By Aldon Thomas Stiles
California Black Media

There is a growing body of evidence that disparities in medical treatment in the United States — compounded over centuries by the legacy of slavery, Jim Crow segregation and prevalence of anti-Black biases — have adversely affected the health of Black women in numerous ways, including the birthing process.

In June, the tragic and high-profile death of Olympic Gold Medalist and sprinter Tori Bowie during childbirth brought more national attention to the crisis of Black maternal mortality in the United States.

Aware of the discrepancies in treatment as compared to women of other races and terrified by the potential mental health ramifications of those disparities — which can lead to greater fear and anxiety about pregnancy and childbirth — some Black women are seeking alternatives to hospital births.

Black women die at nearly twice the rate of white women during labor, according to data from the National Institutes of Health (NIH).

In July, the U.S. Department of Health and Human Services (HHS) announced that the federal government has launched a civil rights investigation into the treatment of Black expectant mothers at Cedars Sinai Medical Center in Los Angeles.

“Maternal health is a priority for the Biden-Harris Administration and one in which the HHS Office for Civil Rights is working on around the country to ensure equity and equality,” read an emailed statement from HHS to several news outlets.

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The federal investigation comes seven years after the 2016 death of a Black woman, Kira Dixon Johnson, who died from internal bleeding following a cesarean section at Cedars Sinai.

Dr. Melissa Frank, director of the Division of Maternal, Child, and Adolescent Health with the Los Angeles County Department of Public Health, stated that she has “lived the disparity” associated with maternal healthcare.

During the delivery of her second daughter, Franklin says she could tell something was wrong and expressed that to hospital staff, “I feel like I’m dying,” but her concerns were largely dismissed.

When the hospital staff finally checked on her, they discovered that her blood pressure was dangerously low to which she responded, “I told y’all!”

According to data from the Centers for Disease Control and Prevention (CDC), in 2021, Black women in the U. S. were more than twice as likely as white women to die due to complications related to maternity and the birthing process.

In California, the risk of death due to pregnancy complications is four to six times higher for Black mothers than any other ethnic group, according to data from the California Health Care Foundation.

Research has indicated that maternal mental health conditions, including prenatal and postpartum anxiety and depression, are the most common complications of pregnancy and childbirth.

According to the American Hospital Association Institute for Diversity and Health Equity, 12.5% of birthing people will suffer from postpartum depression. However, Black women are about 1.6 times more likely to deal with its effects than white women.

Hiring a doula is one solution Black women are using to help address some of the mental health issues associated with the birthing process. A 2013 study by the National Center for Biotechnology Information found that mothers who received support from a doula during childbirth were two times less likely to experience complications.

A doula is a trained professional who provides emotional and physical support to pregnant individuals during pregnancy, childbirth and the postpartum period.

Doulas are not medical professionals and do not deliver babies or provide medical care. Instead, they offer support in the form of physical comfort, emotional well-being, information, and advocacy.

According to another study by the National Center for Biotechnology Information, doula-assisted mothers were 57.5% less likely to suffer from postpartum depression or anxiety. This confirms that having the support of a doula during the birthing process can have a significant positive impact on the mental health of mothers.

The long history of discriminatory care towards Black women in the healthcare system has resulted in another mental health issue: generational trauma.

“When we speak about Black maternal health, we cannot ignore the fact that the foundation of medicine in this country and many of its early principles were deeply rooted in racism,” said Assemblymember Akilah Weber (D-La Mesa), a board-certified obstetrician/gynecologist, and founder and past director of the Pediatric & Adolescent Gynecology Division at Rady Children’s Hospital-San Diego.

“Some of the earliest examples of experimental research relied on these racist concepts. The pain of Black individuals was not only ignored but assumed to not be experienced to the same degree as white individuals.”

Franklin emphasized the importance of culturally competent care for the mental health of Black mothers.

“The support of doulas as alternative birthing spaces gives Black women the opportunity, the choice of giving birth in a way that’s culturally affirming,” said Franklin. This highlights the significance of providing care that is sensitive to the cultural needs and experiences of Black women during the birthing process.

Franklin also pointed out that doulas alone cannot bear the burden of an unfair healthcare system. She emphasized the importance of hospitals employing well trained providers who operate in anti-bias and anti-racism spaces. This can help Black women give birth with “the support of a village.”

California has been taking steps to address healthcare disparities and improve outcomes for Black mothers and birthing individuals. The state introduced various policies and initiatives aimed at making culturally competent care a reality.

For example, the Department of Health Care Services (DHCS) has taken steps to improve access to doula services for expectant mothers. One such initiative is the inclusion of doula services as a preventative care option covered under Medi-Cal. This can help make doula support more accessible and affordable for those who need it.

