- For most mothers pregnancy is a time of hope expectation and sometimes fear.

Today's guest focuses the lens, literally on the maternal health challenges facing black women in the United States.

The legacy of racism, staggering numbers of maternal mortality, postpartum depression, and difficulties accessing care.

She's Dr. Ade Osinubi, this week, on "Story in the Public Square".

(upbeat music) Hello, and welcome to a "Story in the Public Square" where storytelling beats public affairs.

I'm Jim Ludes from the Pell Center at Salve Regina University.

- And I'm G. Wayne Miller with the "Providence Journal".

- This week, we're joined by Dr. Ade Osinubi.

A photographer filmmaker and emergency medical resident at Penn Medicine at the University of Pennsylvania health system.

She's also the producer of "Black Motherhood Through the Lens", a powerful documentary that has been receiving acclaim at film festivals around the country.

Ade, thank you so much for being with us.

- Thank you so much for having me.

- This is really a beautiful and powerful film, and we were also struck by the fact that you were a fourth year medical student when this was released, I think.

And so we kind of wanna know how did you get that all done.

But for the audience that hasn't had the privilege of seeing the film yet, just give us a quick overview.

- "Black Motherhood Through the Lens" is a documentary about four black women's experiences and navigating the reproductive healthcare system.

It talks about various disparities that black women face when it comes to infertility, postpartum mood disorders, as well as maternal mortality.

And so it covers the stories of Shannon, Shalene, Ajoma and Jamie who discuss their various experiences along the continuum of the reproductive healthcare system.

So that's a little bit of a bio of the documentary.

- But why did you wanna make it?

- For me, I created a documentary, started starting from my first year of medical school.

I've always been interested in women's health and black maternal health issues hit quite close to home as a black woman myself.

Around the time when I started medical school there was a lot of media attention about the black maternal mortality crisis, which was of course, was something that I wanted to address in my way.

And I also felt that in these conversations there was not much media attention being raised about other disparities impacting black women when it came to infertility, postpartum mood and anxiety disorders, et cetera.

So statistics show that black women may be two times more likely to experience infertility and they may be two times more likely to also experience postpartum mood and anxiety disorders.

And so that's why I wanted to create this film to try and shed more light on various issues impacting black women in reproductive healthcare.

- So the four women that you profile here speak very powerfully, very candidly very forcefully about the issues that you explore here.

How did you find these four women?

I mean, I do some documentary filmmaking myself, and, you know, you don't go to a casting agency and just get the right people.

Talk about craft.

How did you find these four women?

- I like to say it was divine connection, because the way that I met each of the women was really, really impactful for me.

And so the first woman I started filming was Ijama or Dr. Ijama Kolo, rather.

And she is a PhD as well as a social media entrepreneur.

I used to take her photos for her blog and around Mother's day, a couple years ago, she posted about her experience with infertility for about a year.

And so I reached out to her to see if she would be willing to speak to me about her experiences and she obliged.

And then after that was Shalene.

I met her through the reproductive equity space in Rhode Island because she's a huge leader in the Province, Rhode Island community and beyond.

And so she opened up to me about her experience with infertility while being uninsured.

And then for Shannon, I met her through an OB-GYN actually who was affiliated with Brown and she told me, oh I have a friend who's eight months pregnant.

Would you wanna include her in her film?

And then that's how that happened.

And then lastly, Jamie, I knew her kind of through the reproductive health space as well.

And I was following her on Facebook and I saw that she gave birth maybe four months prior.

And so I just wanted to talk to her about her postpartum experience.

And she revealed to me that she actually experienced postpartum depression after the birth of her first child, now eight years ago.

So that's kind of how I came to meet all four women.

- And obviously you spent a lot of time with each of these women.

You went into their homes, you went to other places with them.

How long did it take to put the film together?

And then I want to hear about the editing of it, which of course is a critical piece of filmmaking too.

But talk about the journey of following these women around and how long it took to make.

- For me, because I was a full-time medical student.

I filmed this in a piecemeal fashion.

And so I tended to work on each segment of the film on its own.

And so for a Ijoma story, we had maybe about two total filming days, because she actually moved to Kenya in the middle of filming.

So we had to really get as much footage as possible.

For the other three women, they are based in Providence.

And so I would say I had about three or so three to four filming days including the formal sit down interview day.

And so that was kind of spread out over two to three years.

The COVID pandemic definitely delayed things a little bit.

