The phrase “Black women, mothers, and birthing people” is used throughout this three-part series to recognize people who identify as non-binary, honor surrogates, and pay respect to those who have lost a child.
Melissa Franklin, who earned a doctorate in organizational change and leadership from University of Southern California, did everything experts recommend while pregnant with her first child in 2007.
She ate well. Exercised. Attended doctor’s appointments. That wasn’t enough to prevent her first daughter, Hannah, from being born at 27 weeks and five days, weighing less than two pounds.
Two years after Hannah’s difficult birth, Dr. Franklin was pregnant with her second child and again, followed all of her doctor’s prenatal care guidelines. Again, her baby – Heaven – was born early and underweight. Dr. Franklin herself experienced severe complications during childbirth.
Black people experience higher incidences of heart disease, diabetes, and hypertension compared to any other racial group. Black moms, women, and birthing people are also much more likely to have a severe maternal morbidity – unexpected difficulties during labor and delivery that result in major consequences to their health.
Studies show racism, implicit bias, and stereotyping cause these racial health disparities. Cherished Futures for Black Moms and Babies, a collaboration between five Los Angeles County hospitals, community-based organizations, public health agencies, and health care workers, aims to change that.
A group of eight Black women community advisors play a key role in the program’s success in hospitals.
Dr. Franklin details in “Fighting for Hope” how her painful experience exemplifies the role racism plays in Black people’s health. It also dovetails with the work she does with First 5 LA and as part of the Cherished Futures collaborative.
Today, her children, now 14 and 11, are vibrant and strong. But it’s not enough to simply reduce the number of deaths and improve patient well being.
“I can emerge from the birth experience alive, but was it a positive experience or was it traumatizing?” she said. “I’ll know we’re making progress when Black babies, mothers, and birthing people stop dying at inequitable rates, when we can experience joyous and happy births.”
Community advisors inspire change
Dana Sherrod, Cherished Futures lead, who also experienced a traumatic birth, knows how critical it is to elevate Black people’s experiences.
“Integrating community advisors as members of each hospital team has significantly deepened the collaborative’s conversations around topics, including community trauma, and the impact of racism on daily living, health, and birthing outcomes,” Sherrod said.
Community advisors bring the community’s voice to a hospital to help leadership plan ways to address the disparities using data and the expertise the advisors bring to the table.
Mashariki Kudumu, maternal and infant health director for March of Dimes Greater Los Angeles, is a community advisor at Cedars-Sinai and a mother. This work is important to her for two reasons.
“First, maternal and infant health are indicators of our population’s health. If you think of children as the greatest resource for our future, we want our population to be healthy,” she said. “Second, as a Black woman and Black mom, this work is personal to me. It’s really about families having access to information, resources, support, and respectful and responsive health care so they can have healthy pregnancies and babies.”
She and her three sisters, all of whom are university graduates, each had babies born early. All have good jobs and excellent insurance, yet that didn’t prevent traumatic births. Kudumu attributes it to racism and toxic stress.
The Los Angeles County African American Infant and Maternal Mortality (AAIMM) Initiative is a program led by the Los Angeles Department of Public Health, dedicated to closing the county’s Black-White gap in infant mortality. Community action teams around the county bring different perspectives to the table because the needs in an area like South LA are different than in, say, Antelope Valley. Several Cherished Futures community advisors, staff, and collaborative partners, including Melissa Franklin and Mashariki Kudumu, work closely with this effort. The initiative is a joint effort among several organizations, with AAIMM pulling the levers and a focus on achieving equity county-wide.
One way community advisors benefit hospitals is by helping executives and clinical staff understand the origin of these health disparities. Kudumu often discusses with staff structural determinants of health, how red lining is tied to generational wealth and, ultimately, how it all affects health outcomes.
“They don’t often talk about racism or inequities in medical school,” Kudumu said. “Cherished Futures is helping our hospital partners learn more about the impact of racism on health and moving them to take action. It’s hitting people in the heart and they are developing a deeper understanding.”
Making community connections
Dr. Sarah Kilpatrick, a physician at Cedars-Sinai, chairs the hospital’s Department of Obstetrics and Gynecology. She understands why building community is important – it’s the basis of trust.
Having respect for patients is critical for providing meaningful care. That includes listening to patients and being mindful of implicit bias.
“We all have implicit bias. Whoever says they don’t is either naïve or maybe lying,” she said. “Whether it’s bias about race or age or weight, your job in a health care setting is to provide the best care you possibly can, and that takes a conscious effort at times.”
Some Black people don’t trust the hospital environment because they fear doctors or nurses won’t offer them the same care they do white people, which Dr. Kilpatrick said has a historical basis in truth. Cherished Futures helps bridge that divide.
“Part of that is building trust for the hospital and respect from the health care community. If you get to know somebody, if the hospital gets to know our community, you get more comfortable, respect is more easily uncovered,” she said. “That’s when you get to know life from their perspective and not just your perspective as a doctor in a hospital.”
At Cedars-Sinai, Dr. Kilpatrick said there’s now open discussion about racism – something no one mentioned five years ago. Faculty, residents, and staff have also grown more diverse, with more LGBTQ, Black, Latinx, and Asian workers than ever before.
“That diversity helps us, and we still have a lot of work to do, but people are willing to listen and support others when there’s a call-out on disrespectful behavior,” she said. “We can respectfully identify it, then take steps to articulate one-on-one why that’s not appropriate. You can’t shame someone into better behavior.”
Cherished Futures continues to build critical relationships between hospitals, health care systems, clinicians, and other stakeholders. Their efforts bring hospitals and Black community leaders together to create systems-level change at the clinical, institutional, and community level.
Our Health California shares a commitment to understand and tear down the systemic barriers that communities of color face in California. Your support helps us ensure that access to quality health care and personal safety is a right for everyone, not a privilege for some.
In Their Own Words:
“Like every other institution in this country, hospitals have a role in ensuring justice for all. There should be no disparity in the quality or delivery of services to any person. People go to hospitals for healing. People look to medical practitioners for help, so I expect practitioners of healing to be all about the healing. One body is like another body. There is a mutual benefit for hospitals and communities to get together, because we need each other.”
Yolonda Rogers-Jones, County Coordinator, Los Angeles County Black Infant Health Program