Michelle L. Drew, DNP, MPH, CNM, FNP-C BMMA Collaborator and Kindred Partner

1. Black mamas matter allianceReclaiming Maternal and reproductive justice through grassroots women centered action Michelle L. Drew, DNP, MPH, CNM, FNP-C BMMA Collaborator and Kindred Partner Ubuntu Black Family Health Collective Founder and Director

2. Why “black mamas matter”?

3. Black mama Matter alliance • Our Mission: Black Mamas Matter Alliance is a Black women-led cross-sectoral alliance. We center Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice • Our Vision: We envision a world where Black mamas have the rights, respect, and resources to thrive before, during, and after pregnancy. • Founded in 2015 • Collaboration across disciplines • Common Purpose • Collective Power

4. Black mama Matter alliance : goals • Change Policy: Introduce and advance policy grounded in the human rights framework that addresses Black maternal health inequity and improves Black maternal health outcomes • Cultivate Research: Leverage the talent and knowledge that exists in Black communities and cultivate innovative research methods to inform the policy agenda to improve Black maternal health • Advance Care for Black Mamas: Explore, introduce, and enhance holistic and comprehensive approaches to Black mamas’ care • Shift Culture: Redirect and reframe the conversation on Black maternal health and amplify the voices of Black mamas • Founded in 2015 • Collaboration across disciplines • Common Purpose • Collective Power

5. Black mamas matter alliance goals • Reproductive Justice • The human right to maintain personal bodily autonomy, have children, not have children and parent the children we have in safe, sustainable communities • Loretta Ross • Birth Equity: • The assurance of the conditions of optimal births for all people with a willingness to address racial and social inequalities in a sustained effort.

6. Finding the root causes of inequality • Black mothers who are college educated fare worse than women of all races who never finished high school • Obese women of all races have better outcomes than black women of normal rate • Black women in the wealthiest neighborhoods have worse outcomes than white women in the poorest neighborhoods • Black women that initiated care in the first trimester have worse outcomes than NHW who had no prenatal care

7. Framework for change

8. How societal factors impact health

9. Racism as a social determinant • Race is a social NOT biological construct • Race is not a genetic cluster nor a population. • Race is not a genetic cluster nor a population • Racism affects health both directly (i.e., via chronic stress) and indirectly. • Race-based discrimination across multiple systems creates differential access to high-quality schools, safe neighborhoods, good jobs, and quality healthcare, in other words, by shaping SDOH.

10. Its racism not race • Racism affects health both directly (weathering) and indirectly through race based discrimination across multiple systems which creates differential access to high quality schools, safe neighborhoods, quality healthcare. Thereby shaping the SDH

11. Implicit bias in medicine • Neel Shah MD “We believe Black women less when they express concern about the symptoms they are having, particularly when it comes to pain • Physicians are taught and accept race based stereotypes that are not rooted in fact • Blackness alone risk factor for cesarean when seeking care in academic medical centers • NICU nurses gave more attention to white babies than all other races • In every measure of reproductive health disparities Black women were diagnosed later and have worse outcomes regardless of income

12. Maternal morbidity/mortality risk factors Clinical Risk Ractors Social Risk Ractors • Housing • Income • Neighborhood safety • Air quality and environmental stress • Food insecurity • Access to quality, comprehensive, culturally competent health services • Low educational attainment • Unemployment or rigid scheduling • Eclampsia • Cardiac disease • Acute renal failure • Obesity • Chronic conditions • Serious obstetric complications • Hemorrhage • VTE • Infection

13. History of reproductive injustice • J Marion Sims • Joseph Delee and the demonization of Black midwives • Lying in hospitals • Medicaid and Medicare

14. Delaware Social Determinants of Health • https://www.edgap.org/#6/37.886/-97.000 • Delaware spends 3-6 times more to imprison an adult than it does to educate a child • There are more Black folks in Delaware prisons than there are matriculated in state funded public universities • Income inequality: The top 5% control 10x more wealth than the lowest 20%, 5 times more than the middle 20% • Educational inequality: family wealth is a predictor in performance on standardized testing even with a common core curriculum

16. Delaware social determinates of heath Wilmington • 70% of population are minorities • Highest rate of income inequality • Poorest educational inequality in the state • Medically underserved area based on provider to population ratio • Disproportionate crime rates • Designated a food desert • Limited access to safe green spaces

17. National and state based solutions • HR 1318 Preventing Maternal Dealths Act • Maternal and infant mortality Review • Recognize the special needs of ethnic minorities • Perinatal and Maternal Quality Care Collaborative • Adopting IHI Health Equity Framework • Reimbursement for doula care • Free tuition to community/vocational college programs • Robust law enforcement

18. Institutional solutions • Evaluate workforce diversity at all levels • Require bias training among all members • Intentional focus on ethnic and social diversity in residency recruitment • Center care in MCH around the family

19. Individual solutions • Evaluate personal implicit bias • Lean in • Reject the urge to deflect • https://implicit.harvard.edu/implicit/

20. Implicit bias testing My results: Go figure But I’m Leaning In

21. Community based solutions Full Range to address all SDH Community Based Doula/Community Health Workers • Food bank • Energy assistance • Sheltering • Educational mentoring • Neighborhood blight/community gardens • Job creation/job training • Transportation • Health clinics • Community Based Doulas • Voter Education Empowerment

22. Example: ROOtt Restoring our own through transformation Location: Columbus Ohio Services • Comprehensive health Education • Fatherhood intiatives • Advocacy • Healthcare • Doula Services • Mental Health Services • Legal services referrals • Community based research

23. Community based partnerships Benefits of Collaboration Potential Partners • Academic institutions • Local/State Advocacy Agencies • Local Businesses • Racial and Social Justice Organizations • Local Media Outlets • Greater chances/ amount of funding • Increase opportunity for collective impact • Share data and intel on local issues • Develop trusting relationships • Break down walls • Eliminate silos

24. Black mamas alliance partners

25. Black Maternal health week 4/11-4/17