music) (upbeat music continues) - Hey y'all, I'm Kiara Butler and welcome to "Generation Rising," where we engage in difficult conversations that our communities face every day.

Today my guests are Quatia Osorio, better known as Q, founder of Our Journ3i.

She's also the executive director of the New Urban Perinatal Education Center and a doula, a retired doula.

And then we have State Senator Tiara Mack.

Welcome ladies, how are you?

- [Tiara And Quatia] Good.

Thanks for having us.

- All right, so I recognize that this episode can be a little heavy, and I wanna let our viewers know that, so before we start, I wanna kick us off with a question around Black joy.

What does that mean to you?

- Oh, I love Black joy.

Don't you love Black joy?

- I love it.

- It is just being in peace and free and love.

Sometimes it's hugs.

Right now, it's grits in my mind.

Just being in existence and at peace in a place and a space that you don't have to run or feel stressed and you can just enjoy.

Oftentimes, it's really in community for me, just being in community I just feel so much Black joy, I be so happy.

My children, they gimme Black joy.

- Yeah, go ahead.

- Yeah, for me it's unapologetic.

It is free.

It is liberated.

It's silly.

It is loud.

It is defiant.

It is waking up early, being bothered by nobody.

It's staying up late, still bothered by nobody.

Yeah, it's smiles, it's hugs, it's reading.

It's both the isolation of knowing I got me, but it's also the aspect of knowing I've got community and community got me.

- Yep, and Tiara, you mentioned defiance and unapologetic.

How do you balance that being a state senator?

- I create my own rules.

That is being the only queer Black woman up in that space.

And this coming year we still have general elections, so I don't know if I'll have any other Black women, but this past year I had Cynthia Mendes and that was it.

And this session, I could be the only one.

I'm the youngest, I'm the Blackest, I am the queerest, and so I get to make my rules of what it looks like to lead, and luckily my community and the people who elect me appreciate that I lead with authenticity, heart, love and that I stand up for communities in ways that are authentic to me and communities.

I'm a directly-impacted person, formally low-income, and so I know what it's like to have many of the experiences that the families have, whether or not they look like my family's or not.

Many of the experiences of working paycheck-to-paycheck, fighting to make sure that you can pay both rent and your utility bills, making sure that you can pay for life's basic needs, and then also having your family around there.

Those are all the experiences that I grew up with and still resonate with, and that's what I fight for, so I get to make my own rules, because there is no blueprint of what it looks like to have someone like me in office.

And the office is not created for me, so instead of trying to fit into it, I create my own rules and make it fit around me.

- I wanna warn people that this may get heavy in the conversation, and so please, if you need to take space, please take space.

And so research shows that Black women are two times more likely to experience complications during pregnancy.

Why is that?

- Well, racism, let's just start there.

That's just the detriment of all health wellbeing, wellness, including spiritual and emotional.

For our Black women in the United States, we are generally, in Rhode Island specifically, we're two to three times greater.

In some states it's as high as 12, three to four standard, as far as the nation, and a lot of it has to do with, since we're no longer breeding free labor, sometimes we're a burden to the system.

They can't kill us, they can't bury us, and so unfortunately, we still...

The healthcare system was not welcoming to us.

Remember, we used to give birth in the basement, no medication, and so while we are now allowed upstairs into the facilities, a lot of the mindset of they don't need as much pain medicine, they still have thick skin, a lot of those negative connotations still further, oh, they're drug seeking, because the whole war on drugs thing, has people believing that Black people are drug seeking in order to get gain, or they're too poor, they don't deserve to have this baby, so why should we give them quality care?

So that we're dealing with a lot of bias, a lot of racism, a lot of discrimination within the medical industrial complex, better known as our hospital and healthcare system, and it's pervasive.

And it's in a way where, no matter how you look at it, where we flood it with Black providers, if they're still in the system of harm, they really can't take care of us the way we need to at macro levels, and so we often find new ways to try to take care of each other.

The community has been decimated, because welfare systems has caused us to break apart our Black families.

You can't go on welfare and get food stamps if your partner is still in the house.

We're not going to help you.

