When a friend told me about a conversation sponsored by Community Action Agency of New Haven’s Black Maternal Health Project on Wednesday, I changed my plans for the night, hopped in my pickup truck, and headed to Southern Connecticut State University’s campus. I wanted to see the film Aftershock and hear the panel of Black women health providers talk about it and the stories it tells — true stories of two families that lost their wives, moms, and daughters due to preventable birthing complications.
Too many Black women in the U.S. die from preventable birthing complications each year. The disparity between the morbidity of Black women and those of any other race is alarming, particularly for an industrialized country like ours. I and most of my friends and family know women who did not leave the birthing room with their newborn babies. I started my career in public health here in New Haven in 1986 and for 10 years worked with Black women and the Black community on reducing health disparities in neighborhoods like Dixwell and Newhallville. Thirty-five years later, the problems Black women and people experience have not gotten better. Data from the Centers for Disease Control and other places on health and birth outcomes bear this out. The inability to receive good unbiased care still haunts our communities, and health disparities still conspire to deflate our ability to thrive. My career has taken many twists and turns since 1986, but I always keep public health and Black women’s health at the forefront of my work to build equity for Black communities.
The screening took place at the theater in the campus Student Center and strolling from the parking lot to the building proved a tad bit challenging; there could have been more signage. But I managed to snag a security person and then an amiable student who pointed me in the right direction. I walked into the center, and students buzzed about the brightly lit space as sunlight streamed through the floor-to-ceiling windows, in contrast to the dimly lit and hushed theater when I walked in. I’d heard about the film when it came out and read about the families and stories it features, and I was excited to see it with an audience of peers.
Full disclosure: the friend who told me about the event was Jenell Lawson, the Deputy Director and mind behind the Black Maternal Health project. I remember her telling me about her vision back in March. She wanted to leverage her relationships with the vibrant communities of brilliant Black women she belonged to and bring their collective power together with the Community Action Agency of New Haven to impact birthing and maternal health outcomes. Lawson did it. She brought her agency together with The New Haven chapters of the National Coalition of 100 Black Women, Inc. and The Links, Inc., two service groups that focus on Black women and the community. The partnership expanded when she tapped into New Haven Healthy Start and DHJ Services.
We settled into our seats as we read the handouts in our gift bags and Lawson opened the evening. She gave the audience background and context, sharing with them how the program started, why it’s important, and why the movie Aftershock acts as a beacon for the Black Maternal Health Project and the Black birthing community. She then introduced representatives from the project’s core partners who spoke about why they joined the effort and how Black maternal health fits well within the scope of their organizational missions.
The Interim President of Southern Connecticut, Dr. Dwayne Smith, spoke briefly before we jumped into the program. Smith explained why he felt it was important for the school to be a part of the dialogue and I got a chance to chat with him when we both popped out to grab a bite from the concession area as a few more people took the mic, and the program began. He told me he believed the school should be a part of this because SCSU “is an equity-minded institution and there’s certainly disparities in maternal health and Black women as it relates to mortality rates. Black women have one of the highest mortality rates of any other women in terms of childbearing and some other health issues, and so I, we, felt that it was critical for Southern to be in the forefront of the discussion.”
The panel for the screening consisted of six Black women doctors, nurses, and health professionals working and leading in the field here in New Haven and across the country. From Dr. Cynthia Hall McCraven, a well-known OB/GYN who leads with her desire to impact health outcomes for Black women, to Kulwinder Nicole Bajwa, a nurse midwife who works tirelessly to elevate the role of midwives and changes how the medical profession addresses issues of maternal health, the panel was impressive.
I thought we would simply watch the movie, and afterward, the panelists would talk about it. Instead, we viewed critical excerpts that the panelists used to catalyze conversations about the medical complications and procedures that had led to the deaths of the two moms in the movie. It was a brilliant way to unpack the heavy and complicated medical, family, mental health, and other issues that surface in the film.
We started with a short clip that showed how a woman succumbed to a pulmonary embolism. Dr. Djana Harp explained how these embolisms occur and why Black women experience them before and during labor. The clip and film as a whole illustrated how the voices of Black women are too frequently ignored by medical professionals and how our questions and concerns are silenced and invalidated, even when there is a life-threatening medical complication at hand. Dr. Harp broke it down for an audience of 40 or so mostly women who eagerly listened as she described symptoms to look out for and explained ways to self-advocate and demand that providers listen and take these concerns seriously.
