Miriam Zoila Pérez: How Does Racism Affect Pregnant Women And Babies? Why do pregnant women of color have different health outcomes from their white counterparts? Writer and activist Miriam Zoila Pérez explains the ways racism manifests for these women and their babies.

Miriam Zoila Pérez: How Does Racism Affect Pregnant Women And Babies?

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It's the TED Radio Hour from NPR. I'm Guy Raz. And on the show today, the Consequences of Bias and Racism. And those consequences can affect everything from the opportunities you have, to where and how you get educated, and even your health.

MIRIAM ZOILA PEREZ: Black women in the United States are 4 times more likely to die during pregnancy and childbirth than white women.

RAZ: This is writer Miriam Zoila Perez.

PEREZ: In certain places, that gap is even higher. So in New York City, for example, that rate is 12 times. Black women in New York City are 12 times more likely to die than white women in New York City during pregnancy and childbirth.

RAZ: Why?

PEREZ: I mean, the answer that I've come to, and a lot of people have come to, is racism - literally the way racism impacts people's bodies, and their health and their well-being.

RAZ: About 10 years ago, Miriam started working as a volunteer with pregnant women from a wide range of backgrounds.

PEREZ: And I was really interested in the anthropology of reproduction and read a lot about that. But then the reality of what women are experiencing that I saw in the hospital context was so racialized in a way that that academic study did not uncover.

RAZ: Here's more from Miriam Zoila Perez on the TED stage.


PEREZ: African-American women in particular have an entirely different experience than white women when it comes to whether their babies are born healthy. In certain parts of the country, particularly the Deep South, the rates of mother and infant death for black women actually approximate those rates in sub-Saharan Africa. In those same communities, the rates for white women are near zero. They're also twice as likely for their infants to die before the first year of life than white infants, and 2 to 3 times more likely to give birth too early or too skinny, a sign of insufficient development. Native women are also more likely to have higher rates of these problems than white women, as are some groups of Latinas. For the last decade, as a doula turned journalist and blogger, I've been trying to raise the alarm about just how different the experiences of women of color, but particularly black women, are when it comes to pregnancy and birth in the U.S. But when I tell people about these appalling statistics, I'm usually met with an assumption that it's about either poverty or lack of access to care. But it turns out neither of these things tell the whole story. Even middle-class black women still have much worse outcomes than their middle-class white counterparts. And while access to care is definitely still a problem, even women of color who receive the recommended prenatal care still suffer from these high rates. And so we come back to the path from discrimination to stress to poor health, and it begins to paint a picture that many people of color know to be true. Racism is actually making us sick. Still sound like a stretch? Consider this. Immigrants, particularly black and Latina immigrants, actually have better health when they first arrive in the United States. But the longer they stay in this country, the worse their health becomes. People like me, born in the United States to Cuban immigrant parents, are actually more likely to have worse health than my grandparents did. It's what researchers call the immigrant paradox, and it further illustrates that there's something in the U.S. environment that is making us sick.

RAZ: So the research that you found points to this idea that racism actually translates to physical symptoms and long-term health problems.

PEREZ: Right. So what we understand now is that discrimination actually has an impact on people's health through basically the nervous system, the mechanism the nervous system. So when you experience the discrimination or the threat of discrimination, your body is flooded with hormones like cortisol and adrenaline that are really helpful when you're actually facing a life threat but really have a sort of negative impact when it happens all of the time over long periods of time. So things like being concerned that you're going to get pulled over while driving your car. Even just the threat of that creates, like, this feeling of nervousness. And, I mean, people can relate to this, right, in the nervousness they have when, you know, they have to slam on their brakes really quickly or something. Or the nervousness they experience when they have a conflict with someone. Over time, that kind of fight-or-flight constant response actually weathers your - the sort of systems that keep you healthy, as well. And so that's kind of what people are starting to point to in understanding why these health disparities exist across lots of different health issues, not just maternal health.

RAZ: So let's talk about an African-American mom in an American hospital who's 4, in some cases 12, times more likely to die in childbirth than a white mother about to give birth. What are some of the things that an African-American pregnant woman might face that would cause the possibility that she would die in childbirth?

PEREZ: So I mean, I think you have to start, like, before she gets the hospital, right? So it's what we were just talking about around people's experiences, people's broader life experiences and the challenges that folks face and the ways that race impacts. How many more challenges and barriers and sort of difficult and stressful events does someone face? So one of the places you can look at it is high blood pressure. So you can kind of understand that maybe physiologically that if you're constantly under stress that your blood pressure might have a response. Well, preeclampsia, high blood pressure in pregnancy can be really, really dangerous.

RAZ: It can kill you.

