The United States has the highest maternal mortality rate of any developed country. And in Oklahoma, Black women account for 10% of births across the state but comprise 22% of maternal deaths. These numbers follow a harrowing trajectory in healthcare: according to the U.S. Centers for Disease Control and Prevention (CDC), Black women experience pregnancy-related deaths at three times the rate of white women. Oftentimes, these deaths are preventable. But it’s more than a healthcare problem; evidence shows that racism and discrimination — and the stress caused by both — are what sustain maternal mortality and morbidity amongst Black women. This is regardless of their socio-economic, education or health status. The Tulsa Birth Equity Initiative is trying to change that.
“It is not just a maternal health issue when we think about the disparities that exist with historically marginalized groups; it’s a racial equity issue that seems to span many sectors, like education and the criminal justice system,” says LaBrisa Williams, Tulsa native and director of the Tulsa Birth Equity Initiative (TBEI), a community-based doula program that provides doula services to expecting parents. Williams, who oversees TBEI’s efforts to equip local families with the tools they need to have healthy and supported births, points to key historical events like the Tulsa Race Massacre of 1921 as the roots of systemic hurdles that contribute to Black maternal issues.
“There's a lot of research on how Black women[‘s health] may begin to decline in early adulthood as a physical consequence or a result of socioeconomic inequities and all the -isms — like racism and sexism — that they've experienced,” she continues. “I think it also is parallel to many other cities here in the States in terms of us working towards racial equity. It is a maternal health issue, but it doesn't just span the maternal health sector.”
Many of the racial health myths and misconceptions that are believed nationally — like that Black people have a higher pain tolerance — widely exist in Tulsa, Williams emphasizes. This introduces another problem. For instance, a Black person may be prescribed a different medication for a health condition than a white person would for that same condition. And tools like the Vaginal Birth After Cesarean (VBAC) calculator, which determines the success rates for vaginal birth among women with a previous cesarean delivery, use race and ethnicity to determine risk. These are just a few of the many examples of the disparities that exist in the healthcare system.
It is not just a maternal health issue when we think about the disparities that exist with historically marginalized groups; it’s a racial equity issue that seems to span many sectors, like education and the criminal justice system.
For Kimberly Butler, Senior Program Officer at the George Kaiser Family Foundation, the focus has been on maternal child health and the reproductive lifespan of people with a uterus. And as a fellow Tulsa native, she’s intimately familiar with the needs of the community.
“Tulsa is a very conservative community, and the first project that I started on was around reproductive access to comprehensive family planning and contraceptive services,” says Butler. “We had to do that very carefully and always keep in mind the reproductive justice framework while keeping the community in mind.” Each of Butler’s projects have started with looking at data and anecdotal information from Black people in Tulsa to determine what the community needs. “‘How do we make contraception free at clinics?’ grew to a much broader topic of access,” Butler continues. “From that it grew to looking at prenatal postpartum maternal mental health, seeing the disparities in data about maternal deaths and morbidity in Oklahoma, and looking at racism within that.”
TBEI’s mission is to drive accessibility and positive birth outcomes through its doula training program. In order to achieve this goal, the program prioritizes services for those who need it most, including Black, native, and teen parents in underserved communities. The initiative has also provided services to expectant moms who reach out because they need extra support with a medical condition like hypertension or preeclampsia, or have experienced complications with a previous pregnancy.
“We get clients that are single parents, married clients, folks who just transitioned to Tulsa and lack some support around their pregnancy experience and maybe don't have family here, clients who vary from private insurance to Medicaid and everything in between,” says Williams. “We wanted to make sure we were reaching and supporting those who are really experiencing complications related to pregnancy and that could benefit from additional support, knowing that all people can benefit from doulas, but wanting to make sure we support those that are experiencing the disparities the most.”
Ebony Easiley, a single mom from Tulsa, was able to reach out to TBEI for birthing support. “It was very beneficial in mental support that I got from them that, a piece that I was missing with being a single mom,” Easiley shares. “They helped me in a lot of different ways, all the way through childbirth and after. So it's just been a very good resource and something that I didn't even know existed. I feel like without them, my experience wouldn't have been the same.”
As advocates seek an end to the maternal mortality crisis, the rest of the country could take a cue from TBEI to save the lives of Black women and their babies. A shift in the way healthcare addresses the needs of Black women and birthing people is not a feat that can be conquered overnight. But providing the support in the communities that need it most — like what TBEI is doing for Tulsa — is a necessary starting point.