Tori Bowie, Weathering & the Black Maternal Mortality Crisis

BIANNA GOLODRYGA, HOST: Well, turning now to the U.S., in the maternal mortality crisis facing black women who are three times more likely to die from pregnancy related complications. Last month, Olympic gold medalist, Tori Bowie, died from birth — childbirth complications when she was eight months pregnant. Journalism Professor Linda Villarosa investigates the relationship between race and health in her latest book, “Under the Skin.” She joins Michel Martin to discuss.

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MICHEL MARTIN, CONTRIBUTOR: Thanks, Bianna. Linda Villarosa, thank you so much for talking with us.

LINDA VILLAROSA, AUTHOR, “UNDER THE SKIN”: Thank you. Good to see you again.

MARTIN: Likewise, although I’m story about why we’re talking today. You are a recognized authority in science journalism on the issue of maternal health more broadly, and black maternal health in particular. So, when you heard about the death of the Olympic gold medalist, Tory Bowie, who was, you know, eight months pregnant, 32 years old, just, you know, just a really disturbing story. I was just curious what went through your mind?

VILLAROSA: I was heartbroken. I felt so sad for days, really. And specially because I’m a big fan of track and field. I remember her in the four by 100 meters relay when they won the Olympic medal in 2016. But also, it gets tiring and hearing the statistics about black maternal mortality.

MARTIN: Well, speaking of the Olympics, you know, three of the four members of that relay team, it emerges, all had complications during pregnancy or giving birth. What do we make of that?

VILLAROSA: Well, I think it just speaks to how common this is among black women. And also, it speaks to really getting rid of the myth that it’s all related to poverty or it’s all the women’s fault. That this is a problem that has been growing and is at a crisis stage.

MARTIN: One of the things that I think people really remember is a piece that you wrote in 2018 where you pointed out that, you know, the thinking had been that this is a poverty issue. That this is just, you know, people who have poor diet or poor access to health care. And you’re reporting and the research done by many in the medical field indicate that’s just not the case when it comes to black women. That’s not the relevant factor. Could you say more about that? Why is race so powerful of an indicator when it comes to pregnancy complications and — maternal mortality and infant mortality?

VILLAROSA: I think I want to first state that poverty makes everything worse. But poverty is not the only reason for black women’s maternal mortality. And I think I was really shocked when I first heard the statistic that even a black birthing person with a college degree or even an advanced degree is more likely to die or almost die in childbirth than a white woman who hasn’t finished high school. And now, even newer research speaks to wealth. So, it used to be just education differences, but now even wealthy black families are more likely to lose a mother during pregnancy childbirth and the time after. So, that is surprising. It was surprising to me. It still, sort of, gives me goosebumps in a bad way.

MARTIN: Well — and one of the reasons that we know this is that people are becoming more vocal about their experiences during childbirth. I mean, very famous women, like, Serena Williams, Beyonce, and other track and field star, Allyson Felix, have shared some very disturbing stories about experiences that they had. Some — in some cases, near death experiences during childbirth. Are there some through lines here?

VILLAROSA: Well, both Allyson Felix and Tory Bowie had preeclampsia, which then became for Tory, eclampsia which is a severe — the severest form of preeclampsia. And black women are 60 percent more likely to have preeclampsia and also to have the most severe form. And that is also transcends race, it also transcends class lines. So, I think that is alarming. Allyson Felix also had preeclampsia and had a very low birth weight baby who was in the NICU right after birth. I read an essay by her. She did everything right. She did — had prenatal care. She knew what to do to keep herself healthy during pregnancy, but she still almost had a tragic birth outcome. So, that speaks to beyond poverty and even beyond access to health care.

MARTIN: And one of the other things that I think your reporting and that of others has pointed out, is that these outcomes are getting worse. First of all, why are these — did these racial disparities exists? And why is it getting worse?

VILLAROSA: Well, I’m going to say one thing is the data has gotten better. So, now we know more than we did, even when I was first reporting in 2018. COVID made things worse as far as in the country. But also, because we don’t — the reasons for black maternal mortality and for the gap that transcends class and education. We’re not sure how to combat it. It’s very difficult because it has to do with toxic stress in society. And so, you know, having better access to health care is always good. It always helps. But it hasn’t closed the gap in this case.

MARTIN: Say more about what you mean about toxic stress and what role, you think, that plays or that the research indicates that that plays.

VILLAROSA: How I’d like to frame it is through the lens that Arline Geronimus uses, she’s a researcher and a professor at the University of Michigan. She calls it weathering. And her theory is that the lived experience of being black in America, especially a black woman, causes a kind of toxic stress that comes — becomes full-blown during birth, which is a stress test for the body. And so, then you see these poor birth outcomes because of the day in, day out battling discrimination.