We're not gonna assist you.

You're always worried about your Black partner being locked up, going to jail, that type of violence again, so the mental exhaustion, the allostatic load, the stress, macro, micro aggressions in the workplace, just bearing down, so it's constant environmental injustice, again, to Black birthing body.

It is the stress of going into the healthcare system where they don't believe you, and there has been numerous scholarly studies and research about not being believed when you go in for healthcare, I very much advocate, as a doula, for people to write inside their medical health charts.

Give a summary of what your appointment went like.

Because oftentimes me telling my provider, "Hey, I don't think I want an induction," or "I don't want an epidural, I don't want this.

"I wanna have my baby naturally."

They're told to the provider, but it doesn't get written into the notes, and so- - Wait, so you're telling me we get to choose what we want while we're going through a birthing experience?

- Hopefully, yes, choice is one of those things that we're actually pushing for.

That was the big proponent for the Doula Bill, was you get to choose your doula provider, and so it's not, oh, my medical card says I go see Dr. such and such and am I assigned a doula?

No, you interview your individual doulas.

You have consults with them and then you say, "Oh my gosh, I really love our relationship.

"I think I wanna choose you.

Do you have space for me?"

And it really allows it to be a natural and organic relationship that's built.

But as far as the way the Black maternal health system goes, this has been a constant epidemic.

We've been constantly targeted.

You look at rural populations down South, they're running two, three hours before they can get maternal health.

They are in what they call maternity deserts, which is unbelievable.

These are intentional, because as long as birth is a business, and if it doesn't bring in enough revenue, then why are we doing it, even though it's one of the most integral, intimate and sacred times of our lives, people are treating it as transactional.

Partners, they may now be allowed in the room, but no one's really talking to them when they're in that space.

No one's really advocating for those choices, because the system, itself, is so stressed out.

We are understaffed, we're overstressed.

The insurance companies continue to either bundle for cost-saving benefits, which then unfortunately allows providers and systems to become creative in how they're going to do detrimental harm in order to make up for the buck on that backend.

The appointments are shorter instead of longer, because we need to get more volume, so there's less quality in the conversations.

Everything is very transactional and instantaneous.

And so when you think about stuff like that, you coming in new to a provider office, fearful, scared, the belief is, oh, I'm just gonna trust this expert.

They know everything about me, but most of the times they don't.

You are an individual person, but they're trained in just generalities.

And so what does it look like to try to customize that care with your provider?

And then knowing all of the stresses that provider has and then knowing that provider probably doesn't like you, you're Black, They don't know why you keep on breeding more people.

They read everything on the news about the violence, the lack of self sustainability, the dependency on the welfare system.

The "welfare queen" rhetoric is still running around, or they're drug user, seekers.

Again, all of that comes in, and so you're faced against all that, on top of the fact that everything that you went through to even get through this door.

I say this for people who are seeking for fertility or who have pregnancy loss, and they're trying to come again, there's all these anxieties around and our system just is not built for that.

It's not built for a general patient-centered, quality care.

It's built for transactional care when it comes to medical health, and I think that we're seeing a shift of that.

The more people are speaking out, the more things that are making news, the Black maternal institutions like Sister Song and the Black Mamas Matter Alliance coming out and really highlighting what is going on and then the more research that is being done.

And I think as long as we're seeing those, they're not large shifts, but they are those ripples that are making change.

Hopefully, we can see that number shift a little bit.

But right now you are your biggest advocate for your care, and if you don't like your provider, leave.

And if you think your provider has caused you harm, please report them, there needs to be an investigation, and take some of that ownership and some of that power back.

But oftentimes, when Black and Brown people are going into the care system, especially if they are pregnant, gestating or just looking to birth, it's difficult for them, because they don't really know where to go.

And it's not like somebody comes up the hallway and says, "Hey, congratulations, "let me walk you through this process."

It doesn't happen.

Most people go right back to their same GYN, and the GYN's birthing philosophy might not actually align with your philosophy.

And now there's this clash, but by the time you find out, you're 35 weeks long, and you're like, "Can I leave?

Do I stay?"