The other clips we viewed focused on pre-eclampsia, breast/chestfeeding, understanding the data about Black maternal health outcomes, and what tells about how Black women receive care, as well as the roles of midwives and doulas in birthing. Each clip allowed the panel and audience to unpack the underlying issues that lead to the poor birth outcomes experienced by Black women. The panel tackled a range of issues as they shared their insights and expertise and told their personal birthing stories. We learned that, unsurprisingly given the data, each of them had been touched personally by the complications experienced by the women and families in the film. Even with their degrees and knowledge, these women knew firsthand what it feels like to be on the receiving end of the all too frequent cultural incompetence, implicit bias, microaggressions and systemic racism that occur in medical institutions. Their lived experiences as Black women and medical professionals allowed them to use that lens to educate the audience about how to advocate and demand to be heard, seen, and acknowledged in their birthing journeys.
Some of the most compelling moments in the evening centered on the data. The film clips we viewed did a great job of giving information about the statistics around Black women and birth outcomes. The clips and the conversation also unearthed other harsh realities, like how the rise in caesarian sections, a major surgery, from the ’70s to today correlates with the rise in mortality and morbidity rates for all women — but for Black women in particular — and how cost drives that uptick. It is cheaper to perform a c‑section then it is to deliver vaginally, and insurance companies incentivize hospitals to perform the procedure. Insurance companies play a big role in how women are treated during the birthing journey.
The film clips also explored how implicit bias and racism are embedded in diagnostic tools and provider training. For example, a tool that calculates the likelihood that a woman can deliver vaginally significantly decreases that likelihood when race is added as a variable. A doctor in one of the film clips tells us that this occurs only because of how the calculation tool was programmed, and that the idea that Black women can’t deliver vaginally is based on racist notions that have plagued the medical community for generations. He says of the calculator, “We’ve literally created algorithms where we’ve conflated race and racism. If you’re Black, your odds drop.” He goes on to say, “That has nothing to do with who they are or their biology. The calculator ends up gatekeeping treatment care and support, so if you’re Black, you’re less likely to get good support to have the actual delivery that you want.” That is significant and staggering.
The panel deftly addressed each of the points brought out in the clips. They expounded on the data and gave perspectives on how and why the medical community generates data and uses it, and how that data influences how doctors approach care and treatment. Dr. Tamiko Jackson talked about the importance of breast/chest feeding and why we can not allow medical practitioners to talk us out of it because babies don’t latch on, or when moms experience other challenges. She said we must remain mindful of the “cultural competence of the provider” and how cultural biases impact standards of care. Kulwinder Nicole Bajwa talked about the role of midwives and how they can be allies and advocates in birthing rooms and throughout the delivery process after we watched a clip describing the history of midwifery in this country, and how midwives are not as widely used here as in other countries where maternal health outcomes fair far better than in the U.S.
Another clip delved into the history of obstetrics and how enslaved Black women became guinea pigs for antebellum doctors who performed inhumane experiments without the benefit of anesthesia or other pain relief. Dr. McCraven dug into the historical context the film touched on. Her discussion of how doctor training and the “medicalization of the birth process” negatively impacts Black maternal health outcomes was thought-provoking. Dr. Evans, a professor at SCSU, brought up new data from the CDC saying that 1 in 5 women report being mistreated by medical providers during their pregnancy, and these numbers climb when you overlay variables like race, age, income, and medical coverage. Black women and poor Black women thus experience mistreatment and negligence at higher rates during what should be one of the most exciting and wondrous times in their lives.
The panel lifted up solutions while exploring problems. It shared strategies about how to advocate for and elevate the needs of Black women in obstetrics and birthing, both within the medical community and as patients and consumers. The audience stayed engaged by asking questions and sharing their own experiences. We all learned a lot from the film and the panel. We all saw ourselves in the families on screen. Stanley Bernard, one of the only men in the audience, said that too often movies like this only show single women, but this one had fathers too; it was important to show us as families with fathers who are there for the family.
“My wife had pre-eclampsia with three of her births and with one of her births she had gestational diabetes,” he said. “She almost died all three times. What happened in the film, that happened to me, and I had to be there for her as the father. So, I was happy to see those dads. That was great.”
Small groups of audience members gathered to chat in the hallway as we left the now near-empty student center. Even though the event ran long, there was a buzz of enthusiasm that followed us out of the building. We were energized and ready to share more information, educate our family and friends, and support efforts to change Black maternal health outcomes.
Aftershock is available on Hulu.
Thanks for this review. I look forward to seeing the film.
There are two excellent books that recently came out that address this important topic: Weathering by Arline Geronimus and Under the Skin by Linda Villarosa. I can't recommend them highly enough.