Tamika Jackson’s heart stopped beating while she was giving birth to her son.
Doctors were able to revive Jackson. But the moment and the subsequent trauma underscored why some people do not have a great experience giving birth.
“I wasn’t listened to when I delivered,” Jackson told attendees at an October health summit in Dearborn, Michigan.
“There wasn’t anything to do with my health. No economic disparity existed. I was perfectly healthy,” said Jackson, a community organizer for Mothering Justice.
“There are so many moms and babies that are not here to tell you what’s happening inside of those rooms and how important this work is,” she said.
The United States, with the highest maternal mortality, infant mortality, and preterm birth rates among developed nations, has a maternal and infant health crisis. Giving birth is more dangerous for Black non-Hispanic women, who are nearly three and a half times more likely to die from labor complications than white non-Hispanic women, according to a new study of 2023 data released this month by the Centers for Disease Control and Prevention. Preterm birth, high rates of cesarean birth, inadequate prenatal care, chronic health conditions, and socioeconomic and other environmental factors increase the risk of poor maternal and infant health outcomes, according to March of Dimes.
Lawmakers in Michigan reintroduced a series of bills this month that focused on addressing areas where the state lagged in maternal healthcare for people of color. While some of the bills in the so-called “MI Momnibus” stalled at the end of the last legislative session, one was signed into law last month, along with several other laws to help improve reproductive health that were not a part of the original package.
Birth Detroit Midwife Eliken Amable-Brumfield holds a baby during a final postpartum visit in the clinic. Photo courtesy of Birth Detroit
“Ensuring healthy pregnancies and improving maternal health outcomes should transcend partisan divides,” said Michigan Sen. Erika Geiss in December. “This is an issue that affects all families and deserves the support of both the Senate and the House, regardless of the political landscape because these issues are inherently non-partisan.”
Advocates are now focused on making pregnancy and childbirth more equitable and more accessible for communities of color.
How Michigan lags behind on maternal health
Michigan Sen. Erika Geiss, lead sponsor of the MI Momnibus bill package, and Sen. Stephanie Chang, who has also proposed bills for the MI Momnibus, speak on the Michigan State Capitol steps against proposed amendments to the Earned Sick Time Act, Jan. 29, 2025, Lansing, Michigan. Photo courtesy of Mothering Justice
Just more than 10 percent of births in the United States are preterm, occurring before 37 weeks, according to the Centers for Disease Control and Prevention. A country’s preterm birth rate is one of the key indicators of maternal and infant health, and the U.S. has one of the worst preterm birth rates among developed countries globally. Rates of preterm birth are even higher when the mother is Pacific Islander, Black, or Native American/Alaska Native, according to the March of Dimes.
Dr. Sonia Hassan, associate vice president of Wayne State University and founder of its Office of Women’s Health, said in an email that some countries, such as Finland, Japan, and Norway, have preterm birth rates around 5 to 6 percent.
“This underscores the ongoing domestic struggle with maternal and infant health care administration despite sky-high spending,” she wrote.
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The state of Michigan received a C- grade for its preterm rate of 10.3 percent, according to the latest report card from the March of Dimes. This is a slight improvement over the two previous years. When looking at Michigan’s largest city, the rate worsens. Detroit received an F for its preterm rate of 15.6 percent. Michigan preterm birth rates are also much higher when the mother is Pacific Islander, Black, or Native American/Alaska Native. Pacific Islanders had the highest preterm rates in Michigan at 16.5 percent, followed by Black infants at 15.2 percent.
“Disparities within U.S. cities like Detroit and rural areas like the [Upper Peninsula] make these challenges even more pronounced, with preterm birth rates higher than many lower-income countries globally,” Hassan said.
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In Michigan, the infant mortality rate in 2022 was more than two times higher for Black non-Hispanic mothers than for white mothers, according to the Michigan Department of Health and Human Services.
Michigan’s maternal mortality data also shows a stark contrast in outcome by race. In 2021, the pregnancy-related maternal mortality rate was 36.5 deaths per 100,000 live births for Black mothers, compared to 16.5 deaths for white mothers.
According to the state, about 80 percent of these pregnancy related maternal deaths are preventable.
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Hassan also said a lack of data around Arab American pregnancies makes it difficult to identify concerns specific to that group. Arab Americans have been underrepresented in larger data collection efforts, such as the U.S. Census, because the group has been racially categorized as white since the early 1900s.