- [Kiara] Do you start over?

- Do you start over?

You don't know your options.

There are five birthing hospitals in the state of Rhode Island.

People mainly only know one large tertiary hospital.

And so letting people know, you could choose your own provider, you can leave this provider office, you could birth at a different hospital.

Rhode Island does allow for a home birth.

You can birth at home with a licensed midwife, with a doula.

And I think people are learning that, but for Black people, it's like almost given ourselves permission to hope that we can be more than a social service call after we have our baby, that's the biggest fear.

I often was hired, because people said they didn't wanna die and because they felt like they needed a protector almost when it came to certain things that was being done in the hospital.

And a lot of that is really for a doula, pausing, making sure you're okay with the decisions that are happening and speaking with you and your partner saying, "Do you understand what they're saying?"

Or, "Do you have any more questions?"

Because oftentimes these people are just hustle and bustle.

This is the way we go to work, another pregnant person, we're just doing this.

And oftentimes, they're using vernacular that's medical that you don't understand.

They're speaking over you.

They're speaking at you.

There's no shared consent, and so how can we have a discussion about the quality of my care if you're just like, "Well, this is what we're gonna do, okay?"

Like, wait, I really didn't agree, but you just agreed for me.

And then we go through this process, and you feel robbed.

And then that unfortunately can spiral to postpartum anxiety, postpartum depression, and unfortunately postpartum psychosis, which is very detrimental in the hospital hospitalization.

People just can't get better, because their mind is always resonating on failures and things that they didn't get to do during their birthing, or they had birth trauma, and it's just so bad.

Sometimes they only have one kid, or they just can't attach to their child, and then that travels down in trauma, into our wombs, into our children, and then you have a generation of people who love their child, but not in the way where it's very nurturing, because they know that they have to love that child from a distance as a protective mechanism.

- Yeah, and then they also see it in the systems.

You have our school systems that are pipelines to prisons.

You have, again, what you were talking about, Black families aren't seen as a whole unit, because in order to get social services, which they consistently deny us, through lack of generational wealth, lack of generational upward mobility, you only rely on social services, and you don't have a generation of certain providers, or the school system is not educating enough in order to get a living wage.

Our systems are also not set up for our families to have a living wage.

We just fought last year to pass a $15 minimum wage, but we won't get that till 2025, and that's two gosh darn late.

I've been advocating since I've been in office for a $25 minimum wage, which is a 50 to $55,000 salary a year for each family, because that's what you need in order to raise a family.

I'm a former low-income Black woman.

My mom raised me and my five siblings on $45,000 a year.

How she did it, I have no idea, but she made it work and here today.

And there're also so many other systems, even just navigating how to get to prenatal appointments, even in order to get to appointments.

If you are a low income person, and you rely on the bus, it's sometimes an hour.

You have to take time off work.

We don't have PTO.

We don't have maternity leave.

We don't have maternity leave that will forward you in order to be out of work or out of pay for months at a time, given your health and focusing on you and your baby.

We also don't have schools or environments that create environments where our children can survive and thrive.

In my district, district 6, in South Providence in Washington Park, we have some of the highest rates of asthma in the nation.

We're a top 10 asthma rates in the nation, so you're raising children that you know are going to have confounding, compounding health impacts.

You are raising them in environments where the air is not safe to breathe, where the soil is not safe for them to play in at the playground.

You're sending them to to schools where there's lead in pipes.

You're living in a home with lead in pipes.

And so every single aspect of the system is not made for us to survive and thrive in the communities that they give us, because they have relegated us through redlining, through gerrymandering, to communities that were not meant for our families and to grow up, survive and thrive.

And they put us into school systems that then, do not set them on the pathway to face that upward mobility.

Then they don't give us homes, so we're losing generational wealth.

And so every part of the system, whether it's the actual birthing process, the pre-birth, or even raising a family, these are decisions that many of us can't take lightly, because what if they go to this playground?

What if they get lead poisoning by the age of five?

What if they develop asthma, and I can't afford for them to be out of school for weeks at a time, because they're hospitalized?