MARTIN: I am mindful of the fact that the doctor that you mentioned was so far ahead of her time. In fact, you reported on this. She actually got death threats for her work. But you know, having said that, how do we identify that as, sort of an atmosphere condition as opposed to something genetic?

VILLAROSA: There was some very good data and research a couple of decades ago that this proved the genetic cause. And they looked at first generation African immigrants from some of the poorest countries. White women from Europe, white women from America, and black women from America. So, all three groups had normal birth weight babies except the African American women, and their babies were significantly smaller. Then they looked at the next generation. So, one generation later, they looked at the birth rates of the babies again. And the white babies from European countries had actually gotten a little larger. The white American babies were the same, basically, normal birth weight. The black women — black American women’s babies were still small. But now, in one generation, the women who were African immigrants, from some of the poorest countries in the Caribbean and Africa, their babies matched African American and — babies. And what I remember about that data was, it was by these two really wonderful researchers from Chicago. And, you know, I’ve interviewed a lot of scientists and researchers and they don’t really say things that are, kind of, like, outrageous. They’re more conservative. And I remember, they said, something about being black in America, black women, is bad for your body and bad for your baby and that thing is racism.

MARTIN: The states with the highest maternal rates are all on the south. And I just have to wonder if that means something. I mean, Arkansas, Mississippi, Tennessee, Alabama, Louisiana. Does that mean something?

VILLAROSA: These are the states that have been, you know, underfunded, left behind many times. They have the poorest, as we call, social determinants of health. The environments are often polluted. They don’t have access often to healthy water. You can, you know, look at Mississippi as an example, that’s where Tory Bowie was born and raised and went to college. And that has the highest rate of infant mortality. It has among the highest maternal mortality. It has the highest rate of child mortality. It’s the poorest state. And it also is the state with the highest percentage of black people. Most black people in the country live in the south. So, you have a whole bunch of factors all coming together. And so, I think it’s not surprising. It’s also the state where the Dobbs decision happened, so it was the end of reproductive justice in that state, so it made things worse. So, I was — I’m not surprised, but I’m saddened. My family came up from Mississippi to Chicago, my grandparents and all of their siblings, and so it makes me sad that Mississippi, especially, but so much of the south has been left behind.

MARTIN: How did you get interested in this, if you don’t mind my asking?

VILLAROSA: I got interested when I heard those statistics. And I was really interested in weathering as well, because I wanted to have some kind of rain for this. I also thought about my own birth. I was like Allyson Felix, I was — did everything right. I was the health editor of essence magazine, so I was really the poster child of good health, trying to be. And I was really surprised in my second trimester that my doctor told me that my baby was not thriving inside. And I went to a specialist who was asking me all kinds of questions, like, do you use drugs? Do you eat, you know, like every kind of unhealthy food? Do you drink? And all of these questions. And then I finally asked my regular OB/GYN, why would I be asked these questions? And she said, you have something called intrauterine growth restriction, which happens to people who are much less healthy than you, or who are using drugs and alcohol during pregnancy. So, my baby was just short of preterm. I basically held her in so she was not preterm, but she was low birth weight and she weighed four pounds, 13 ounces. She could fit in the palm of my hand. She’s downstairs now, working, and is a healthy young adult. But I always wondered, why would that happen to me? And once I got the explanation for weathering and I understood that, then I thought, oh, I wonder if that is what happened to me and my baby?

MARTIN: And I want to go back to something you said about, you know, the way that you were, sort of, interrogated. One of the things that you pointed out in your reporting and others have as well is that it’s not just the, sort of, the assumption that black women are doing something wrong. Like they’re eating the wrong things, they’re drinking too much, et cetera. But it’s also the not being listened to. And I just — can you just say more about what role that that plays? I mean, this is something that maybe people will remember if they followed Serena Williams’ story. I mean, she’s a world class athlete who’s — presumably knows her body very well. But when she tried to indicate to her doctors, like, something was wrong and she suspected what it was, they didn’t listen to her.