Hassan said limited studies do suggest that Arab American women “face community-specific barriers to accessing prenatal care based on factors like immigration status, duration of residency, and acculturation that can influence health behaviors and outcomes.” Findings also suggest that Arab American women born outside of the U.S. have poorer outcomes than those born in the U.S.
Hassan also said some cultural practices, including extended family support and deployment of community networks, could positively affect breastfeeding rates and infant care practices in these populations, but “further research is needed, and these strengths can be undermined in the face of structural barriers to accessing health care.”
Implicit bias, economic equality, and whether a provider is culturally competent are all factors that could prevent communities of color from getting the prenatal care they need, she added.
Better data, better consumers
In talking with Black mothers, Danielle Atkinson often hears how their pain was not recognized, their concerns dismissed, or their birth plans ignored by doctors.
“At the heart of it is women, particularly Black mothers, talking to us about their experiences with in-hospital births and the treatment they receive from their physicians and the bias that they [encounter],” said Atkinson, national executive director and founder of Mothering Justice, a nonprofit that supports mothers of color.
“We have a system that has systemic oppression in it,” she said.
Danielle Atkinson, national executive director and founder of Mothering Justice, speaks March 6, 2024, at State of the Mama DC in Washington D.C. Photo courtesy of Mothering Justice
Though cases of maternal mortality are tracked by public health entities, it is more complicated to track every incident of maternal injury or harm, she added.
“If you nearly died or stopped breathing, those things are not recorded,” Atkinson said. “You are just going in blind to a hospital or a care provider not knowing that before you, somebody almost died. That would inform your decision about your care.”
Mothering Justice worked with women legislators of color to develop the “MI Momnibus” bills.
These bills reflected a broader effort in other states, like Colorado and California, to create an additional layer of state-level protections to address the racial disparities in maternal health.
Michigan Sens. Erika Geiss and Stephanie Chang stand with Mothering Justice staff and volunteers Jan. 29 on the Michigan State Capitol steps after speaking for mothers and families against proposed amendments to the Earned Sick Time Act. Photo by Mothering Justice
The bills included provisions that would have helped patients become better consumers because they would be able to see more statistics about their potential provider, like how many maternal deaths a hospital has documented the past year.
This kind of data would also give hospitals a good business incentive to address any inequities found, such as bias towards Black people, she added.
Equitable access to tests and treatments
Another challenge Michigan faces is that not all pregnant people are offered the same access to all the tests and treatments needed for a safe and healthy pregnancy.
For example, Hassan said, a short cervical length during the second trimester of pregnancy can indicate a higher risk of premature delivery. Doctors can check for this using a transvaginal ultrasound between 19 and 24 weeks of pregnancy, followed by treatment with vaginal progesterone, to improve odds that a pregnancy can reach full-term. However, some health systems do not offer this test, which is associated with a 45 percent reduction in the preterm birth rate, according to a study published in the journal Ultrasound in Obstetrics & Gynecology.
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Hassan leads a statewide coalition of medical and academic institutions that seek to improve outcomes in maternal and infant health. The SOS MATERNITY Network was launched in October to ensure that pregnant Michiganders receive the same required tests and treatments. The program also offers free transportation to every pregnancy visit. Other accommodations include compensation at specific visits, and continuous support from a patient navigator who guides people through their pregnancy.
Partners within the network are also documenting the Middle Eastern and North African identity of patients in the program to help expand the body of perinatal research.
Michigan’s first Black-led freestanding birth center
The disparities in birth outcomes for Black and Indigenous mothers and infants exist because of historical and current inequities in the country, said Elon Geffrard, cofounder of nonprofit organization Birth Detroit.
“The urgency of addressing health outcomes in our community, especially with Black parents, makes our work essential in a world where large health systems have not addressed or been held accountable to the longstanding mortalities and morbidities that BIPOC (Black, Indigenous, and people of color) communities are experiencing at record numbers,” Geffrard said.
Birth Detroit co-founders at opening of Detroit Birth Center, Michigan’s first Black-led freestanding birth center. Pictured left to right: Elon Geffrard, Char’ly Snow, Nicole Marie White, and Leseliey Welch. Photo by Patrick Thomas, Bassett Photography, courtes of Birth Detroit.
