Inside the fight to save America’s mothers

Can the maternal mortality rate among Black women be reversed?

Shalon Irving tried to do everything right. She didn’t miss a single doctor’s appointment during her pregnancy. She ruminated for days on a birthing plan to account for every conceivable variable: the music that’d play during childbirth, the guests allowed in the delivery room, the conversations they could and could not have in that space. She’d even tasked her mother with preemptively sterilizing the already sterile hospital room — just to err on the side of caution.

Irving understood that even the smallest of details could drastically alter health outcomes. She served as an epidemiologist for the Centers for Disease Control and Prevention and, prior to that role, as lieutenant commander for the U.S. Public Health Service. Her work focused on invisible dangers, like structural inequality and trauma, and their impact on patients’ well-being. So holding her daughter Soleil in her arms on January 3, 2017, against all odds, perceptible and otherwise, became what she considered her greatest accomplishment.

But exactly three weeks after she gave birth, Irving suffered a cardiac arrest. She’d been experiencing high blood pressure, weight gain, swelling and other symptoms — all of which she relayed to her health care providers over numerous appointments. Her last doctor’s visit took place hours before her heart attack. Irving tested negative for blood clots and preeclampsia, so she was sent home with blood pressure medication despite her insistence that something remained wrong. She turned out to be right. Emergency responders brought her to a local hospital after Irving collapsed to place her on life support. She died four days later.

Despite her caution, education and excellent insurance, Irving fell victim to a statistical pitfall that has long plagued the American health care system. More mothers die of complications related to pregnancy in the United States than any other high-income country in the world. Most of those deaths occur anywhere from a week to a year after birth. And they’re growing more frequent. The CDC published a report earlier this year with data that places the maternal mortality rate — the number of maternal deaths for every 100,000 live births — at 32.9 as of 2021. The number is up from 23.8 the year before and 20.1 two years prior. For Black women like Irving, the current rate more than doubles at 69.9 deaths. 

“We know exactly how this could happen, because it’s been happening to so many families around the country for decades, and it’s unacceptable.”

A confluence of ailments is behind the lapse in maternal care for Black women. An estimated 36 percent of all counties in the U.S. are areas with little to no access to maternal care — two-thirds of which comprise rural counties. Higher rates of predisposition to conditions like hypertension, cardiovascular disease, diabetes and obesity also account for some of the disparity. Though more prevalent and nebulous are the social issues at play. New research points to how chronic stress caused by exposure to discrimination or racism, generational inequities that lead to a lack of health care access and implicit bias imposed by health care practitioners can widen the gap for Black mothers. A version of that disparity had already been documented at the time of Irving’s death six years ago, though with far less public understanding. “Shalon’s death was devastating. I remember going to her funeral, and the director of the CDC came and said, ‘We don’t know how this could happen,’” says Congresswoman Lauren Underwood, a Democrat from Illinois and a friend of Irving’s from graduate school. “We know exactly how this could happen, because it’s been happening to so many families around the country for decades, and it’s unacceptable.”

Two years after the funeral encounter, Underwood co-founded the Black Maternal Health Caucus with North Carolina Rep. Alma Adams and then-Sen. Kamala Harris, both Democrats. It’s since grown into one of the largest bipartisan caucuses in Congress and has led to the introduction of the Black Maternal Health Momnibus Act, a package of 13 bills proposed in both the House of Representatives and Senate that aims to end America’s maternal mortality crisis. And while it’s gained little traction since its debut in 2020, a perfect storm of restored national attention, newly dismal data points and the act’s formal reintroduction in May could help prompt a new trajectory for nationwide maternal care. One where invisible dangers, much like what Irving devoted and lost her life to, no longer take hold of health outcomes. “This is not a partisan issue,” Underwood says. “This is about taking action to save moms’ lives.”

