The California Black Women’s Health Project (CABWHP), a statewide nonprofit organization that works to improve the health of Black women, is continuing the fight to address medical racism and emphasize that Black women are able to have joyous births amidst a nationwide Black maternal and infant mortality crisis.
Raena Granberry, senior manager of Maternal and Reproductive Health for CABWHP, spoke with State of Reform about the work the organization is doing, and how racism plays a role in the experiences of Black birthing people.
“The racism in the medical field leads to discriminatory care. It is very difficult for the medical field to not have these deep-seeded sorts of practices of racism, especially around women’s health and reproductive health and gynecology related to Black women—when the entire field and study of gynecology started in the brutal practices of teenage girls.”
— Granberry
California released their final California Reparations Report in June as part of Assembly Bill 3121 to study and develop reparation proposals for African Americans, who experience ongoing harms as a result of slavery and its lingering effects. The report stated that enslavement and racism are, at minimum, partially responsible for African Americans having the worst health outcomes of any racial or ethnic group in the country.
James Marion Sims, who is referred to as the “founder of modern gynecology,” and was an enslaver, experimented on enslaved women by performing forced and non consensual vaginal surgeries. The Reparations Report said Sims used enslaved women’s bodies to advance his professional status, and forced enslaved patients to work as enslaved nurses and surgical assistants, which they did not receive recognition for.
Racism and implicit and explicit bias continue to show up in the healthcare field today, Granberry said. She said she spoke with a medical student two years ago who was convinced that Black women have more testosterone in their bodies than white women.
“Those ideas still float around, and sometimes ideas get misconstrued with evidence and with research that’s been done,” Granberry told State of Reform.
While every pregnancy and birthing experience is different, Black birthing people have joyous and beautiful births, and while some of these beautiful Black birthing stories come from hospital births, Granberry said that the majority are stories from midwifery and the assistance of doulas. Even though beautiful Black births occur across the country, Granberry noted how Black birthing people have worse outcomes than other racial and ethnic groups.
“We know that wealthy Black women have worse outcomes than poor white women. We know that healthy Black women have worse outcomes than unhealthier [white women] or white women who smoke. Black women with advanced degrees have worse outcomes than white women who haven’t graduated high school, or who have a high school diploma,” Granberry said.
Environmental disparities play a vital role in the health outcomes of Black birthing people and their babies. Black communities were historically and knowingly built in unsafe areas, like near factories or on contaminated lands, creating predispositions to illnesses which could make pregnancy more difficult.
The healthcare workforce shortages and the growing rise of medical desserts also impact the options and ways Black birthing people experience pregnancies.
“When we know that these institutions—historically and yesterday—have had these discriminatory care practices to Black women … a lot of the time you don’t want to be continually going to these doctor’s offices where you’re not treated fairly,” Granberry said.
The Momnibus Act—which requires all healthcare providers that care for pregnant people to receive implicit bias training every two years—and the Dignity in Pregnancy and Childbirth Act—which aims to reduce preventable pregnancy-related deaths and associated health disparities—two pieces of legislation passed in recent years that work to protect and address some of the issues Black birthing people experience, but Granberry said that a system overhaul and distribution of power is needed.
“The systems change overhaul and the distribution of power is what it’s really going to take, and that’s the slowest part, and that is the part that most people in power are unwilling to do.”
— Granberry
At the local level and across the state, CABWHP is supporting guaranteed basic income, which was an initiative piloted through the Abundant Birth Project in San Francisco, where Black and Pacific Islander women and birthing people received monthly payments to assist and reduce stress for a total of 12 months. Granberry said CABWHP is looking to support a guaranteed basic income initiative in Los Angeles County in the future, but a timeline has yet to be determined.
“Black maternal health is a crisis, and it should be funded as such. It should be funded in the way that we fund the crisis that happened overseas that we support—all of these different things that we support in an astronomical way—we do not do that for the people, and especially for our Black people.”
— Granberry
CABWHP recently partnered with the University of Southern California to investigate the special benefits of Black-led, non-clinical, community-based social and technical support for Black women and birthing people in Los Angeles County. Data was collected from 21 participants, including five community-based organization leaders, five birthworkers, and 11 birthers.
The report highlights recommendations for improving community-based care , provides advice from Black birthworkers to new birthworkers, among other recommendations such as grant writing and training. Granberry said it’s crucial for facilities to disaggregate all data.
“We’re still dealing with agencies and hospitals and different folks who will tout, ‘We’re not doing that bad of a job,’ but they don’t know what they’re doing as far as their Black patients are concerned, because they’ve never disaggregated data to see what the experiences of Black patients and birthing people are. If you don’t know, then you can’t begin to make changes.”
— Granberry
CABWHP also offers an Advocate Training Program, which seeks to empower Black women who aren’t heavily involved in policy advocacy to advocate for their health, the health of their families, and the health of their communities.
“I like to wrap my concern in hope, because we are working very hard, and we have a lot of things happening with Black women, Black people, Black femmes [who] are taking responsibility on our own—we’re doing a lot on our own,” Granberry said.
To reduce mental health stigma, anxiety, and isolation among Black women, CABWHP launched a statewide movement—Sisters Mentally Mobilized—which trains Black women to become mental health community advocates, with over 150 Black women having been trained. CABWHP launched the most recent Sisters Mentally Mobilized cohort in Sacramento in June.
Looking to the new year, CABWHP will continue to advocate for reparations for Black California residents.
“A lot of attention gets placed on our pain—it’s marketable, it’s profitable, you can see it as entertainment—it’s always about our pain,” Granberry said. “I really want to uplift the fact that Black women, femmes, people, do have joyous births, can have joyous births, and we’re continuing to work towards that. I don’t like the fact that the only narrative about our birth is always negative. It scares Black folks who can have babies, it creates more stress for them, and that’s unfair because other folks don’t have to deal with that.”
CABWHP has been holding recent discussions about highlighting international Black birthing stories. A member of the organization shared with State of Reform that she experienced a beautiful Black birth overseas as a high-risk pregnancy, and while there were language barriers, her experience was joyous. The organization is working to develop ways to share positive, international Black births as a way to model what the organization is working toward in California.