PEREZ: It can kill you. Right. So that's one of the things that we see higher rates of in African-American women. I think it's also important to note that Native American women also face higher rates. They're sort of the second group. And then when it comes to Latinas, it depends on who you're talking about and the subgroups. And then white women have the best outcomes. And Asian women, again, tend to have better outcomes, but it does exist in other groups.

RAZ: It seems to me that part of this goes back to your idea of the immigrant paradox - right? - that it's about the environment.

PEREZ: Right.

RAZ: Like you leave, you know, El Salvador. And you had your mom and your sisters and your brothers and your uncles and aunts. And you lived nearby. And then you managed to get across and you're alone. And you're out of that supportive environment.

PEREZ: Right. But even people with their families here still struggle, right? So it's not just the immigrant traveling alone. But I do think that social support is a big piece of the puzzle. And that's where the individual model really goes to its worst is that we - not only do we not provide environments where pregnant women are supported, we also criminalize and penalize them for their actions. So you're seeing a rise in women being prosecuted for drug - substance abuse - substance use during pregnancy or even for the outcome of their pregnancy, if they end up with a miscarriage, being charged - criminally charged in places like Alabama, for example.

But yeah, women are being criminalized for the choices they make during pregnancy. And you see that in certain states. And that's, I mean, that's the exact opposite of what is ever going to help that person have a successful and healthy pregnancy is criminalizing them and putting them in jail, which is a great context for a pregnant woman, like, absolutely not, right? So you start to see when we blame individuals for these situations, then we penalize them. And it's the exact opposite of what's going to make them healthier.


PEREZ: This problem, that racism is making people of color but especially black women and babies sick, is vast. I could spend all of my time with you talking about it, but I won't because I want to make sure to tell you about one solution - the JJ way. Meet Jenny Joseph (ph). She's a midwife in the Orlando, Fla., area who's been serving pregnant women for over a decade. Her clients, most of whom are black, Haitian and Latina, deliver at the local hospital. But by providing accessible and respectful prenatal care, Jenny has achieved something remarkable. Almost all of her clients give birth to healthy full-term babies.

Her method is deceptively simple. Jenny says that all of her appointments start at the front desk. No one is turned away due to lack of funds. No one is chastised for showing up late to their appointments. No one is talked down to or belittled. Jenny's waiting room feels more like your aunt's living room than a clinic.

When you finally are called back to your appointment, you're greeted by Alexis (ph) or Trina (ph), two of Jenny's medical assistants. During one visit I observed, Trina chatted with a young soon-to-be mom while she took her blood pressure. This Latina mom was having trouble keeping food down due to nausea. As Trina deflated the blood pressure cuff, she said, we'll see about changing your prescription, OK? We can't have you not eating.

That we is actually a really crucial aspect of Jenny's model. She sees her staff as part of a team that, alongside the woman and her family, has one goal - get mom to term with a healthy baby. This is a big departure from the traditional medical model because it places responsibility and information back in the woman's hands. So rather than a medical setting, where you might be chastised for not keeping up with provider recommendations, the kind of settings often available to low-income women, Jenny's model is to be as supportive as possible. And that support provides a crucial buffer to the stress of racism and discrimination facing these women every day.

But here's the best thing about Jenny's model. It's been incredibly successful. Remember those statistics I told you, that black women are more likely to give birth too early, to give birth to low-birth-weight babies, to even die due to pregnant - complications of pregnancy and childbirth? Well, the JJ way has almost entirely eliminated those problems, starting with what Jenny calls skinny babies. She's been able to get almost all her clients to term with healthy, chunky babies like this one.

This is a infant, a baby girl born to a client of Jenny's this past June. So a similar demographic of women in Jenny's area who gave birth at the same hospital her clients did were three times more likely to give birth to a baby below a healthy weight. Jenny is making headway into what has been seen for decades as an almost intractable problem. It's a revolution in care just waiting to happen.

RAZ: I mean, is the Jenny model - the Jenny Joseph model - can it happen? Can you imagine that model existing all over the United States?

PEREZ: This can work in any context. It's about the way that you treat people, and it's about access to the clinic, right? So I do think if we understood the interventions to these problems, understood this to be an intervention, it should be funded to the tune of millions of dollars like a lot of other interventions are funded, right? If Jenny's model was a pill that you could take, it would be like the next big thing, right?

But it's not a pill. And in some ways, it's more simple than a pill. But that's not the way that our system is set up to deal with these kinds of interventions. And they require people to create environments that are relatively free from bias - right? - and that treat people of color with respect. And that's surprisingly, unfortunately, a really difficult thing right now.

RAZ: That's Miriam Zoila Perez. She's a writer and the host of two podcasts, Radio Menea and Tonic. You can see her full talk at ted.com.

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