“I should have said something,” said Telika Howard. “Why didn’t I say anything?” Howard gave birth seven times in seven hospitals, and seven times she was traumatized. She felt the medical professionals did not understand her needs or give her the best possible care.
In 2001, at the age of 21, Howard gave birth to her second child at Regional One Health Medical Center in Memphis, Tennessee. She said a nurse came in and administered a shot without her permission. When Howard asked what it was, she said the nurse replied, “It’s a birth control shot because you don’t need to be having any more children.”
In 2004, she gave birth in Chicago, where she lives now, at a hospital that is now closed. She said she felt like she was put on display, as several medical students observed her without her consent.
Then in 2011, Howard was pregnant with twins in Rose Medical Center in Denver, Colorado, and called an ambulance in a panic. “I’m freaking out thinking, ‘OK these babies are coming early,’” she said. “Well, when I got there, they said I’m fine and I just need to drink more water.”
When the nurse entered the hospital room, Howard said she was told she shouldn’t have called an ambulance because that costs taxpayers money. “She doesn’t know me,” said Howard. “She doesn’t know my insurance information. She is just assuming things about me: I’m Black. I must be poor. I must be here on government medical assistance. And even if I was, that wouldn’t be something appropriate to say to anyone.”
She continued. “It comes from history, you know, this fake welfare mother that was put out there,” said Howard. “Welfare queen—they are these Black women that just have lots and lots of babies just to drain the system and go into our precious pockets.”
Howard is one of the many Black people across the nation who deal with discrimination in the health-care system and suffer pregnancy trauma at the hands of hospital staff. Black women face higher maternal mortality rates, are more likely to have postpartum depression, and are 50 percent more likely to deliver a premature baby than white women. Black women are three times more likely to die from pregnancy-related conditions than white women in Illinois and six times more likely to die in childbirth than other races in Chicago.
After her first traumatic birth experience, Howard became a certified birth and postpartum doula, who, while not a health-care professional, provides support during childbirth. She is among the growing number of Black women in Chicago helping other Black women have a more comfortable experience giving birth, by pushing for more equitable, culturally appropriate, and accessible options, including access to birthing centers, medical facilities staffed by midwives that are often more like homes than hospitals.
“This has been going on for a really long time since they’ve thrown out Black midwives and brought birth into hospitals,” said Howard. “They are not wanting babies of color to be born, to be here. They just feel like it’s a drain on our system.”
In her book Killing the Black Body: Race, Reproduction, and the Meaning of Liberty, Dorothy E. Roberts, Chicago native and law professor at the University of Pennsylvania, wrote, “The picture of reckless Black fertility is made all the more frightening by a more devious notion of Black women’s childbearing.” There is a deep-rooted history of racial intolerance in the American health-care system. During the second half of the 18th century, physicians entered the field of obstetrics, breaking traditional midwifery and escalating tensions between Black midwives and medical professionals, who later banned the practice altogether.
The State Board of Health was organized in 1877, leading to the government-controlled medicalization of birth. (Illinois was the first state to require licensure for birth.) At the time, only white men were allowed to practice obstetrics. That year, the Medical Practice Act gave health boards the authority to determine who could be a physician, and eventually pushed fundamental changes in medical school curriculums, purged unlicensed practitioners and outright frauds, reduced the number of nonmedical school graduates, revoked licenses of abortionists, unified the best organized of both regular and irregular medical practitioners, and marginalized midwives.
“These were white men,” said Tayo Mbande, cofounder of Chicago Birthworks Collective, an organization dedicated to improving birth outcomes for women of color and their babies. “White men who sought to have a better understanding of something they had no idea about.”
Indeed, the first State Board of Health was made up of five white men with full beards, one white man with a goatee, and one white man with just a mustache.
When Jeanine Valrie Logan, a certified nurse midwife, was about to have her first child in September 2010, she faced an obstacle. “I’m going to have a baby in a birth center, but there were none. I’m having my baby at home,” Logan said. “I’m not going to a hospital. No, I’m a doula and a student midwife.”
