- Just ahead on "Black Issues Forum," we'll talk about the top reproductive health concerns of Black women, what's hurting and what's helping, stay with us.

[upbeat music] ♪ Welcome to "Black Issues Forum" I'm Deborah Holt Noel.

Since the time of the Supreme Court's decision on Roe v. Wade and Dobbs v. Jackson, there have been conversations not only about a woman's right to agency over her body but also about her own health and mortality.

In Black communities, the conversations are often led by a striking statistic.

Black women are three to four times more likely to experience a pregnancy related death than white women.

Now, a documentary on Hulu titled "Aftershock" is refueling the conversation with data behind this statistic and the compelling personal stories of three Black families.

- After she gave birth, Shamony was complaining that she had really sharp chest pains.

- The ambulance came.

I'm telling them the symptoms.

- "Is she on drugs?"

- Next set of people come in.

"Is she on drugs?"

- They kept asking her monther, "Is she on any drugs?"

- I'm like, do y'all talk?

- We waited a solid 12 hours.

- She's gone.

Today, we're talking about some of the top reproductive health concerns of Black women including fibroids and infertility.

We'll meet our guests in just a moment but first Kenia Thompson brings us this report about a birthing practitioner who studies have found can greatly improve pregnancy outcomes.

That person is the doula.

- My family's very holistic.

- 'Cause a lot of our families do want a more holistic approach and those options are very limited in North Carolina.

- [Kenia] Fair accessibility and treatment of pregnancy care is a glaring area of need for north Carolinians, especially those in rural counties.

- Even though I have seen some advances change where providers are becoming more patient centered in their care, the entire system as a whole just really makes it impossible for that to be continuum care across the board because that is not the business of birthing in this country.

- [Kenia] Jamie Stewart who already has a seven year old son recalls the lack of intimacy and care in her first experience with maternal health providers.

- I would have no idea who was going to deliver my baby because it could be any doctor from any of the three shared practices that would've been on call at the time.

So I did it that way but I didn't feel comfortable.

- Every hospital policy is completely different.

So though you envision having this ideal birth when you go into the facility, that could change.

- [Kenia] For moms to be like Jamie who desire experiencing childbirth on their own terms, midwives and doulas create a safe space for their wishes to be granted.

- Now being older and being wiser, I wanted to make sure that I was with people that had my best interests at heart, who were professional, who would care, who would listen, who would advocate for me if there was an emergency.

And so that's why I am now with the midwife and having a doula.

- A doula is a non-clinical support system for our families.

We help coach them, we provide emotional, physical and mental support.

We help our clients navigate their pregnancy and postpartum with whatever information they need that they feel like they're not getting in medical spaces.

- I feel very confident in the providers that I've chosen to go through this home birth with.

I wanna be comfortable.

I wanna have my loved ones around me.

I don't wanna be restricted in any way, restricted to a bed or not allowed to eat or only on clear fluids.

And so, I'm extremely excited to be at home and to be at peace and be able to control the environment around me so that I can go through labor as easily as possible.

- As depicted by the Hulu documentary, "Aftershock", a disproportionate number of Black women are failed by the U.S. maternal health system every year leaving behind their children, their partners and their families.

- It's very scary.

I have people in my family that have gone through things that are pretty traumatic when it comes to healthcare, one being facial paralysis.

My aunt she went to the doctor, she told the doctor about it and I'm not sure how it was addressed immediately but that's something huge to come up during pregnancy to not be with someone that can adequately provide you with information about what's happening to your body.

How long can you expect for this to last?

Will this have any effects on you long term?

- A midwife is a clinical provider.

In North Carolina, you have to be a nurse in order to be a certified nurse midwife.

They have tons of medical expertise, background and training to do it very complex medical issues.

And we provide support for them as well to make sure that whatever assistance they need with their client that we're aiding them along the way.

- [Kenia] Midwifery and doula care provide a comprehensive approach to women's health and goes beyond pregnancy care.

- For us, we wanna know how are your social determinants of health being met?

Are you having housing issues?

Food insecurity?

Are you dealing with racism on the job?

All of these things because these things can impact the overall birth and the body of the pregnant person and so we wanna make sure that we are looking at people from a very holistic approach.

- [Kenia] Although every pregnancy is different, Jamie is confident in her choice to utilize midwife and doula care for her second birthing experience.

- I have the utmost faith in them, yeah.

If anything were to happen I mean, they've given me enough opportunities to ask as many questions as I have.

They've always provided an answer without any hesitation.

I know that it's something that they do all the time and so very confident in my providers.