And then also I was sitting down to study for board.

So I had to take a nine month hiatus and then I picked up and filmed the last portion of my film, which featured Jamie.

- So when did you do the editing and talk about that process?

Again, a very critical part of filmmaking.

In addition to the music and some of the soundtrack too.

But talk about the editing.

- So I'm a self taught videographer as well as an editor.

And so I learned a lot of things from YouTube University.

So luckily coming into this process, I already had fairly good experience with editing.

I used Final Cut Pro.

And so for me, I would just edit when I had time.

And when I felt motivated to edit.

I did a lot more cleaning and editing during my fourth year of med school since especially after I was done with interviewing for residency.

And so there, I took a lot of time and it was just painstaking detail to go through each soundbite, just to make sure it was as smooth as possible.

So that's kind of what my process looked like.

And usually after I filmed the formal interview, I would sit down and transcribe it within a couple of days.

So it'd be super fresh.

And then I would, after that go and film B roll to kind of align with what was said in the interview.

- Ade, you're clearly a tremendously talented, creative, expressive person.

How does that align with the, you think of people drawn to medicine and healthcare as you are being very scientific and analytical, but you have this creative spark as well.

Put that into some sort of context for us.

The reconciling those two parts of your person.

- That's a great question.

And that was something I talked about actually in my college applications.

So I actually applied to college and med school at the same time.

And I talked a lot about my interest in writing, film and how that can communicate the human experience, which is what we are trying to elucidate in medicine, right.

Especially in the emergency department where I work.

All we really have are patient stories in the beginning to try and make a diagnosis.

And so I really do think that creativity is a very innate part of medicine, and I'm really encouraged that more and more people are accepting that as part of medicine.

There's this sect, narrative medicine, which is again focused on patient storytelling and that has become more legitimized over time.

And so for me, one of my missions in medicine is to highlight the stories of marginalized communities that often go on hold.

And my experiences in my short life have shown me how powerful film, photography, writing can be in exposing various health inequities and advocating for change.

- So talk about maternal deaths.

There's a great disparity in the black community compared to the white community.

First of all, what defines a maternal death for those in our audience who may not have heard that term or been familiar with it.

- So for maternal mortality, that is pregnancy related death.

Either during the birthing process or right after the birthing process.

And studies have shown that black women may be two to four times more likely to die due to pregnancy related causes.

In some places like New York City, that factor can be eight times.

- Wow, wow.

- Which is truly alarming.

And a lot of the reasoning can be preexisting health conditions.

However, there is a large component that stems from medical racism.

There's a lot of women who have said, oh, I felt like something was off.

I didn't really feel like that they were in an optimal condition.

And when they communicated that to their healthcare team, some people were blown off and that actually led to care being, them preventing care from being given to them.

And so those are just some of the things that contribute to the maternal mortality disparity impacting black women.

- And a factor there.

If I'm not correct, if I am correct.

And I am correct, is the fact that for many black women that their healthcare team or their healthcare providers are not black, they're white.

And they're not really informed with the issues of the people that their patients.

Talk about that, because we see that, of course not just in New York city, but across this country.

- Yes, representation is a very big part of that.

There's a very small percentage of physicians that are black.

Very small percentage of those that are black women.

There is something to be said about having a provider that looks like you and understands your cultural background.

And that was actually discussed in the film with Shannon's experience.

She was lucky enough to actually have a very black provider team.

She had a black OB-GYN, there were black OB-GYN residents, and she talks about how she actually saw a decrease in her blood pressure when she was on the operating table about to get a C-section.

She was very nervous.

It's a major surgery.

And then when she had that team that looked like her blood pressure actually dropped.

And so there is the importance of representation.

However, I will argue that representation is not the cure all for medical racism and these health disparities, right?

Because the institution of medicine has been built on these inequities and these problematic perceptions of various patients.

And so it's one thing to have more black physicians, but for me, it's really about changing medicine as a whole to make it a more holistic as well as safe place for patients of all backgrounds.

- So you talk about change.

Are you seeing any change here?

Awareness is being raised, I think.

Certainly by your film in similar work, whether on the screen or in writing or in whatever format.

Are you seeing signs of change, number one?

And number two, what would you recommend be done to expedite change?

- Yeah, for me, I've definitely seen a lot of change in terms of advocacy work and just people being more aware.

I was lucky enough to go to Brown and train at Brown Medical School.

And Brown is a very socially conscious place.