Logan said she could not find a Black midwife that practiced home birth in the city. Through a Google search, she found a white certified nurse midwife to deliver her baby at her Lincoln Square apartment. A 2007 law had authorized only ten birth center licenses in the state: four total in Cook, DuPage, Kane, Lake, McHenry, and Will counties; three in municipalities with a population of more than 50,000 that were not located in collar counties; and three in rural areas. And of those birth centers, one had to be owned or operated by a hospital and another by a federally qualified health center.
The first alternative birth center in the state, PCC Community Wellness, opened in Berwyn in 2015. A few years ago, Logan started working at the birth center as a certified nurse midwife after finishing school at Frontier Nursing University in Kentucky. She’s now working to open a birth center on the south side. (“It’s our vision to provide culturally-safe, evidence-based midwifery care alongside families and within community,” she says in a fundraising video.) Logan’s work on passing House Bill 738—which Governor J.B. Pritzker signed on August 20—will expand access to birth centers on the west side, south side, the far south side, and East Saint Louis. Eleven birth centers are now allowed in those six counties.
Illinois representative Robyn Gabel, one of the main cosponsors of the bill, said expanding women’s options in childbirth has always been a core component of reproductive rights. “Obviously, there’s prejudice in the whole system,” said Gabel. “Women should have maximum control over their bodies.”
This year, Gabel was also a cosponsor for House Bill 0004, which provided coverage under the medical assistance program for doula services, and House Bill 354, which allowed out-of-hospital births by certified professional midwives (CPM). Until then, Illinois only legally allowed certified nurse midwives (CNM) to perform out-of-hospital births. Now, under the Licensed Certified Professional Midwife Practice Act, midwives trained to do home births will be allowed to practice midwifery as the “means of providing the necessary supervision, care, and advice to a client during a low-risk pregnancy, labor and the post-partum period, including the intended low-risk delivery of a child, and providing normal newborn care.”
These bills came after Pritzker signed an Omnibus Health Equity bill that included provisions for doula training, providing support throughout the prenatal, labor, and delivery, or postpartum period; medical assistance coverage for doula and home-visiting services; and a requirement that the Department of Healthcare and Family Services consult with doula program experts and home-visiting experts.
“[That] women don’t have access to deliver their children in their community is amazing to me and the fact that you’re not surviving, so many women are not surviving the birth of their child, is amazing to me when we spend, again, trillions of dollars in health care . . . to create access to health care that people just somehow do not get,” said Illinois representative Camille Lilly, one of the sponsors of the bill, in a Zoom meeting with the public and Planned Parenthood.
There are more women in Illinois who want a home birth than midwives who serve them. According to the 2020 demographic report from the American Midwifery Certification Board, 85 percent of CNMs and certified midwives identified as white, while less than 7 percent of midwives identified as Black or African American.
“You can search high and low, you are not going to find any other Black CNM who is providing home birth support,” said Mbande of Chicago Birthworks Collective. “All of the student midwives I know that are Black are training to be CPMs. CPM licensure would mean that there could be dozens of Black home birth midwives. I mean dozens of them.”
“The doctors rushed me to having an emergency C-section,” said Ashley James. “I really didn’t really have a say in this situation.”
Fourteen days after the C-section, James’s baby passed away in the ICU at Advocate Christ Medical Center in Oak Lawn. “I wish I had someone who was there in my corner for me,” James, who was 18 at the time, said. During her second hospitalized birth, James lost another child. “That’s why I want to be there for women, especially for Black women in Chicago.”
James works on-call for Chicago Volunteer Doulas and said her experiences shaped the way she views the current American health industry.
“There is this statistic that Black women are so strong that no one offers to help because they’re like, ‘Oh, well you’re a strong Black woman, you don’t need my help because you got it all together,’” James said. “But at the end of the day, we are all human as well and have emotions as well and some women don’t want to act like they are a burden and don’t seek the help they need.” James said that like many others, she kept quiet.
Only four hospitals on the south side provide delivery services—Mercy Hospital in Bronzeville, University of Chicago in Hyde Park, Advocate Trinity Hospital in Calumet Heights, and Roseland Community Hospital on the far south side. This year the lack of options became even more critical when it appeared Mercy Hospital would close, though an agreement was struck to keep it open thanks in part to strenuous community advocacy. The closing of Mercy would have eliminated 30 OB/GYN beds where 900 babies were delivered last year.