- And now I'd like to welcome Dr. Velma Taormina, a women's health medical consultant and advocate and obstetrics gynecology specialist.

Dr. Pam Oliver, Executive Vice President at Novant Health and President of Novant Health Physician Network.

She's also a practicing OB-GYN.

And Keisha L. Kusar, a certified professional life coach, speaker and wellness instructor.

She's authored two books including the title "Sister to Sister : A Guide for African American Girls" and she says she works to help women achieve their unlimited boldness and potential.

I am so pleased to have all three of you here on "Black Issues Forum" today.

Dr. Taormina, I wanna open up with you.

Can you share a little bit about what you know about the value of a doula in the birthing experience but also in addressing some of the health disparities we talked about earlier?

- Sure, thank you for having me.

As we saw in the video, doulas can play a very important part in our healthcare team.

You know, as we have studied the issues specific to North Carolina about what's causing these disparities and how can we address them?

One of the things that we noted was that we did not include doulas in that provision of care.

We know from the studies done in other states that they can be an asset to the team.

- And most importantly they're an advocate for the patient.

So, by listening to the stories of individuals with lived experiences, and by having conversations with the doulas that are in our communities, we have been able to work with them to develop policy change recommendations that are needed to bring them into the fold so that they are part of our healthcare team.

But one of the things that we identified in that work is that we don't have enough doulas in our state.

We didn't have a central registry so although we know that they're practicing throughout many communities, we don't know where they're specifically located.

We don't know what specific doula services they're providing.

Their certification process was not standardized.

So we've taken the recommendations of how to move forward with making them a part of the team, but we have to develop the workforce.

And then on the other hand, we also recognize that we have no way to pay them.

So there are many birthing facilities that are paying for the services of doulas during the birthing process.

And there are individuals who can pay for services, but many women in our communities can't afford that cost out of pocket.

So while we have one group that's working on increasing the number of doulas in our communities, we have another group of advocates that are working with the payers in our state so that we can include them on our fee schedules, so that they can be paid for the work that they're doing.

- It's important work.

- So, there's a lot more happening in that space.

- Very much so and I'm grateful that they're being seriously taken as a profession and that the work is beginning to start to incorporate them.

Dr. Oliver, doulas can't do it alone of course, in addressing the kinds of disparities, the level of disparity that exists.

What more do you see needs to be done?

- Well, you're exactly right.

This is, maternal mortality is a complex issue and the disparity is complex.

So absolutely embracing doulas as part of a team but making sure that women have access to this dependable team that respects them and provides them with high quality care is important.

So I think that part of that is that we have to recognize access from the standpoint of physical locations, where do women actually receive care?

Doulas, midwives, being part of a bigger team for our high risk patients because not every pregnancy is low risk and amenable to a home birth or a birth that most of us would imagine and dream of.

And it's also about the quality of care.

You know, there have been studies that have shown that a large percentage of African American women live in the South and happen to be in areas and at hospitals that don't perform as well when we look at quality.

So that is an issue and it's that leading to our disparity.

And the fact that as a professional woman with multiple degrees my risk of dying in childbirth is still higher than a white woman who drops out of high school.

It's not all about education, money and insurance.

And that's why I appreciate the black maternal health caucus and the Momnibus.

They introduce 12 bills that address this from many many angles, whether it's data and understanding the issue better, addressing the social determinants of health and what we need to address to make sure the women can take care of themselves before and during pregnancy.

And access for many demographics that maybe right now may not have the best access.

- I wanna pull you in Ms. Cousar because we're talking about some policy and we're kind of talking in very matter of fact terms, but you, I would imagine, get an opportunity to have interaction with women, with girls on a regular basis.

What would you say the top three things are, or the top things are that we could be doing but that we don't in order to ensure our own reproductive health?

- One of the top, one of the three I would suggest would be looking at how we can better advocate for ourselves in terms of our mental and emotional health.

Even though there's these policies, there's situations and circumstances that cause challenges in reproductive health, I believe that from the ladies and the women and girls that I work with primarily is being more advocates in terms of our mental and emotional and physical health.

There's things that we can do that we have ownership and control of that can be advantageous to us as we continue to grow and progress in relation to reproductive health.

- Why aren't we advocating for ourselves?

What's happening?

- What's happening is, is more fear, fear base, not feeling adequate enough, being afraid to sound the alarm, to open our mouths, to share what our situations and concerns are on a everyday plane level versus feeling like I'm not adequate.

- Just feel squashed.

- Many people don't feel like they're, right feeling like their voice doesn't matter.

And that their voice doesn't have enough weight when they are in front of certain people, based on race, ethnicity, based on many different factors.

