Oakland’s public conversation about health care must begin with a simple truth: a doctor’s appointment is not the same thing as access to care.

For a mother juggling work and child care, access may mean a text-message reminder, a bus pass, an evening appointment, or someone who can explain what Medi-Cal covers. For an older patient managing diabetes, it may mean help scheduling a specialist visit and understanding new medications. For a family that has been dismissed or misunderstood in medical settings, access may begin with meeting a community health worker who knows the neighborhood, speaks their language, and treats their concerns with respect.

Community health clinics make that kind of care possible. They are part medical provider, part navigator, part educator, and part trusted local institution. Proposition 44 threatens to narrow the definition of what counts as patient care in a way that could undermine the very supports that allow patients to receive it.

The statewide measure would require covered nonprofit community clinics to spend at least 90 percent of their annual revenue on health care or qualifying program services. The ballot measure directs the Attorney General to establish more detailed guidance on what expenses qualify. Clinics that do not meet the threshold could face penalties for the difference. The Legislative Analyst’s Office reports that affected clinics currently spend an average of about 80 percent of revenue on health care services.

A percentage may look like a clean measure of accountability. But health care is not cleanly divided between what happens inside an examination room and everything that enables a patient to enter one.

Consider the work that happens before and after a visit. Clinic staff maintain confidential patient records. They follow up after missed appointments. They keep information systems secure. They recruit and train employees in an expensive and competitive health care labor market. They coordinate referrals, process claims, purchase supplies, maintain buildings, and make certain that patients are not lost somewhere between diagnosis and treatment.

Oakland families should not be asked to accept the fiction that these functions are unrelated to care.

The danger in Proposition 44 is not only its 90 percent figure. It is that the meaning of “qualifying” spending will be worked out later. A clinic preparing a budget today may not know whether a navigator, health educator, transportation program, outreach worker, technology upgrade, or other patient-support service will be counted the way it expects. Yet the financial consequence of getting it wrong could be immediate.

The Legislative Analyst’s Office says clinics falling short of the requirement could be required to pay the shortfall amount to the state and could seek to recover the money only if they show compliance within five years. The same analysis estimates state enforcement costs in the low tens of millions of dollars annually, supported by fees.

That is a troubling arrangement for organizations that are expected to provide care to people with the fewest alternatives.

Oakland has learned that trust is not built through slogans. It is built when a patient is listened to, when a parent can secure an appointment for a child, when a clinic returns a call, and when a person receives help without being shamed for their income, insurance, language, immigration history, or prior experience with the system.

For Black residents in particular, trustworthy care is not an abstract goal. Persistent inequities in health outcomes and patient treatment are real. Community-centered clinics can help bridge the gap with culturally responsive staff, patient navigators, behavioral-health programs, and partnerships that understand the conditions shaping health outside the clinic door.

Proposition 44 could pressure providers to treat those supports as expendable because they do not fit neatly into a state-enforced formula. That would be a mistake.

Accountability is necessary. Clinics that receive public resources should be transparent, well governed, and focused on their mission. But good oversight asks whether patients are being served well, whether money is managed responsibly, and whether communities can obtain needed care. It should not rely on a rigid ratio that may punish clinics for doing the hard work of reaching people who need more than a brief medical encounter.

A broad coalition of providers and community organizations opposes Proposition 44, including the California Primary Care Association, the California Medical Association, the California Hospital Association, Planned Parenthood Affiliates of California, and the California Teachers Association.

Oakland needs health policy that expands the circle of care. Proposition 44 risks drawing that circle smaller.

The Oakland Post editorial board urges a No vote on Proposition 44.

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By Antoinette Stewart-Eneh, Special to California Black Media Partners

Word Count: 1058

Note: Client A, B & C, names are withheld for privacy; these accounts reflect my recollections as their Doula.

Client A rocked her hips on a birthing ball, surrounded by pale wood and warm textiles in a softly lit Scandinavian-style office. I was her doula through a Southern California maternal health company combining nurse-led care, technology, and wraparound support.

She was a healthy Black woman in her thirties. Her baby girl was doing well; her partner took notes as we discussed labor and advocacy.

Then we turned to their chosen hospital. I knew it well—and remembered a phrase from another client’s experience: “Policy of Sovereignty.”

Client B had been told she needed a repeat cesarean as a precaution, though the reasoning was unclear. Her obstetrician, who performed her first cesarean two years earlier, had assured her throughout pregnancy that she was healthy, healed, and ready for a vaginal birth. We asked staff to review her chart, consult her obstetrician, and reconsider immediate surgery. Instead, they invoked the “Policy of Sovereignty.”

The physician on duty, we were told, had final authority, regardless of her established care plan. I asked whether an ultrasound or reassessing the baby’s position could offer clarity. Cesareans can be lifesaving. But were Client B’s history, informed consent, and circumstances guiding this decision—or was routine overriding individualized care? We kept asking for her obstetrician. Beneath every request was a deeper question: Was she being heard?

The Numbers Behind the Stories

Statistics arrive in clean columns. The experiences behind them do not.

Maternal mortality and pregnancy-related mortality use different time frames and methods and are not interchangeable. Finalized 2024 CDC data recorded 649 maternal deaths nationally. The overall rate was 17.9 deaths per 100,000 live births, but for non-Hispanic Black women it was 44.8, compared with 14.2 for White women and 12.1 for Hispanic women.

In California, Black birthing people experienced 56.5 pregnancy-related deaths per 100,000 live births during 2020–2022—3.8 times the White rate and four times the Asian rate.