Though the expansion of birth centers on the south and west sides allows reproductive autonomy for Black women, Howard sees the continued exclusion of Black women in new birthing center laws. Previously, Howard worked with Chicago Volunteer Doulas, Birthways Chicago, and Chicago Family Doulas. She said the majority of the clients from the latter two organizations are from north-side areas that are predominately white.
“It was good money and everything, but it just wasn’t where my heart was,” said Howard. “I was basically treated like a servant, and I am not in this to just be a servant to the rich. I am in this to make a difference.” Recently, Howard left Family Focus Lawndale and will soon start as a lactation consultant specialist at the University of Illinois Chicago hospital in the mother and baby unit.
Mbande, who unexpectedly got pregnant in college, would later realize her experience was not traumatic because of the support around her, especially from her mother who was instrumental in all of Mbande’s pregnancies, births, and postpartum journeys.
“There are so many Black women who don’t have this,” Mbande said. “The support my family was able to provide influenced the information I sought out and influenced my confidence to seek out information and make decisions that at the time felt super radical, like saying no to an induction or choosing the position to birth in.”
When Mbande had her second child, she kick-started her organization Chicago Birthworks Collective, which aims to help navigate the health-care system, and teach those delivering how to advocate for birth rights or curate their own birth experience. “White women are not the folks that need more access to birthing options,” said Mbande. “Black people should have their babies where they live. If a Black person lives somewhere where they can’t have a child, then that is the problem.”
Angela Ellison was nine years old when her mother died from blood clots, nearly a month after giving birth to Ellison’s younger sister. “That’s probably why I am passionate about maternal health and child health,” Ellison, senior director of the Office of Community Engagement and Neighborhood Health Partnerships at University of Illinois Chicago, said. “It is that energy and my mother was a middle-class Black woman living in the south side of Chicago, living in the 60s, but she delivered at a hospital on the north side where they might or might have not given all the treatment they could have given to her.”
Her mother was in the hospital for three weeks. “Did they run the test in 1969 to see? Were there tests around blood clots in 1969? I don’t know,” she said. “But it seems like to me there might have been.”
Ellison said when she comes into the doctor’s office and asks for a specific drug to alleviate her pain, the medical staff will question whether or not she is a drug addict, whereas a white woman might have a medical professional write a prescription when asking for similar pain relief medication. “Because of who I am, I have always sought doctors who look like me,” she said.
Ellison is a project director for UIC’s federally funded Healthy Start initiative, which is aimed at addressing health disparities experienced by women and infants in Englewood, Auburn Gresham, and South Shore. She said the Black and Brown communities she researched on the west side in the 1980s experienced 28 deaths per 1,000 live births, and on the south side as high as 36 deaths. The white infant mortality rate at the time was eight deaths.
The Adequacy of Prenatal Care Utilization Index scores “adequate” care as 80 percent or greater. According to the Chicago Health Atlas, today Englewood scores 51 percent, Auburn Gresham 58.5 percent, and South Shore 58 percent.
UIC was one of the five organizations in Illinois to receive Healthy Start funding in 2019, but the only organization with an academic medical center. Despite the pandemic, Healthy Start served over 300 Black women and babies this past year. It also partners with Uber to provide patients with transportation for their medical appointments. So far, Ellison said the program has made 30 trips a month. Ellison wants to hire doulas and has a community-action network to bring people to talk about common issues and create an agenda to address health equity.
“Doulas are critical to this work and are important in improving birth outcomes for Black women,” Ellison said. “If you can’t have a provider that looks like you, having a birth worker or doula would be very helpful.”
“I always hear there’s something wrong with Black women,” Ellison said. “‘Oh, I’m sure it’s because they’re getting high and drinking.’ More often than not, our clients are not drinking or smoking or getting high; that’s not contributing to low birth rate. What’s contributing to low birth rates is not getting proper rest, not getting enough exercise, not having access to quality food, running into health-care providers that treat them less than human, and who don’t talk to them and don’t speak to them.”
“If you care about the large-scale issue,” said Mbande, “which is all that is beneath maternal mortality for Black women, which is racism, then you would be looking at a whole big picture of things. It’s not just starting a bunch more birth centers. It’s not just about getting more midwives. It’s about radically changing the experiences and radically addressing how institutions feel about and how they value Black women.”