Birth Detroit opened Michigan’s first Black-led freestanding birth center in Detroit in January of this year. The center, designed to provide a comfortable, home-like environment, focuses on community-based care. The goal is developing partnerships with patients, offering things that can be harder to come by in large health systems, Geffrard said, including longer prenatal appointments, broader definitions of who can serve as birthing support people, earlier discharge from care and postpartum home visits. There are only a handful of centers like it in the nation.
Out of about 400 freestanding birth centers in the country, only about 40 are Black, Indigenous, and people of color led. “This is because of differential access to resources and opportunities based on race in the US,” said Leseliey Welch, co-founder and CEO of Birth Center Equity, an organization helping Black, Indigenous, and people of color led birth centers develop sources of capital. Since founding the organization in April 2020, Welch has cultivated a network of 57 developing and established birth centers that are Black, Indigenous, and people of color led, and invested more than $3 million in growing access to birth center care in communities.
“Birth is not a medical emergency. Most of us can safely give birth with midwives in a community setting – resulting in healthier birth outcomes, better birth experiences and significant system-wide cost savings,” Welch said.
Birth Detroit midwives with some of the tools they use to help people give birth. (L to R) Char’ly Snow, Chief Clinical Officer; Vanessa Landrum, Midwife; Angela Foster, Midwife; Elikem Amable-Brumfield, Midwife; Jessica Fladger, Midwifery Education Faculty and Midwife. Photo by Patrick Thomas, Bassett Photography
The new Detroit Birth Center staffs midwives and doulas of color, which have existed long before modern maternity care.
“Midwives have been caring for women and families since the beginning of time, it is not innovative to return to this form of care, it is essential and critical in the times we are in,” said Geffrard, who is also a doula.
The trained midwives and doulas at Birth Detroit are people from the community and are key to addressing the urgent and disparate health outcomes of Black birthing people because “large health systems have not addressed or been held accountable to the longstanding mortalities and morbidities that BIPOC communities are experiencing at record numbers,” she added.
A young family with baby at Detroit Birth Center opening. Photo by Patrick Thomas, Bassett Photography
Instead of today’s “medicalized birth culture,” Welch would like to see develop “a beloved birth culture, a birth culture that is family centered, midwife led with physician collaboration, community held, and that honors the inherent value of all people,” Welch said.
How new state laws expand resources for maternal care
To support this kind of work in underserved areas, Michigan Gov. Gretchen Whitmer signed a law last month to begin licensing freestanding birth centers.
Before that law, Michigan was one of 10 states that didn’t offer licenses to freestanding birth centers. This meant patients were not able to get the costs of care used in these facilities reimbursed by Medicaid, making them less accessible to low-income families.
“The impetus behind HB 5636 was the closure of some birth centers, many of them rural, because their patient populations cannot afford to pay for care at the facilities out of pocket,” said Democratic state Rep. Laurie Pothutsky, who introduced the bill.
A family room is seen at the newly opened Detroit Birth Center, Michigan’s first Black-led freestanding birth center. Photo courtesy of Birth Detroit
People in rural communities often have to travel over an hour to access a hospital, so without access to freestanding birth centers, care is even less accessible, she added.
With “staggering” maternal and infant mortality rates among BIPOC Michiganders, “ensuring that people feel supported, safe, and heard when it comes to their care is crucial in providing better outcomes,” the lawmaker said.
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Another new law signed last month helps expand maternal care services by building a pipeline for doulas, community health workers who support pregnant people through labor and delivery but do not give medical care.
“This bill [HB 5826] will establish a scholarship program for aspiring doulas who demonstrate financial hardship, expanding maternal care services to women in underserved communities across Michigan,” said Democratic Rep. Mai Xiong, who introduced the bill. “I look forward to seeing the positive impact it will have on mothers and families in our state.”
Michigan Rep. Mai Xiong speaks with journalists on the House floor in Lansing, Michigan. Photo courtesy of Michigan House Democrats.
Xiong was born in Ban Vinai Refugee Camp in Thailand. Her mother gave birth alone, inside a bamboo hut with a dirt floor, with no access to clean water or medical care, and cut the umbilical cord by herself. Her mother also gave birth to five of Xiong’s older siblings alone in the rural mountains of Laos.
“It’s a miracle my eight siblings and I survived,” Xiong wrote on X, after the bill passed in December. She contrasted her mother’s experience to her own, giving birth to four children in the U.S. with the assistance of a medical team.
“I can’t imagine what my mother endured. No mother should ever have to give birth alone during one of the most critical moments of her life.”