As a doula serving Los Angeles and San Bernardino Counties, I see faces behind those numbers. I remember concerns raised softly, then firmly, then desperately. I am tired of watching Black families enter spaces meant to protect them, only to discover they must defend themselves while laboring, bleeding, trembling, or recovering.

Returning to Client A

Client A’s labor stretched nearly 48 hours. As her condition worsened, she, her partner, and I asked whether a cesarean should happen sooner. A provider questioned my place as a doula, then said she was next.

Six more hours passed.

She entered surgery visibly ill with a serious uterine infection, her baby malpositioned and stuck. Her partner later recalled the provider saying, “This baby would never have made it through the birth canal.”

Those words landed like a blow. Our urgency had been treated as ignorance. With Client B, we questioned why surgery was inevitable. With Client A, why it was delayed. Doula advocacy is not about one kind of birth. It is about informed consent, individualized care, and timely action. Hospital routine should never outweigh the person carrying the risk.

Survival Cannot Be the Standard

The Black maternal health crisis includes unequal care, untreated conditions, racial bias, delayed referrals, poor communication, and inadequate postpartum support. It is about birth plans respected only until a hospital becomes less busy and postpartum care that asks whether a mother survived, not whether she has what she needs to recover.

Survival cannot be the standard. Technology can support care, but it cannot replace human connection. An algorithm cannot detect fear in a patient’s eyes, and a mission statement alone cannot ensure adequate staffing or culturally responsive care.

The Story of Client C

Before I arrived, I heard the chaos through Client C’s phone. Staff struggled to locate her baby’s heartbeat on an external monitor as her fear and blood pressure rose. I pleaded for an internal electrode before surgery.

“There’s not enough time,” a nurse said.

“I would like to wait for my doula,” Client C called out.

But she was medicated, hurried through consent, and wheeled away while I listened.

In the operating room, after a shift change, another nurse placed an internal electrode and said, “The previous monitor wasn’t working.”

No one responded.

According to her father, the obstetrician avoided eye contact: “We need to move forward.”

Surgery may still have been necessary; that was not mine to determine. But if faulty equipment helped create the emergency, the family deserved acknowledgment and explanation—not silence. No family should have to wonder whether major surgery followed an unavoidable crisis or a machine failure no one recognized in time.

From Prevention to Accountability

After supporting nearly 100 families, I have learned that danger often begins before admission. I have urged clients to seek care—and heard why they feared returning: dismissed pain, harsh words, shame for asking questions.

Care cannot be holistic where Black families do not feel safe enough to speak or return. Representation matters, but providers of color cannot repair inequity alone. They need adequate staffing, mentorship, culturally responsive training, reliable equipment, and colleagues that are reflective of all the aforementioned. It’s not the Black providers job to care for just the Black patients, everyone should have the same goal.

The Momnibus Act, California’s Medi-Cal doula benefit, the Transforming Maternal Health Model and the Perinatal Equity Initiative require more than promises; they need sustained funding, reliable reimbursement and accountable implementation.

Birth should be sacred. Yet too many Black birthing people arrive carrying the burden of proving their pain is real. A doula can listen, educate, comfort, and advocate—but cannot repair a system that refuses to listen. The true measure of progress is what happens when a Black birthing person says, “Something is wrong.”

Are they believed? When equipment fails, is that failure acknowledged? Do families leave not merely alive, but safe, respected, supported, and whole?

Until those answers are consistently yes, California’s maternal health success story remains unfinished.

About the Author

Antoinette Stewart-Eneh is a mother of two, holistic maternal wellness advocate, and birth and postpartum doula who has supported families since 2019. She serves as program operations coordinator for Frontline Doulas, a volunteer client coordinator with the Joy in Birthing Foundation and a childbirth educator in South Los Angeles. She is studying to become a midwife and lactation educator.

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By Dr. Maritony Jones, Special to The Post

When community activist Jonathan “Fitness” Jones heard concerns from senior residents in East Oakland about illegal dumping, recurring trash issues and the health hazards they created, he decided that watching the problem was not enough. 

Jones, a member of the African American Sports and Entertainment Group (AASEG) and an Oakland Private Industry Council board member, learned that seniors were frustrated by the recurrence of illegal dumping even when trash has been cleared. Recurring trash can contribute to unsanitary conditions, attract rodents and leave residents feeling that their neighborhoods are being overlooked. 

On Saturday, Sept. 26, Mr. Jones joined High Street Coalition volunteers at Dick’s Donuts near High Street and Quigley Street, spending the morning picking up trash and helping beautify the surrounding neighborhood.

High Street Coalition volunteers organize community cleanups on the second and fourth Saturdays of each month. 

Following the cleanup, Jones talked with Richard Johnson, CEO of Formerly Incarcerated Giving Back (FIGB). Johnson said he wanted to bring formerly incarcerated nonprofits together not only to help clean up the city, but also to bring youth with them to mentor the next generation. 

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Jones and Johnson discussed developing a community model that brings formerly incarcerated individuals, Oakland youth and nonprofit organizations together to clean and beautify the city. 

The vision is to create opportunities for formerly incarcerated adults to take leadership roles while mentoring young people through hands-on community service. The program could also provide youth with opportunities to develop leadership skills, learn teamwork and responsibility, and potentially gain employment experience. 

The goal is bigger than removing trash from the streets. It is about restoring neighborhoods while building relationships between generations and creating opportunities for people with lived experience to give back to their communities. 

Jones believes the message is simple:  

“We don’t talk trash, we pick up trash.” 

The proposed collaboration seeks to bring Oakland nonprofits, formerly incarcerated leaders, youth, residents, businesses and community organizations together around a shared purpose — cleaning the town, beautifying Oakland and building a stronger community together. 

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