VILLAROSA: I’m always surprised at how often that happens, and one of the statistics that struck me, initially, was that black women are much more likely to meet the person delivering their baby for the first time when they’re delivering the baby. So, that speaks to a, sort of, lack of consistency in health care. But also, even when your Serena Williams, who knew what was going on with her, tried to communicate with physicians about what was going on with her and wasn’t listened to initially. So, that speaks to something much worse that’s going on. I think in general, overall, I think of the case of Dr. Susan Moore. It’s not related to pregnancy, but she was a black woman who went into the hospital with COVID in 2021. She was a physician herself, tried to speak to her caregivers about what was going on with her body. She wasn’t listened to. She made a video of herself from her hospital bed and spoke about that. And the refrain throughout her video was, this is how black people get killed. And then she did die of COVID. In the investigation of the hospital system in — it was in Indiana. They – – one of the reasons they pointed to was they — the — some of the providers that were caring for her felt like intimidated by her medical knowledge because she was a doctor. Saying please, this is the kind of care I need. So, that speaks to not being listened to that can turn out to be deadly.

MARTIN: And what you’re saying is that that’s not — it’s — that, you know, education is not protective in the way that you might think that it would be. You think that somebody who could speak to, you know, medical professionals on their level would be listened to. Is there any — I don’t know, explanation for that?

VILLAROSA: I think part of it is a stereotype that’s been floating around for hundreds of years of the angry black woman. So, then when we’re speaking with authority or we’re speaking with — trying to be assertive, it sounds to others angry because of the stereotype that we’re often angry. Sometimes, I show a cartoon of Serena Williams, you know, several years ago she was playing in the U.S. open, and she pushed back against a call. There was a cartoon that ran shortly after of her looking completely crazy, super angry, just really out of control. And I thought, if that is the image of her that is international, then when she gets into her hospital room and she starts talking about, actually, this is what I have. I have a pulmonary embolism. I know what it is. This is what I need, she is sounding angry and then she’s not listened to.

MARTIN: You mentioned that you are kind of haunted by the death of Tory Bowie for days. And I’m just wondering if there’s anything that we can point to that offers some hope in a situation like this?

VILLAROSA: When I saw that she had died of respiratory distress, I thought of the phrase, I can’t breathe. George Floyd’s words that became a rallying cry for racial justice in this country. I am a really hopeful person, and I look at the way that medical students, midwifery students, nursing students, are trying to be much more birth justice and social justice oriented. So, the providers that are working with black birthing people are trying to do better. With my book, I’ve traveled around the country to a lot of medical schools and I’ve been really excited about their willingness to think differently. To want to be different kinds of providers. I think of Doula Care. Doula Care used to be something that was only for the privilege. Many doulas, including the ones I wrote about in 2018, the doula collective, are much more birth justice oriented. We’ll work with people on a sliding scale. Some states cover doula services for often the most poor women or the women who need it most. So, a doula is someone who can be with you when you’re birthing to be your eyes and ears. When I was covering maternal mortality in 2018, it was really the doula that saved the birthing person’s life that I watched and was the hero of the story. So, those kinds of things do make me more hopeful.

MARTIN: I do wonder if the end of nationwide access to abortion care will have an impact. I mean — because, obviously, the proponents of these restrictions believe that they are in the service of preserving life, and I’m just wondering if what you see in the landscape.

VILLAROSA: Well, I think the abortion is part of a package of reproductive justice, so that means people in this country and everywhere should have the right to have a child. So, you can’t be sterilized against your will or without your consent. Should have the right not to have a child, so that means abortion care should be national. Should be a federal law. And birth control should be affordable and easily accessible. And then the third part of reproductive justice is the right to raise a child in a safe and healthy environment. In — if you get rid of abortion care, you don’t have reproductive justice. So, people that are against abortion and, you know, it’s part of a bigger package. You have to also care about mothers and babies.

MARTIN: I, kind of, am thinking about the fact that there has been such a backlash against looking at anything in a systemic way in some parts of the country. I know a lot of the attention has been on, sort of, book bans and curricula, and the, say K through 12 years. But it just makes me wonder that if there is so much resistance to thinking in systemic terms, how does this get addressed?

VILLAROSA: I have done several grand rounds at different hospitals, including the hospital where my own children were born, the OB/GYN department. And I don’t go in saying, I think you’re all racist. I go in saying, we have a systemic and an institutional problem. And one of the ways you can combat it is by going through some, kind of, implicit bias training or anti-racism training yourself just so you’re aware as individuals of, you know, of what you — what may be going through your mind because of, you know, the racism that is baked into society. And I try not to blame individuals. But I do say this is a problem. There is, without a doubt, there’s so much evidence to say that we have discrimination and racism in our health care system. It’s not even arguable anymore. There’s been, I like to say, that we have enough evidence to fill the Library of Congress. So, we should stop arguing about that and try to figure out how to address the problem.

MARTIN: Linda Villarosa, thanks so much for talking with us about this.

VILLAROSA: Thank you. Thank you.