for Black women. “There are warning signs we need to recognize to get them the care they need.”

But on the South Side, Black women face additional obstacles when it comes time for delivery. There are few birthing centers on the South Side. Numerous hospitals have either suspended or closed their labor and delivery units. Between 2019 and 2020, maternal care offerings on the South Side dropped from 7 to 3, including Jackson Park Hospital and Medical Center, St. Bernard Hospital, and Insight Hospital and Medical Center. This disinvestment in healthcare has caused the area to become known as a “birthing desert.” 

Black Girls Break Bread is one of a number of efforts underway to improve outcomes for pregnant Black women. The nonprofit Chicago South Side Birth Center will be one oasis in this desert when it opens, but it is still in the process of fundraising. 

Earlier this year, at the future site of the Chicago South Side Birth Center, Governor J.B. Pritzker proposed $23 million in funding to support community-based care in Illinois’s Fiscal Year 2025 budget. Pritzker has also announced a number of initiatives to aid the issue of birthing inequity. These include Birth Equity Resource Building Grants, a Child Tax Credit, a $5 million increase to the DHS Home Visiting Program, a new DHS diaper distribution program, and a $1 million increase to the Illinois Reproductive Health Facilities Grant.

On Monday, Governor Pritzker signed a law that expands insurance coverage during and after pregnancy to lower infant and maternal mortality rates among Black women in Illinois. This law will ensure that insurers provide state-regulated health care plans to cover pregnancy and postpartum services for covered individuals for up to twelve months after the end of a pregnancy. The Department of Healthcare and Family Services expects it will take several months before all eligible programs such as midwife services, doula visits and lactation consultants are fully included in the expansion.

In the meantime, Black Girls Break Bread and other organizations are encouraging existing healthcare providers to pay more attention to the needs and the voices of Black women. According to a survey of research published in the Journal of Midwifery Women’s Health, pregnant women need “culturally congruent” prenatal care, meaning healthcare providers who are of the same culture or understand their culture.

“In my experiences working as a midwife, in Englewood and South Shore, patients would gravitate towards me because they felt that connection,” Pearson said. “I looked like them and I was gonna really support them. You have to let them know that you care, even if you don’t have all the answers. If they really believe that you’re trying and you care, then that translates a long way.”

Seven years in, Black Girls Break Bread has a raft of achievements but still struggles to convince some healthcare providers that racism and unconscious bias exist and need to be remedied. “That’s a constant struggle,” Davenport-Williams said. “It becomes exhausting having to constantly explain the disparities and how systemic this is. In my belief, it shouldn’t take this much to be able to just eliminate a lot of the disparities that we face.”

Kayla Lane is a 2024 graduate from Columbia College Chicago with a B.A in Journalism, and has a passion for writing about culture and social justice.