By Wesley Brown – Heightened by rising health inequities during the COVID-19 pandemic, the U.S. Centers for Disease and Control (CDC) earlier this year sounded the alarm to bring awareness to Black maternal health and childbearing.

During Black Maternal Health Week on April 11-17, the CDC issued a public memo noting that 700 people died during pregnancy or in the year after. Another 50,000 people each year have unexpected labor and delivery outcomes with serious short- or long-term health consequences.

And although every pregnancy-related death is tragic, CDC officials noted that most are preventable, especially among Black non-Hispanic women. Recognizing urgent maternal warning signs and providing timely treatment and quality care can prevent many pregnancy-related deaths.

“Black women are three times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias,” the CDC said in a statement. “Social determinants of health prevent many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.”

At the grassroots level in Arkansas, several Black maternity health advocates are working with the Arkansas Department of Health’s (ADH) Office of Health Equity to reduce the maternal/infant mortality rates in Arkansas. According to the CDC, Arkansas has the third-highest maternal mortality rate in the nation. Among the 50 states, Arkansas has 35 maternal deaths per 100,000 live births, compared with the national average of 20 deaths per 100,000 live births.

Arkansas Birth Angels

Sarita Hendrix, a former AHD breastfeeding peer counselor with the Arkansas WIC (Women, Infant and Children’s) program more nearly a decade, said she left the state agency in 2021 to directly work in the community to educate Black women and families about maternal care.

In her new role, in late 2017, Hendrix became one of the state’s few certified Black doulas, supporting both hospital and home birth in conjunction with licensed medical providers. The former ADH childcare veteran has also been a certified lactation counselor since 2015 and is now part of a statewide apprentice program to become certified midwives.

“Myself and one of my colleagues are aiming to be the first Black licensed midwives in the state of Arkansas,” said Hendrix.

The former ADH worker said she got in to “birth work” after relocating to Arkansas from her native California. She said her experiences in breastfeeding and maternal care were vastly different than those on the West Coast.

“I was not used to things being so weird,” said Hendrix. “And when I say weird, breastfeeding and natural childbirth were unheard of in Arkansas, except with older Black women in our community. “There were plenty of great stories around Black women and midwives, but it kind of stopped around our parent’s age in the last generation.”

As an ADH counselor over the past decade, Hendrix said she learned of the health disparities facing Black women at childbirth that has become a national issue. For example, she said many of the factors that contribute to these disparities range from variations in quality healthcare, underlying chronic conditions, and poverty and financial issues to structural racism and implicit bias.

“So, I asked: ‘What I can do to help this?’ That was not my experience with my baby, and was not my sisters’s experiences with their children,” said Hendrix, who has three children with her husband, Xavier. There are Sierra, 16, Xavier Jr., 10, and Ava, age seven.

Today, Hendrix is invested in educating Black women about maternal health issues through the Ujima Maternal Network, a local 501©3 nonprofit she co-founded as a vehicle for “solely improving the maternal and infant mortality rate in Arkansas.”

“We help the families in the community obtain doula and lactation services, connect to healthcare providers – things of that nature so that they can get the support and specifically-focused care they need in order to have a safe pregnancy and birth – whether that be at the hospital or home,” said Hendrix.

She added that most of the women that come through Ujima are women of color, and most of those are Black expectant mothers. As part of its services, Hendrix said Ujima educates women about the child-bearing experience and provides ongoing support services and referrals to Black healthcare providers.

“We get them hooked up with (health) providers that are Black, and those that look like them. That’s because research shows that we fair better with providers that look like us,” she said.

Maternity deserts

Other services provide by Ujima include and training for those women interested in becoming doulas, certified lactation specialists, and scholarship programs for “community birth workers” to take information back to their local communities, especially across rural Arkansas.

“There are ‘maternity deserts’ in Arkansas, especially in the Delta,” said Hendrix. “We have quite a few women reach out to Ujima from those areas to get one year of training so they can be doulas in their communities where there are holes and gaps in (maternal) care.”

Zenobia Harris, founding director of the Arkansas Birthing Project, agrees. She said the issue of maternal care for Black women is one of the most critical healthcare issues in the state. A pediatric nurse practitioner for AHD for nearly 35 years, Harris is now a part of the national Birthing Project USA that lays claim to being the “underground railroad for new life.

“My challenge and my role in life at this point is to bring awareness to child-birth and infant mortality in the African American community and to do whatever I can to promote improvement for women of color,” said Harris, who retired from the state Health Department six years ago.

Founded in Sacramento, Calif., by Arkansas native Kathryn Hall-Trujillo, the Birthing Project promotes a culture of women’s wellness for communities of color in the U.S. and globally by providing training, technical assistance, and capacity building to local community leaders to replicate the organization’s  “sister friending” model.

After hearing Hall-Trujillo speak on Black maternal health during a March of Dimes event more than 25 years ago, Harris said she began interested in starting a Birthing Project chapter locally. “Since she was originally from Arkansas, that’s what intrigued me about it. I became interested in the work that she was doing and wanted to bring that work to Arkansas,” said Harris.

Today, the ADH retiree commits her time and passion to what she calls one of the most important health issues facing Black Americans, the health of a mother and her child as the foundation of the Black  family.

“We actually train local community women to provide social support to women who are pregnant who need to or don’t know how to access services in their communities,” said Harris. “It is sort of like little sisters with their big sisters. We actually become like an extra family member to them and their children. It is more of a social, cultural model than a medical model.”

Harris said the local chapter of the Birth Project provides a wide-range of maternal health and child-birth services, including monthly meetings to support pregnant mothers and improve the birth outcomes for women of color. “What’s more important than a healthy child?” she asked rhetorically.

In northwest Arkansas, attorney Kesha Zaffino is a mother and lactation consultant who advocates for parents, doulas, midwives, and birthing mothers across the U.S. She said although racism does play a role in health care disparities, maternal health is also impacted by other factors.

“The problem is the medical model of care and how it treats labor and delivery,” said Zaffino, a former JAG (Judge Advocate General) in the U.S. Air Force whose legal practice in Bentonville focuses on personal injury, medical malpractice, and other civil matters.

“Plus, if you have a segment of society that in general (is) in a different socioeconomic status, their health outcomes will be subpar. Also, if we’re saying that Black women are more prone to preeclampsia than white women, that will account for some of the disparity right there and that may not be racism — maybe genetics, lifestyle, diet and nutrition,” said Zaffino. “Now that’s not to say that racism and biases is not playing a part in this. I don’t doubt that at all but it’s a very complicated issue.

“You don’t know what you don’t know. Everyone can have a better outcome with the right information to advocate for yourself and your partner,” said the northwest Arkansas legal expert.

During the 2017 legislative session in Arkansas, Zaffino helped craft a bill that changed state law by requiring mothers to prove they are medically fit to endure a midwife-assisted birth by undergoing two medical assessments with a qualified medical provider or public health clinician.

As a mostly rural state, Zaffino agreed with Harris and Hendrix that rural Arkansas is faced with widespread “maternity deserts” that need more choices in maternity healthcare. Among many things, she said Arkansas needs more practicing certified nurse midwives (CNMs) and certified professional midwives (CPMs), as well as birth centers and specialized obstetricians for high-risk births.

“We need to dismantle the medical model of care (for maternal health) because it’s killing a lot of women, of all races, in the U.S.,” concluded Zaffino.

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