They feel like they are not enough.

And so in order to have a sense of confidence, a sense of awareness, and to feel educated enough to advocate for one's self irrespective of education, status, degrees that you as an individual matters, that's what's most important.

- And that can be quite the journey given all of the things that we have to deal with on a regular daily basis in society.

I wanna go back to you Dr. Taormina because this Momnibus bill has made several provisions that are available right now and they have to do with affordability of services and access.

Can you talk about some of those provisions?

- Yes, and I love what she just said because that is so important for someone to have a voice and to ask for what is specific to them.

So, as part of the work that we've done, Medicaid just recently expanded postpartum coverage for 12 months after delivery.

And that is so important for many individuals because, if they traditionally had had Medicaid for pregnant women then their coverage after a delivery would end in two months.

Now that coverage is for a full 12 months and it's full benefits.

So that means they can go to the dentist.

They can go and get eye care.

But most importantly, especially if you look at our black women, you will see that the most common thing that's going to impact them, and the most common risk factor they have is cardiovascular disease.

And so when somebody comes in for that postpartum visit.

They need to ask, you know, "What problems did I have during my pregnancy, that I need to address in the next year?"

And you wanna have the conversation too, about your reproductive- What we call reproductive life planning.

You know, are you done with childbearing?

And if you are, how are you going to prevent pregnancies in the future?

Or if you're wanting another child, then how do I- I like to say, "How do we tune you up?"

You know, how do we take whatever concerns you have at this time?

And how can we work on a plan to make things better for that next pregnancy?

Because that's where you're gonna see an impact on future healthcare.

You know, so if they had blood pressure problems during that pregnancy.

Well, let's make sure that you're connected with a primary medical home and a cardiologist, so that they can study you and talk to you and listen to you to see what are your needs and how are we going to make that a stable condition going forward into that next pregnancy.

So, you know, we're excited about this change.

But the change is there, now we need to go back into our communities and educate everybody about what that means, and what services are available to them.

- Right, because if the services are there and people aren't taking advantage of them.

There will be this perception that, "Whoa, the services aren't needed."

But then also, no one's getting the benefit from it.

Dr. Oliver, you know, we talked about maternal mortality.

But there's some other statistics in terms of the disparity for Black women.

Black women are three times more likely than white women to have fibroids.

And this is something I never quite understood.

It can cause postpartum hemorrhaging.

Why is there the difference in the number of... Or the incidence of fibroids for Black women?

Is there any explanation?

- I wish I could tell you clearly.

There's a lot of research that has gone into this.

And we do not have an absolute answer to that.

There are many hypotheses around is it related to weight gain?

In obesity?

Does that play into it?

Is it a vitamin D deficiency?

There's so much that's been studied, but we truly do not understand why it is that women of African descent, specifically, have a higher risk of fibroids.

And not just that they have fibroids.

It's also that they're, they tend to be larger, and they are more symptomatic, causing heavy menses or problems with pain.

So there's still a lot of research to be done in this and understand it.

Because we see it in some African nations even, not just in the United States, with women of African descent.

- So even though we...

So even though we may not know why this is the case.

Understanding that it is currently the case, what are some steps that Black women need to be doing for themselves and perhaps for their daughters?

- Oh, well, absolutely.

One thing that we talk about, we want whether you go to a primary care physician, a pediatrician early in life, or an OBGYN is have a conversation about what your periods are doing, right?

The heaviness, there's a lot of- We've normalized for Black women, heavy menses or painful menses in a way that we often don't get an evaluation.

I don't know that my patient has a fibroid, unless I can actually- It's large enough for me to feel on an exam.

Or we get an ultrasound.

And so I think that sometimes we never get the workup that we might need to address the issue.

Because we either don't have the conversation, we have the conversation, our voice isn't heard.

You know, you heard a lot of what we talk about here is about voice and trust.

And so I say, "Advocate for yourself."

And if you are having something that you feel like is out of the norm, when it comes to your period flow or pain.

Really request and demand some evaluation for that.

- Ms. Cousar, you know, when it comes to that self-advocacy in the health space.

And knowing that we feel disempowered already.

How do we change that for ourselves and for our daughters?

Are there things that we need to be putting into practice?

To try to bolster our confidence, to have that voice?

- Absolutely.

There's a couple of things that we can put into place.

Number one, I would say, being transparent and intentional in having conversations in our homes.

Having conversations in our homes about our health.

Whether it's our mental health, our emotional health, our physical health, opens up the dialogue.

So that when you're having these conversations in front of a healthcare provider, it's not something you have not addressed before.

