Public Comments for the NASEM Workshop

Maternal Health Disparities: The Women Behind the Data

Hello, my name is Dr. Monica Rose McLemore and I use she/her pronouns. I am currently professor at the University of Washington in multiple schools and departments. I want to thank you for the opportunity to address the participants of this webinar, particularly since I am currently a member of the Standing Committee on Reproductive Health Equity and Society.

I often begin academic talks with a positionality statement and I will do so here. I was born a preemie on December 31, 1969, when my birthday should have been February 14, 1970. According to the 1969 report from the Centers for Disease Control, more specifically, the US Department of Health, Education, and Welfare — the Public Health Service’s National Center for Health Statistics, in New Jersey where I was born, the total infant mortality rate was 20 infants per 1,000 live births, 16 per 1,000 for white people, and since race wasn’t classified for others, the other category’s rate was 35.3 per 1,000. Double the rate for all other races and ethnicities. In 1969 — When prematurity was a leading indicator for infant death in the first year of life. I’m both lucky and grateful to be alive. And unfortunately, today’s statistics specific to maternal and infant morbidity and mortality are NO BETTER.

I will also add that as a nurse I have been fortunate to learn from, work with, and support doulas. I first will thank you for the incredible work that you do, second, I will remind this audience of your important role in supporting pregnant people regardless of how those pregnancies end, and I third I want to reiterate the fact that despite your important role, the responsibility to solve the maternal morbidity and mortality crisis in the United States does not solely rest on your shoulders. You should NOT have to fix a problem you did not create.

It is in this context that I will begin my brief comments by providing you what I hope to accomplish. Here are the 3-Cs:

· Celebration

· Collaboration

· And I’ll end with a call to action.

First, Celebration. We have just ended Black Maternal Health Awareness week and we applaud the Black Maternal Caucus in the Congress on Securing the $100 million dollars in new federal funding that should transform the perinatal workforce and support much of the great work that doulas, Black Mamas Matter Alliance and other community based and networked organizations have been doing. We must celebrate our wins when they happen and continue to push for more humane health care seeking experiences across th reproductive spectrum.

Speaking of which my next C is Collaboration. I am very much looking forward to this discussion of doula work and services provided. Like many community birth support and doula organizations, the focus this webinar has on birth — is important, however, when we consider the reproductive trajectories of the people we serve, for too long, attention has been on the outcomes of pregnancy and not the phenomenon of pregnancy in and of itself. Abortion, Birth, Miscarriage, Surrogacy, Infertility these are outcomes of pregnancy. Given that most people in the United States will have on average 2 to 3 children, they will spend of much of their reproductive lives avoiding or preventing pregnancies and health and wellness for those individuals when not pregnant is crucial for a healthy life course. I am grateful to see much attention on Women’s Health and Reproductive Health, at the level of the White House including the ARPA-H initiative and the Sprint to Women’s Health. I also am glad to see the push to include uterus having people in pharma and drug clinical trials since much of what we know about those agents and their effectiveness is based on the physiology of men. As citizens we deserve better. Which brings me to a specific call to action.

The Call to Action I am requesting is that for those of you attending this webinar, that you begin to understand the power doulas and other organizations can share and wield specific to using reproductive justice as a guiding light and north star. Reproductive Justice turns 30 years old this year and I’m very grateful to be informed by this advocacy tool, theory, strategy, and praxis. Reproductive justice (RJ) was coined by 12 Black women as a response to the limited frameworks of individual choices. All but 1 are alive and will be at an incredible gala to celebrate in Washington DC in June. This framework is comprehensive and has been widened, deepen, and vastly theorized and published in 2 books in 2017 and 2018.

RJ simply defined as the human right to maintain bodily autonomy, have children, not have children, and parent existing children in safe and sustainable communities. The specific definition I use was more developed using a participatory process (Black Mamas Matter Alliance [BMMA] Research Working Group, 2020) and posits that every person has the human right to:

• Decide if and when, how to become pregnant and to determine the conditions under which they will give birth, make family and kin;
• Decide they will not become pregnant or have a baby and have all options for preventing or ending pregnancy are accessible and available;
• Parent children they already have with dignity and with the necessary social supports in safe environments and health communities without fear of violence from individuals or the government;
• Disassociate sex from reproduction; health sexuality and pleasure, consent, are essential components to whole and full human life.

Therefore, my call to action is for all of us and doula colleagues, I will ask that you join us:

· I call upon us to reject every lie we have been told about reproductive health, rights, and justice in the United States.

· I call upon us to end the cruelty experienced by Assisted Reproductive Technology and Invitro Fertilization families we witnessed in Alabama (that resulted in rapid bipartisan legislation in 10 days after not having any for almost 20 years), and that we support gender affirming care and believe people when they tell us who they are.

· I call upon us to be very critical about losing the protections of Roe and living in the chaos of Dobbs and that we remember that the people we serve are the experts of their own lives and know the care they need.

· I call upon us to demand good care for all people regardless of how they make it to our health systems, emergency departments, and/or need urgent care. I need you all to keep your eye on the Supreme Court of the United States and the Emergency Medical Treatment and Labor Act (EMTALA) decision — it will have impacts that will ripple throughout healthcare including doulas and the important supports you provide to pregnant people.

· I call upon us to remember we are CITIZENS, not customers, not consumers. We have a higher calling than bystander or passive participant in democracy.

· I call upon us to remind people that maternal, adolescent, and child health is a key indicator of the health and wealth of a nation and that ours is shameful and we can do better and deserve better.

· I call upon us to not let augmented intelligence and/or artificial intelligence and other technologies to distract us from the connectedness and sentience that makes us human.

· I call upon those of you who care about the future to step forward to fight to defend it in the now. Write OpEds, Call your elected officials, Demand more from our academic institutions, policy makers, and clinical providers of care. We need to push funders to support childbearing families and to destigmatize sexual and reproductive health. Tell the truth. We have got to stop accepting the lies we’ve been told. There are no sides that matter in reproductive health, rights, and justice except for the ones of the people we serve.

In closing, thank you doulas for your incredible work and the vital role you play in pregnancy related care. And should out to abortion doulas, birth doulas, and death doulas. I’m grateful you are in a larger eco-system that is attempting to change the future for all pregnant capable people. I would like to see you use your excellent track record to join me and others to continue to see the people that we serve as our future work force and to continue to dream and BUILD a more equitable future that operationalizes reproductive justice and moves us closer to health equity. Thank you.