What if the playground that I've been sending them has a carcinogen that is linked to cancer and now my child is 10 times more likely, 20 times more likely to have terminal cancer later in their life or health complications.

These are all of the things throughout the full spectrum of lives that is dictated by policy but is also dictated by how do we care about people?

And we show our birthing parents, and we show our birthing people that we actually don't care about your child unless it's inside of your womb for those 40 weeks.

Before, after, there's nothing protecting them except for you and sometimes these failed systems that aren't meant for you in the first place.

- Yep, I'm originally, I think I said this already, from Mississippi, Jackson to be exact, and I guess you can say it's a predominantly Black city, and so I thought I was getting high quality resources in school.

I thought that what I was getting was cream of the crop, and it wasn't until I moved to Rhode Island that I saw what high quality resources and access actually was.

And so what happens in those spaces where people don't know what they don't know?

And I know you all just worked to pass a bill in Rhode Island for doula services.

How does that go together hand-in-hand when people just aren't knowledgeable on what they don't have?

- So the Black Maternal Health bill, which is the Rhode Island Doula bill, super proud, I was one of the original co-authors of the bill along with certified nurse, midwife, Melissa Nelson, she's a Black midwife, now in Boston at Boston Medical.

And we really did it from the perspective of elevating Black doulas in community in a way that was not only accessible, but it was equitable.

I think this was the first time that we looked at this as an equitable bill, and I was brought in by a representative, Marcia Ranglin-Vassell, because she knew my work in the community with Journ3i since 2015, doing the work, being a Black doula, highlighting Black maternal health.

And she was like, "Hey, we are being presented "with possibly doing this bill."

And she's like, "I won't do this bill without you."

And I was like, "Of course not.

I'm doing it."

And so I appreciated her giving me that direct phone call, having me come in, and then I called in, and started to find nurse, midwife Melissa, and me and her, we went over the terminology, what was the scope, what was the parameters?

But really, we knew, in doing this bill, that there were gonna be compromises made, the way it always is, there's compromises.

We looked at a lot of the other states' bills that had passed and that had failed, and we called the doulas in those states and was like, "If you could get a bill that actually worked for you, "what would it look like?"

Rhode Island is very peculiar.

Our bill is the largest Medicaid-funded bill in the nation.

We are the only state with a dual bill, basically the landmark pinnacle right now as far as doula bills, but it's also built off of, we don't have agencies.

I actually own the only doula agency in the state, but we don't have agencies, so there's no organization, so there wasn't that overhead structure that was problematic for us, as far as financially.

So I, as an independent doula practitioner, I operate my business, it's 3-1-3, so you get three prenatals, one birth and delivery and three postpartum.

What also makes our bills so landmark is it's any way that birth ends, so this was pivotal for us, because we were serving a lot of people who were going through miscarriage, pregnancy and loss, and people going alone.

Unfortunately, when you do lose some... You're experiencing a miscarriage, oftentimes, they give you a pill, and they send you home, and so what would happen is you would be by yourself.

And so it was important that for us, our bill really highlighted, you could have a doula.

You're gonna have a miscarriage, you're going home, you could have a doula, someone will be there with you during that really emotional time, support you, support your partner and support your family about what's happening.

And so, yeah, that bill was a lot.

It was three years- - Yes, it was.

- Unpaid, uncompensated, and I think for people who love that bill, who don't really understand, we asked a lot of people to sacrifice for that bill.

A lot of Black women sacrificed.

They stayed in spaces that was toxic to them and detrimental to them, but they knew that this bill was really gonna make a difference, and it has made a difference.

Doulas are taking way more clients.

We're doing so much outreach.

It's beautiful to hear people say, "I could have a doula, and my insurance will pay?

"That's great!

I don't know if insurance can pay for this.

"I don't know if I would've been able to afford a doula."

But for the first time, they actually have an option, because when we had doulas, it was really meant for people who could pay.

They had that disposable income.

There goes that disparity and wages.

They could afford the $1,800 and the $2,200 for a doula, which is what our white counterparts make in Rhode Island.

So $1,500, yay, but our white counterparts are still making more money than us out-of-pocket paid.

