Black birthing people in the US are three times more likely to die from childbirth-related causes than their white counterparts. It is unconscionable that a child born today could begin life having already lost the parent who carried and birthed them.
In New York City, the mortality rate of Black birthing people is 12 times higher than that for white, non-Hispanic people. This same phenomenon is observed around the world. In the United Kingdom, Black birthing people are up to five times more likely to die of childbirth-related causes than those who are white. In Brazil, Afro-Brazilian birthing people also die at a rate of four times higher as non-Black Brazilians.
Now consider this: over the past 20 years, maternal mortality rates have declined in every industrialized country — except in the United States, where the figure has risen.
The racial disparity in childbirth-related deaths is still observed when you control for age, education level, pre-existing medical conditions, insurance status, or where one gives birth. Structural racism, embedded at every layer of the healthcare system, is the culprit.
The History of the Black Birth Experience
To understand where we are today, we need to look back to the history of the Black birth experience in the United States.
For the 250 years comprising slavery, the conditions of Black birthing people were those of bondage and isolation. Their babies were born into a range of experiences from familial love to rape and exploitation. The safety of a baby and birthing parent was assured only by a class of skilled Black women, who had received intergenerational expertise in midwifery dating back to their African roots.
These Black “granny midwives,” as they are known, provided the foundations of birth-related care in our country — for everyone. They cared not only for Black enslaved birthing people, but also for the white birthing people in their communities. At one point, Black midwives had attended three-quarters of births in the southeastern United States. And yet, when the field of obstetrics developed in the mid-1700s, its leaders systematically attacked and replaced Black midwifery with a medical-industrial complex that had patriarchal white supremacy at its roots.
Indeed, medical advancements brought techniques that could save more birthing people and their babies from infections, blood loss, and fatally-long labors. But the rise of medicine also meant the need for brutal experimentation to establish those techniques. Black enslaved women served as the subjects, providing the elemental knowledge for much of modern reproductive care.
In the early 1900s, as birth moved into hospitals, health care providers left Black birthing people on the margins. Hospitals became places where racist mistreatment was not only observed, but legally permitted per Jim Crow laws. And as Black midwives dwindled in numbers, Black birthing people and their babies, with no other trusted caregiver to rely on, increasingly suffered from childbirth-related injury and death. This reality continues in the U.S.
One hundred years later, today’s doulas, nurse midwives, and lactation consultants pull on the thread left by Black midwives. These community-based birth and family support professionals are imprinted with the spirit of their granny predecessors. As professionals, they value advocacy and accompaniment, and honor the welcoming of a child as a spiritual and community experience more so than a medical one.
These professionals comprise the foundations of the Cleo care model. They ARE our Cleo Guides.
As a global organization, we designed Cleo with birth equity in mind. We want all people to have the capacity to achieve a birth that honors them and their communities. We knew that replicating a medicalized approach to family support — by staffing a care team with doctors and nurses who simply provide care over phone or video — would not transform birth and early infant health outcomes. Moreover, this medicalized approach would not change the conversation about who deserves a good birth, who deserves to feel heard, and who deserves to survive.
Cleo Guides are assigned to families upon enrollment. This becomes the central relationship defining your experience. Guides check-in with you at significant decision points. They talk you through real-time challenges. They are your coach, companion, and expert all at once.
Of course, simply gathering a Guide team with the right professional backgrounds is not enough. They say, “every system is perfectly designed to get the results it gets.” We recognize we must put in work to create a care management system that supports racial equity for families as they encounter prenatal care, birth, and beyond. For the rest of 2020, we commit to:
We will celebrate the expert advocates of birth equity, who have been developing this field and shedding light on hard facts for decades. As we understand this is not a new issue, we will amplify the work of individuals who represent and work alongside Black birthing people. Follow us @hicleo on Instagram, where we will feature these movement leaders.
We will share resources, expert advice, and organizations that provide tangible support for Black working parents. You will find these resources across our social media platforms and on our website. We will also include information for HR leaders looking for ways to support BIPOC working parents.
In our member app, on our social media platforms, and via expert webinars open to the public, we will highlight information crucial to ending birth disparities in the US and globally. We are excited to announce our first webinar, open to the public:
You’ve Heard the Stats About Black Pregnant People: Now What?
Topic: Across the globe, Black birthing people consistently face racism in healthcare, leading to negative downstream effects on birth outcomes - and at its worst, costing life itself. This discussion will aim to provide tangible advice for Black families looking to navigate this reality and seek a safe, dignified birthing experience that honors their humanity.
A Dialogue Featuring Chitra Akileswaran, MD, MBA, Cleo Co-founder and Chief Medical Officer, & Natasha Sobers, DTI Certified Doula, 200hr Registered Yoga Teacher, Cleo Family Guide & Equity and Disparities Specialist at Cleo
Date & Time: Thursday, July 23 at 8:30am PST
Cleo aims to offer evidence-based guidance that also respects individual family decisions. Our goal is to be approachable, companion-like, and feel like an embrace when you are having your worst moment. If anyone needs this support, it is our Black and Brown families who are least likely to find it within their healthcare experiences.
We will steer our members to birth facilities with a reputation of racial equity. We know that one of the most important decisions one can make is where to give birth, whether to avoid unnecessary cesarean sections or to get quality care. In fact, approximately 50% of members who we support actually end up changing their location of birth. Steering families on the basis of racial equity could be accomplished with facilities that have staff that is racially concordant to their patient base or that welcome doulas of color to support BIPOC birthing people. Or, the reputation could be based on experiences reported by BIPOC families at these facilities. We are building an internal database with this evidence to help families from all racial identities achieve the safest, most dignified births possible.
We are also committed to support the broader community. We hope to do that by highlighting BIPOC family stories of positive birth experience and by creating forums for BIPOC families to share with one another and ask and answer difficult questions.
At Cleo, we have a sturdy foundation on which to build our contributions to birth equity. But we also realize that this is just the beginning. To get this right, we will strive to practice humility and self-examination of our privilege, as a for-profit entity consisting of educated, employed individuals.
To our Black families: we are listening and we are here for you.