Los Angeles County Supervisor Holly J. Mitchell has emphasized the importance of doula care in improving pregnancy experiences and birthing outcomes.

In a press release, she stated that “Doula care is shown to improve pregnancy experiences and birthing outcomes. We must increase awareness of doula services for mothers and families across the County and expand our workforce to be more representative of our communities most in need.” This highlights the need for greater awareness and accessibility of doula services, particularly for those in underserved communities.

In the meantime, Dr. Franklin’s advice is to listen to Black women when they express concerns about their health. This means taking their concerns seriously and providing them with the care and support they need.

By McKenzie Jackson
California Black Media

Five percent of the 225,231 Californians who lost their Medi-Cal coverage in June were African American.

According to numbers from the California Department of Health Care Services (DHCS), around 14,000 Black Californians lost health insurance with the state’s safety net health care exchange because they didn’t turn in the required renewal paperwork to continue their Medi-Cal enrollment or their coverage was switched to the state’s insurance provider, Covered California.

Mayra Alvarez, president of The Children’s Partnership, a Los Angeles-based organization that advocates for affordable health care service for families, said it is important for minorities to have health insurance.

“Especially, as we come out of this public health emergency that has disproportionately hit communities of color, we know health coverage is important to our families and livelihoods,” Alvarez said referencing the COVID-19 pandemic.

Medi-Cal is California’s version of the Medicaid program, which offers free or low-cost health care access to low-income people across the nation.

Alvarez and other California officials and advocates were speaking during an online video news conference last week organized by California Black Media and Ethnic Media Services.

The eligibility of 18 million Californians who are enrolled in Medi-Cal will be reviewed by the DHCS for the first time since 2020. As a result, between this summer and next spring, state officials estimate that 1.8 million to 2.8 million people could lose their Medi-Cal coverage.

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To help Californians keep their insurance, DCHS has created a number of easy-to-navigate resources that state residents can access online. The state is also partnering with Community Based Organizations (CBOs) already connected to people in cities and towns across California to help educate the public through a bilingual campaign informing people about how they can prevent losing their health care coverage.

The Medi-Cal eligibility redetermination process, which officials call the “great unwinding,” is part of a massive undertaking taking place in every state to find out who qualifies for Medicaid.

A single Californian making $20,121 or less annually is eligible for Medi-Cal. In the past, participants had to prove their eligibility each year, but in March 2020 Congress suspended the income-verification requirement for Medicaid to make sure people had health insurance during the pandemic.

Those protections expired in March. The federal government has projected that 15 million Americans will lose their health insurance during the nationwide renewal process due to procedural reasons or excess income.

California’s DHCS began verifying the eligibility of Medi-Cal enrollees two months ago.

DHCS Assistant Deputy Director of Health Care Benefits and Eligibility Yingjia Huang said over one million Medi-Cal users had their eligibility reviewed in June. She expects that trend to continue monthly as batches of people come up for renewal until the end of the redetermination process in May 2024.

DHCS has an automatic renewal system for Medi-Cal users whose income the state can confirm on its own. The department is notifying people that they will receive a renewal packet in the mail via text, phone calls, and email.

Huang said individuals lost their Medi-Cal service either because they didn’t complete the renewal paperwork and return it to a county DHCS office by the June 30 deadline or they had an increase in income that allowed DHCS to move their coverage to an affordable health plan with Covered California.

Residents whose coverage was transitioned to Covered California are notified and able to review their new health plan, according to Covered California CEO Jessica Altman.

“California is well-positioned to help consumers through this process and help them keep coverage,” she noted.

Participants who were removed from Medi-Cal’s rolls but are still eligible for the service have until Sept. 30 to get their insurance reinstated. To do so, they must complete the renewal packet and return it to a DHCS office.

DCHS is advising all Californians to take the following steps: update their contact information online; check for mail from their county health office; create or check their online accounts; and complete their renewal forms (if they receive one in the mail).

DHCS and its partners, Huang stated, are committed to helping people maintain health insurance.

“Please be sure you are looking out for the yellow envelope and renewal packet,” she said. “We really hope we continue to keep our members on coverage.”

Community Clinic Association of Los Angeles County CEO and President Louise McCarthy said 64% of the 1.9 million Los Angeles County residents that visit CCALAC locations for health services are Medi-Cal enrollees. They can receive help completing the renewal forms at any of the 113 centers, McCarthy explained.

“A number of folks are letting that yellow packet slide,” she said. “If you haven’t seen the packet, reach out, and we will help you navigate the system.”

There were also 53,836 newly enrolled Medi-Cal participants in June, according to DHCS figures.