And so it was beautiful for people to actually have that support, and when we do it, we're also bringing that education piece in.

- Yeah, and I was fortunate enough to be able to work with you and several other people on the bill for all three of those years, from both the advocate standpoint and the organizing standpoint, and then finally, in my first year, I was able to help pass that bill.

And just even being a co-sponsor and having to still educate people.

Federally, we also pass a Momnibus bill, which is about Black maternal health as well, because it's a problem nationally.

But it was just so shocking how few people actually knew or were able to access the information that Black women are dying in childbirth.

You can say it so many times.

We said it for three years, and it wasn't until the third year that they finally listened and not just heard, but they were like, "Oh, so you mean we have to do something about this?"

And it was Black women on the front lines, women of color, day in and day out, meeting outside of the State House, inside of the State House, long nights at hearings, educating people- - It was wonderful having a community-organized organization in our state, I think was so key for us, because they were on the ground doing the surveys, really getting that information out, and then having the reps, the sponsors on the bill, educating people in the House, what is a doula, the testimonies of.

A doula is also not just for the birthing person, but we're also for the family.

We try to maintain that family unit, and that was beautiful to bring back Black culture as a unit.

Oftentimes as a doula, I think I've only ever had one genuine single mother.

All of my families have partners, and we welcome them into the space, and I think it was great because oftentimes, we've seen the research where it shows that Black fathers are more present in their kids' lives than any other race.

And people are like, "Oh my gosh, I can't believe it."

But no, we did the research, it's true.

And so for me, I loved having the partners there, and they would do the hip squeezes.

By the 12th hour, they're taking that break.

(laughs) - And then we also had families in the State House, and I think that was also just one of the most joyful, talk about Black joy.

I remember for one of the first doula hearings that we had, we had food, we had coloring books, and we had dancing.

And I was leading some of the dancing with the kids, 'cause families were coming from all races, all sizes, with children, without children.

People who were currently carrying, people who, they got babies strapped to their chest, and it was so great to see that space being accessible for the first time, because many working families and young families can't access the State House.

So it was the first time where people were brought into that building and met with love and joy and food.

But we still have a long way to go in order for our colleagues, because even now, with Medicaid, a pregnant woman or a pregnant person can only have access to Medicaid services after a certain point in their pregnancy for up to, I think it's now 90 days.

- [Quatia] No, they just extended it.

- They just extended it?

- They just extended it.

It's 12 months now.

- 12 months after.

And that's crazy, because before it was 30 days after.

It was 30 days, and you're like, "The baby's still a baby."

And so having extended care up to that amount of time, we start to see families as a whole unit and not just this moment in time of a birth.

- Well you all talked about the power of moving from that individual level to the collective to getting an entire bill passed that's going to actually work to end generational trauma and harm for a system that's working as designed.

I wanna thank you all so much for giving us information.

How can we stay in touch?

- Oh, so you can find me online.

I'm on all the social platforms, unfortunately, in some way or another, so there's Our Journ3i.

We're on Facebook, we're on Instagram, and we are on Twitter.

And also, my new Urban Perinatal Education Center, which is the first Black and BIPOC maternal health clinic and education space in the state, and we're located in Pawtucket.

And you can find us at Urban Perinatal on Facebook and on Twitter and also on Instagram.

- Yeah, and everyone can find me, Instagram, Twitter, Facebook, TikTok @MackDistrict6, where I post updates on policy, some joy and just keeping folks up to date of what it looks like to legislate and how we pass bills in Rhode Island.

- Yes, thanks y'all so much for holding space and for educating people, because as Black women, we're always expected to educate, and so I just wanna thank you all so much for your time.

But we have run out of time, and so again, thank you for taking space, for creating space for us to learn so much from you.

We have with us today, Tiara Mack and Q Osorio, and for the viewers tuning in, you can watch past episodes anytime on watch.ripbs.org and be sure to follow us on Facebook and Twitter for the latest updates.

(bright music) Thank you ladies.

- [Tiara And Quatia] Thank you.

(bright music continues) (bright music continues) (bright music continues) (bright music continues) (bright music continues)