And so we were openly having discussions about these maternal health disparities how black patients oftentimes are not treated adequately for pain control, et cetera.

So I'm definitely seeing the conversation going and people and parties being held more accountable.

I'm also seeing more education in the hospital system.

I've only been affiliated with medicine formally for the past fourish years, but I've been really encouraged to see at least that there are these panels and discussions and physicians from other institutions being brought out to discuss.

And so for me, recommendations, that is challenging.

However, I think from a legislative standpoint creating more coverage for doulas.

And for those of you who don't know, they are birthing support people.

There's been a lot of advocacy and also legislative work already being done to make doulas more accessible to patients, because they have been shown to help improve birth outcomes.

And I think that just increased resources need to be given to families.

Especially with postpartum care.

There's also increased increased legislation to increase Medicaid coverage to one year postpartum so that women can get the adequate care that they need, because the postpartum period is actually quite long.

So those are some of the recommendations.

And then again, accountability is important.

Encouraging people to speak up if they're seeing patients not being listened to or if they're being disrespected.

- Ade, turning to the broad issues of maternal health and black maternal health in particular, I'm curious after two years, two plus years now of the pandemic how did the pandemic itself impact black maternal health?

- Yes, the pandemic again, further elucidated health disparities impacting black and brown populations and maternal health was not immune to that.

I don't remember the exact statistics, but there was a New York times article that came out a couple of months ago that showed that maternal deaths increased during the pandemic and that black and brown women were more likely to die as well.

And so again, the COVID pandemic impacted maternal health and those impacts I think we'll probably see for years to come, unfortunately.

And then also I recently wrote an article for the Washington Post about how the pandemic impacted postpartum families as well as postpartum mental health, because a lot of families were not able to visit a pregnant patient after giving birth and not really able to give that support.

And so that article really showed two black women's experiences being postpartum during the pandemic and that further showed other inequities that arise, that can arise.

- So why is there this inequity in postpartum mood disorders among black women?

What are the underlying causes here?

I mean, again, you get into this in your film, but what's going on here.

I mean, this is America where supposedly healthcare should be available to everyone and of high quality across.

That isn't the case, but let's hear what you have to say.

As opposed to me pontificating here.

- Some of those factors include access to care, stigma.

As I said earlier, the postpartum period really lasts for a long time.

There's increased advocacy to actually recognize the fourth trimester, which is after a woman gives birth.

And so traditionally the postpartum period, especially for women and their mental health, has not necessarily been prioritized.

And after the baby's born a woman is kind of just left to do and figure out those emotions and figure out how to take care of a newborn, which can be really challenging and isolating.

So in general, there's a lack of support for postpartum patients and then throwing in being black and brown already having those disparities and less access to care.

That can create issues as well.

And studies have shown that in general, black and brown people are less likely to have access to a mental healthcare provider.

So if they're already not having access to a mental healthcare provider and not really going through the motions of understanding what depression, anxiety may look like when it comes to the postpartum period, how can you expect someone to then seek care at that time?

And then another thing to consider is stigma.

Mental health is stigmatized in many communities.

The black community is one of them, which Jamie Potter Rutledge talks about.

And just in general, postpartum depression and anxiety is stigmatized in the United States, because media oftentimes shows a woman giving birth and it being the happiest time of her life, which oftentimes it's really not, because there's so many emotions.

The stress of having a newborn, being isolated.

Just there's so many things.

And so those are just some of the things to keep in mind about why those disparities exist.

- Ade, you wrote a 2021 article for "Glamour Magazine" whose headline asked quite simply, "Where are all the Black Women at the Fertility Clinic?"

What did you discover?

- For me, I wrote that article while I was on my reproductive endocrinology and infertility rotation.

So I went into med school thinking I was gonna do OB-GYN and then I switched to emergency medicine.

And so for me, I was already aware that disparities existed in terms of infertility as well as access to infertility care, such as IVF.

And so, as I said earlier, black women may be two times more likely to experience infertility and they may be two times less likely to have access to infertility care such as IVF.

And so with that in mind and being in Providence, Providence is a fairly diverse city.

When I was on my rotation, I was fairly mainly seeing white women taking advantage of those services, which was something I wasn't super surprised about, because demographically white women are utilizing more IVF services just due to resources.

Resources are a major factor, because IVF and things of that nature are oftentimes not covered by insurance fully or really at all.

