The United States doesn't win any awards when it comes to its maternal mortality ranking amongst other developed countries. In fact, the USA finds themselves at the bottom of the heap. We come in absolutely last when compared to all the other developed nations in the world. Given the resources that the USA has at its disposable, that fact is simply inexcusable. A deeper dive into this information reveals that within the United States, Black parents and babies are more likely to die or face a serious complication than their white counterparts during the childbearing year. The maternal mortality rate in every other wealthy country is going down. In the United States, it is going up! And it climbs steeper and faster for Black parents.

Black Maternal Health Week is a week that focuses awareness on Black families and the inequitable outcomes that they bear during pregnancy, birth and postpartum. 2018 is the first such awareness week and is long overdue. This recognition is the brainchild of Black Mamas Matter Alliance with the support of many national organizations. The Black Mamas Matter Alliance is a Black women-led cross-sectoral alliance. They center Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice. Their vision is a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy.

As childbirth educators and birth professionals, we have an obligation to be aware of and share information about the state of maternity care, especially as it unfairly impacts families of color.

1. More low birthweight babies (2,500 grams/5 pounds, 8 ounces) are born to Black parents. In addition, more very low birthweight babies (1,500 grams/3 pounds, 4 ounces) are born to Black parents.

2. Black parents are more likely to give birth by cesarean than any other racial group.

3. Black babies are more likely to be born before 37 weeks. Additionally, they are also more likely to be born very preterm. Very preterm is defined as a birth that occurs between 28 and 32 weeks.

4. The infant mortality rate for Black babies is more than double that for white infants.

5. Black parents in the United States suffer from life-threatening pregnancy complications twice as often as white parents, and they die from pregnancy-related complications four times as often as white women. Pre-eclampsia, infection, and hemorrhage are among the most severe (and common) complications.

According to Natalie S. Burke, keynote speaker for last month's LamazeLIVE! conference: "For millions of American women, pregnancy brings not only the anticipation of new life but for too many, it also brings the risk of death." Natalie is, of course, acknowledging that the risk of death falls disproportionately on Black parents.

For Black pregnant people, there is not the typical protection from higher mortality rates that seem to come with higher income, more education and a desirable zip code. Even with socioeconomic status from a good education and well-paying jobs, Black women continue to experience high rates of illness and disease - factors in maternal and infant mortality.

As Natalie shared in her presentation, "health inequities are disparities in health that are a result of systemic, avoidable and unjust social and economic policies and practices that create barriers to opportunities. This definition comes from the National Cancer Institute."

I definitely recommend reading Natalie's article "It's Dangerous Bringing Black Lives into the World: Understanding What Matters and Why" for additional information. An excellent resource!

According to Black Mamas Matter Alliance: "Many of these deaths and illnesses are preventable. The U.S. could avoid about 40% of maternal deaths if all women-regardless of age, race, and zip code-had access to quality healthcare. In addition to improving health care access and quality, government actors need to address the root causes of Black maternal mortality and morbidity-including socioeconomic inequalities and racial discrimination in the healthcare system and beyond."

We can lean in and advocate for fair and equitable practices that can help close this gap. All childbirth educators can demand services from our local, state and federal governments that specifically address the inequities in place that disproportionately impact Black pregnant and birthing people.

BMMA recommends these talking points to improve U.S. maternal health outcomes. Black people's health and lives must be a priority. Every state must take steps to ensure safe and respectful maternal care for all people. At a minimum, these steps include policy measures that address the following areas:

• Respect: States must trust Black women with the decisions and resources that empower them and their families. Health care providers and systems must approach every woman with respect and compassion, build her capacity to engage in informed health care decision-making and honor her autonomy to make decisions about her body and care.
• Education: States must ensure that women are equipped with the knowledge, tools, and power to determine if and when they want to become pregnant and have a child. At a minimum, this requires comprehensive, evidence-based information about sexual, reproductive, and maternal health.
• Access: Every woman must have access to health care before, during, and after childbirth. States must ensure health coverage for low-income women before they get pregnant, promote continuity of care and insurance coverage as women's life circumstances change, address barriers to prenatal and postpartum care, and reach women in the communities where they live.
• Prevention: Every state must take action to address and prevent risk factors for poor maternal health outcomes such as obesity, chronic conditions like heart disease and diabetes, and underlying determinants of health. Policymakers influence the structural conditions in which women live, work, and grow, and in turn, these conditions influence maternal health.
• Quality: States must ensure that every pregnant woman has access to facilities, health care providers, and support persons that are capable of safely and respectfully managing chronic conditions, identifying, monitoring, and appropriately addressing obstetric emergencies, and providing unbiased care.
• Equity: To prevent pregnancy-related deaths and sustainably improve maternal health, states must make transformative investments in the health and well-being of Black women and girls throughout the life course, including in the areas of housing, nutrition, transportation, violence, environmental health, and economic justice.
• Data: Every state must have a process in place to collect and disaggregate data about maternal health in a timely manner. Data collection should include both quantitative and qualitative methods, including community-based participatory data, in order to understand the impact of race and socioeconomic inequality on Black women's health.
• Accountability: States must create systems to design and implement recommendations, and hold institutions accountable when they fail women. These include independent and fully funded maternal mortality review boards, supportive maternal health programs that implement review findings, and attention to social determinants of health.

To learn more about the Black Mamas Matter Alliance, check out their website where you can find a wealth of information and resources for yourself and the families you work with. Resources specifically focused on Black Maternal Health Week can be found here. Information is posted about online activities, webinars, events and other useful tools, including a social media toolkit to increase awareness. There you can also find out more about how you can contribute both time and money to making birth safer for Black families. Learn more about Natalie S. Burke, CEO of CommonHealth Action in this interview with Natalie that I completed earlier this spring on the blog. Finally, a great book I read and reviewed on the DONA International blog is "Battling Over Birth: Black Women and the Maternal Health Care Crisis" which focuses on the experiences of Black families during the childbearing year. We cannot ignore the disparities in outcomes due to existing and generational inequities that the United States has forced Black families to shoulder going back through hundreds of years of our history. Your contribution to turning this ship around makes a difference. Please help.

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