Mid-19th century medical journals and Southern hospitals where doctors treated enslaved people proved foundational to establishing a sense of otherness between Black and white patients. Deirdre Cooper Owens writes in her book “Medical Bondage: Race, Gender, and the Origins of American Gynecology” that “physicians’ medical writings … modeled how to treat and think about black and white women and their perceived differences based on biology and race.” This included the belief that Black women had heightened fertility and an abnormally heightened pain tolerance, justifications used to exploit enslaved women as so-called “breeders” and subjects for medical experiments without anesthesia. 

The men behind those experiments included James Marion Sims, dubbed the father of gynecology. And the same sentiments that propelled them persist even after hundreds of years. A 2016 study from the University of Virginia found a majority of more than 200 surveyed medical students believed Black Americans have thicker skin than whites, and a minority even believed Black Americans’ nerve endings are less sensitive. 

“This is not a partisan issue. This is about taking action to save moms’ lives.”

These responses influence the future doctors’ likelihood to offer a patient treatment, which correlates with the 40 percent of Black adults surveyed by Pew Research Center last year who say they’ve had to speak up to receive proper care — the most cited negative experience in the survey. “We’ve got to start listening to folks that tell you that something is not right,” says Kay Matthews, founder of Shades of Blue, a nonprofit focused on providing mental health resources for Black mothers. Matthews began her work after she experienced a lack of medical support as she suffered postpartum depression after losing her daughter to a stillbirth. “I went way too long without being able to get assistance and care because it was something that people were unfamiliar with,” she says. “We deserve to deliver our babies and go home and continue our lives and it’s just not happening.” Matthews’ organization co-sponsored the Moms Matter bill in the Momnibus act, focused on mental health equity. 

They also illustrate why the Momnibus act places emphasis on addressing social determinants of health through research of disparities and tailored training for incoming health practitioners. Certain biases that may be embedded into the origins of present health care systems can appear innocuous or outdated while still posing centuries worth of harm. “When we think about the workforce and who is entering the health care sector, these are the people that are delivering the care for women that are having babies,” says Anuli Njoku, lead author of the academic paper “Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States,” published in February. “Having more curriculum about these issues of implicit bias and how to improve cultural humility could be one way to address unconscious bias.” 

Medical programs that offer students specialized training to understand social determinants of health for minority groups and how to respond with equitable care already exist and show progress. But there’s a demand for more. A joint effort by the American Public Health Association and the Council on Education for Public Health in 2021 echoes the need for increased research on not just quantifying disparity but reducing its harm, as outlined in the Momnibus bills. The study concluded “more research is needed to document how to educate public health students on the roots of the health issues they will address in their careers.” Especially when so much can compound to produce said harm in the first place. “There are nonmedical factors that are ingrained in society,” Njoku says. “Structural racism is a driver of those factors that affect one’s access to education, to housing, income, and how those factors really play a role in where these women may be.”

Which speaks to why the bulk of the Momnibus package includes pieces of legislation to not only fund training and data, but community-based organizations, a diversified maternal care workforce, mental health resources, accessible telehealth models for all appointments, promoting vaccination awareness, and more. One bill that previously comprised that package, the Protecting Moms Who Served Act, was signed into law by President Joe Biden two years ago. The act ensures the Department of Veteran Affairs maintains a coordination program to connect veterans seeking external pregnancy or postpartum care with providers. “Whether we’re talking about challenges and gaps in rural health care, disparities that are seen in a variety of racial and ethnic groups, there’s resources in the Momnibus that help all moms have better pregnancy outcomes,” Underwood says. States like California have also passed Momnibus legislation in recent years, but the goal of enacting the entire framework on a federal level remains unmet. At least for the time being. And as more high-profile athletes, celebrities and public figures come forward about their close calls, as more years inch by since Irving’s fatal collapse, all the more light is shed on solutions. A steady burn, almost as if to rival her daughter Soleil’s namesake. 

This story appears in the November issue of Deseret Magazine. Learn more about how to subscribe.