I think oftentimes between mothers and daughters, even fathers and daughters, whomever is in the the home setting, or having conversations in the community.

We must begin to utilize our voice in various sectors, so that we can have the conversations.

Because when our mouths are closed, we're not opening up to be able to communicate what our needs are, what our experiences are.

So the voice is muted and we don't feel empowered.

Because we have not utilized our voice, and fear sets in, and feeling inadequate sets in.

And so having the primary conversations, being proactive, utilizing prevention in various sectors allows us to communicate.

The next thing I would also say is having a support system.

If you are not confident yourself, being, having another friend to be, to come along with you as a gatekeeper.

To walk into a doctor's office.

To have a conversation with you.

The need for support and sisterhood and community is vital.

If I'm not able to have the conversation, but yet I bring along another sister with me who can support me in these environments.

Together, we are better.

And so I believe that would help in us speaking up for ourselves, as well as for one another.

- I've never even thought of that.

Taking us- Why not take someone with you?

And you know that there are sisters, there are brothers who have that voice and they will not hesitate to speak up.

And maybe you need that person with you.

And that's okay.

That's so important that you shared that.

Let me address one other issue area.

And I'll start with you, Dr. Taormina, about infertility.

There is a higher incidence rate of infertility with Black women as well.

Is there any of your work, or anything in the Momnibus Bill that addresses efforts to have children and infertility.

- Yeah, so that includes a section on increasing awareness of that as well.

When you look at the work that's being done in that space at this time, the majority of that work is being done on white women.

We don't have enough Black individuals that are aware that they can access these services.

But being aware or being able to access it doesn't mean they have access, so, again, just making sure that we have the provider space and the ability for individuals to seek out what that means.

And, as you said, a lot of times we're not having those conversations within our families.

We're not bringing up the fact that "I haven't been using birth control for the last year and I haven't been pregnant, I haven't been able to get pregnant, so what else do I need to do?"

And so just increasing awareness of the fact of what we would consider to be normal timing for being able to conceive and then being able to have those conversations with our girlfriends, with our family members, and then with our clinicians so that we can say, "this is what I'm experiencing now.

If I haven't gotten pregnant, what are my options?

What's the next step?

What's the workup that needs to be done for that?"

- And it's so personal, it can be, I think, embarrassing for a lot of women and I think particularly Black women for some reason.

Dr. Oliver, what would you add to this?

- I would say I reiterate everything that's been said.

We owe it to our daughters to be able to share information, our health history.

You'll hear women who they don't talk about cancer diagnoses in their family, they don't talk about any of their medical history.

It's secret, you keep that to yourself.

So I definitely think the support aspect of this is very important.

And then as you advocate for yourself, seek to understand.

Educate yourself on whatever it is 'cause not everything is black or white.

I say that I want to individualize treatment for my patients based on what they need.

So if they have fibroids, it doesn't mean they need a hysterectomy.

But if they do want to conceive or have a baby, I need to consider what their specific situation is.

And the most important thing is when I sit down with them that I can have a conversation that makes them feel seen and heard and that what I am telling them is something for them and can't be generalized necessarily to their girlfriends.

So the other thing I would say is we have to be careful that we don't think about "what my girlfriend had is exactly what I need," because sometimes that's what comes into the room with us.

And so be open, but definitely support each other and educate yourselves.

- Absolutely, and Miss Cousar, what would you add based on your interactions with women and girls on this issue, infertility?

- I think it's very important that we continue to share that there is healing and hope in our experiences, in our shared experiences and when we begin to speak with one another and speak out, that our voices have so much power.

And we have to maintain a mindset that says "there's no shame, there's no shame, but there's power in my vulnerability and there's power in utilizing my voice" and that there's healing and hope in our shared experiences.

- Those are such powerful ideas and words.

I hope that our audience embraces that.

And we didn't have an opportunity to have the time to talk about the men in our lives, but I was so very impressed with this documentary on Hulu, "Aftershock", the men who were so supportive of their wives, of their daughters, of their sisters, and so I would certainly recommend people to see this documentary.

I want thank you, Dr. Velma Taormina, also Dr. Pam Oliver and Kiesha Cousar.

Thank you so much for your advice.

I want to thank our guests for joining us today and we invite you to engage with us on Twitter or Instagram using the hashtag #BlackIssuesForum.

You can also find our full episodes on pbsnc.org/blackissuesforum or listen at any time on Apple iTunes, Spotify, or Google Podcasts.

For Black Issues Forum, I'm Deborah Holt-Noel.

Thanks for watching.

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