Alvarez, the president of The Children’s Partnership, said no one needs to lose their access to health care during the redetermination process.

“People are falling through the cracks,” she said. Keeping people enrolled, Alvarez added is “an all hands-on-deck effort.”

For more information on renewing your health insurance, visit DCHS online.

For individuals who receive Social Security Insurance benefits and don’t have online access, call, 1-800-772-1213 or contact your local Social Security office.

By Elise Proulx
UC Berkeley News

For more than 80 years, Berkeley Public Health has championed equity and justice around the world.

But in 2020—when vigorous calls for racial justice in the U.S. were sparked by the murder by police of George Floyd, an unarmed Black man, and racial disparities in health outcomes tied to the COVID-19 pandemic—it was clear that more needed to be done both around the world and at home in Berkeley.

Against that background, Dean Michael C. Lu issued a call to action for the school to become an antiracist institution.

In response, a steering group of 23 faculty, staff, and students, led by then Executive Associate Dean Amani Allen and Chief of Diversity, Equity, Inclusion, Belonging & Justice (DEIBJ) Ché Abram, launched ARC4JSTC (Anti-racist Community for Justice and Social Transformative Change), a “comprehensive, multiyear antiracist change initiative encompassing faculty and workforce development, student experience, curriculum and pedagogy, community engagement outreach, and business processes.”

Over a two-year period, the project resulted in the establishment of an Antiracist Pedagogy Faculty Leadership Academy that has trained more than 100 faculty from across the UC Berkeley campus, a series of antiracism trainings for staff and non-faculty academics, and an elective course on antiracism for students.

It has also led to the development of a schoolwide antiracism strategic framework and the creation of antiracism competencies that will serve as a guide for ongoing efforts, as well as adoption of course syllabus language stating a commitment to antiracist pedagogy.

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It spurred a reexamination of many of the school’s practices and policies, from student admissions to faculty recruitment to staff hiring to supervisor training to pay equity to purchasing, contracting, and more. Most recently, the project is training faculty and staff on restorative justice practices to prevent and address discrimination and microaggressions.

“ARC4JSTC had a ripple effect on the possibilities of what an antiracist public health institution can offer to students, staff and faculty,” said Dr. Andrea Jacobo, coauthor and recent UC Berkeley DrPH graduate. “The faculty who were a part of the leadership academy have integrated antiracist principles into their curriculum and have empowered students to be active in the process. Students have continued to be vocal about maintaining antiracist praxis at the core of the curriculum in their respective concentrations. What we started is a moving train that continues to build as we move forward.”

Berkeley Public Health’s journey towards becoming a more antiracist institution is documented in a paper published in a special June 8, 2023, issue of Preventing Chronic Disease entitled “Public Health, Medicine, Dentistry, Nursing, and Pharmacy: Combating Racism Through Research, Training, Practice, and Public Health Policies,” published by the Centers for Disease Control and Prevention.

“While we have a long way to go, our school came together to acknowledge the work that needs to be done and start the journey toward becoming an antiracist institution,” said Dr. Allen, the paper’s lead author. “We’ve learned more about ourselves in the process, both our strengths and our growth edges. The charge before us now is to not be content with the successes we have had but to forge ahead into those uncomfortable places. That is where the magic happens.”

“Berkeley Public Health students, staff, and faculty have acknowledged the importance of anti-racism praxis in making changes within and beyond our campus,” said coauthor and former UC Berkeley public health undergraduate student and recent epidemiology and biostatistics MPH graduate Navya Pothamsetty. “ARC4JSTC’s initiatives like faculty workshops, focus groups, and, most recently, published research on transformative change, are a strong foundation for continued progress towards the goal of becoming a more antiracist institution.”

Schools of Public Health “have a moral, ethical, and disciplinary imperative to support training, research, and service activities that serve our collective mission to promote health and well-being for all,” concludes the paper. “Ensuring our institutional health as a diverse, equity-minded, inclusive, and antiracist-striving organization is fundamental to those efforts.”

“While we’ve still got work to do, I’m proud of what we’ve accomplished in the past three years,” said Lu. “ARC4JSTC has transformed our culture and climate, and helped us become a better version of ourselves.”

Authors include: Amani M. Allen, PhD, Ché Abram, MBA, Navya Pothamsetty, MPH, Andrea Jacobo, MPH, Leanna Lewis, MSW, Sai Ramya Maddali, MPH, Michelle Azurin, MPH, Emily Chow, BS, Michael Sholinbeck, MLIS, Abby Rincón, MPH, and Ann Keller, PhD, and Michael C. Lu, MD, MS, MPH, all of UC Berkeley School of Public Health.