And so for me, my own personal experience, rotating in an REI clinic for four weeks and not really seeing a handful of black women caused me to raise that question and write that article.

- Well, one of the things that I learned in preparing for this episode, thanks to your writing was that Medicaid provides no infertility coverage.

And that sort of struck me.

Why not?

- Well, you have to ask the President about that.

(all laughing) - But there are consequences of that, right?

I mean, can you spell that out a little bit for us?

- Yes, I think that it not having that institutionalized coverage really makes a statement about who gets to have a child, right?

And how IVF is oftentimes looked at as a privilege despite it actually being a right, the right to have a child.

And so I think that once we, as a nation, change our mindset about who can have a child and who should have access to assisted reproductive technologies, that will make a change.

But right now, again, as I said, IVF and things of that nature are seen as a privilege for those who have the money to spend, but infertility is a real medical diagnosis.

And so therefore everyone with infertility should ideally have access to things that can ameliorate that.

- So Ade, your film is set in an urban setting, Providence, Rhode Island, a city.

Do you have any sense or did you examine whether or not there are differences between urban settings and rural settings?

I mean, obviously Providence, Rhode Island is not a rural part of Alabama or Mississippi or pick any number of other states.

What is your sense of that?

Are things worse?

Are they better?

And perhaps you haven't looked at that, but I I'm sure you have at least a sense of that.

- Yeah, so again, thank you for bringing up that important point.

My film was focused in an urban setting, but those disparities of course exist in rural settings and can be even worse.

I watched a docu-series on Vice that actually documented women's experiences in rural parts of Georgia where the nearest OB-GYN provider could be one to two hours away.

And if a woman is having a medical emergency or an obstetric emergency, one to two hours is a very, very long period of time.

And also the fact that women have to figure out transportation to set OB-GYN provider, et cetera, that is a major, major barrier.

And so although I can't formally make any comparisons just based off of my experience creating the film, I will say that a rural setting can negatively impact obstetric care if women are not plugged in with the right resources or having skilled obstetric care providers such as OB-GYNs, such as doulas, et cetera, readily accessible.

- So do you have any feeling on whether if there were a collective will on the part of Americans to change what we've been talking about and what you documented in your film, could these changes happen?

And does it require the collective will?

And that would include politicians at many levels.

Could we have a better outcome here or is it hopeless?

- I definitely agree that we can have a better outcome.

Even smaller community interventions have demonstrated improving outcomes for black women or just women of all backgrounds.

And so again, I think it's really up to the people in charge to set in stone those important pieces of legislation, and to continue lobbying, and to continue advocating for these issues.

Because again, there's a lot of change that needs to happen in America.

However, there are a lot of privileges we have being in this society, because we've truly seen how advocacy and policy work can have an impact on various social issues.

- Ade, we've got about a minute and a half left here and we could probably talk about this all day but one of the themes that emerges throughout the documentary is the power, the value the importance of community.

I think about one of your subjects in the interview, talking about just the ability to discuss their infertility challenges with their mother or other subjects of interviews talking about the importance of finding a doula that they could rely on and other women in their community who were dealing with the same issues that they had.

Can you speak a little bit to the power and importance of community when we come to basic healthcare issues like this?

- Yes, thanks for bringing that up.

Community is a huge, huge, huge privilege.

And I think that, especially when it comes to experiencing infertility maternal death, maternal morbidity, as well as postpartum mood and anxiety disorders, a lot of the women in the film talked about how comforting it was to know about other women who were having those experiences or other people who were having those experiences.

Because a lot of the times people oftentimes feel isolated when they're going through these really real human experiences.

But the beauty of humanities oftentimes these experiences are shared among many people.

And so I think that when it comes to maternal health, community, doula collectives, for example and just other collectives that wanna support the wellbeing of birthing people, they truly can have an impact.

Something else I will talk about is that in the film Shalene joined a breastfeeding support group and she talks about her experience seeing other women who look like her breastfeeding for long periods of time.

So I just wanted to share that narrative to show how powerful community can be.

- It's a tremendous piece of work.

The film is "Black Motherhood Through the Lens".

Ade Osinubi thank you so much for being with us.

That's all the time we have this week.

But if you wanna know more about "Story in the Public Square" you can find us on Facebook and Twitter or visit Pellcenter.org.

For G. Wayne Miller, I'm Jim Ludes, asking you to join us again next time.

for more 'Story in the Public Square".

(upbeat music)