Black babies in the Bay Area are born either too soon or too small, or they die before their first birthday, according to Bay Area public health experts.
But five Northern California counties, a region where the second-highest population of Blacks live in the state, are working to reverse those trends.
Alameda, Contra Costa, San Francisco, Santa Clara and Solano counties have launched the #DeliverBirthJustice campaign to tackle the underlying racism that they say leads to the disproportionate death rates of Black women and infants as compared to other racial groups.
The campaign is an offshoot of the Perinatal Equity Initiative, a statewide effort to curb persistent iniquity and health disparities that threaten Black infant and maternal health, according to the California Department of Public Health.
“We need a Bay Area-wide movement that mobilizes all corners of the Bay Area — from health professionals to policy makers to community members — to end racism and birth justice for Black families. Similar to all the counties, we wanted to approach this issue from a regional lens,” said Mikaela Merchant, Perinatal Equity Initiative coordinator at the San Francisco Department of Public Health (SFDPH).
Merchant says the systems impacting Black moms and families are regionwide, therefore the approach to finding solutions to them must have the same scope. An understanding that Bay Area moms may live in one county but work and get their health care in another county stemmed from five focus groups with 33 directly impacted Black mothers across five Bay Area counties.
A regional approach reflects the lived experiences and needs of the moms and families they serve, said Merchant.
According to Dr. Zea Malawa, SFDPH’s Perinatal Equity Medical director and physician director of Expecting Justice, racialized stress is taking an undue toll on Black births.
Advocates argue that health equity is about more than just access to health care. They say it begins when people have access to everything they need — from health and childcare to economic security and housing.
“ Every single time we dismantle structural racism, we’re saving a Black mother’s life and we are saving a Black baby’s life. Our lives matter, so this work is something that we all need to take on right away,” said Malawa.
Black mothers fare worse on maternal/childbirth measures, with higher rates of low-risk, first-birth cesareans, pre-term births, low-birthweight births, infant mortality, and maternal mortality, according to “Health Disparities by Race and Ethnicity: The California Landscape,” a 2019 California Health Care Foundation (CHCF) report.
People of color face barriers to accessing health care, often receive suboptimal treatment, and are most likely to experience poor outcomes in the health care system, according to data included in the CHCF report. This is regardless of income and education levels, health habits or where they live, according to Merchant. She attributes it to structural and social racism Black people experience throughout their lives, and the biases they encounter from health professionals during their birthing experience.
In the California Legislature, Sen. Nancy Skinner’s (D-Berkeley) introduced Senate Bill (SB) 65, or the California Momnibus Act. If passed, the legislation will provide essential funding to help improve Black maternal infant health outcomes.
SB 65 includes Medi-Cal coverage for doulas, extending Medi-Cal postpartum coverage to 12 months, and a guaranteed minimum income pilot for families with low incomes, Merchant said.
Health professionals, policy makers, advocates and community members from each of the counties are working on different interventions specific to their challenges and needs.
For example, advocates in San Francisco have identified two strategies that they say are necessary and relevant. One is training staff and service providers around biases. The second is working to provide culturally relevant doula services to their communities.
Their work is centered on a partnership between Sisterweb Community Doula Network and county public health nurses. SisterWeb community-based doulas use a unique, innovative program model that provides extended, intensive support to families throughout pregnancy, during labor and birth, and in the early months of parenting in communities that face high risks of negative birth and infant developmental outcomes, according to Merchant.
“The serious challenges that Black moms are facing in regard to health and their community is because of racism,” said Sharayah Alexander, a Black mother in Alameda County, whose experiences helped shape the campaign.
“When we start listening to Black mothers, that’s when we’re going to start seeing health issues decline,” she said. “When people start listening to us, that’s when we’re going to start seeing more beautiful births and more Black mothers and babies actually surviving,” she added.
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