Renewed and warranted interest in birth equity has understandably directed new funders to the field of maternal and perinatal health equity. The crisis of persistent inequities in maternal mortality demands that funders face harsh realities about the genesis of our maternal healthcare system and related programming. No single intervention will enjoy sustained improvement without a critical examination of the root causes of these birth inequities, and systemic injustices in maternal health care, research and funding. While funders reorient their scopes from previous maternal health outcomes to focus on birth equity, it is imperative that funders and program planners recognize the foundation and existing frameworks for action developed by Black women. Acknowledging sustained injustices within the healthcare and funding sector, while retrofitting these systems and exhibiting a commitment to their undoing offers an opportunity to build care models that can assure equitable outcomes for all birthing people.
In the past week, a record number of summits, convenings, and conferences have come together to discuss the future of birth equity, maternal health, and national frameworks for action. Absent from these conversations is the acknowledgment of the work of Dr. Joia Crear-Perry and the National Birth Equity Collaborative (NBEC) in elevating birth equity as a part of the national conversation. While Black women-led organizations may be invited to participate over the course of these events, programming agendas reflect a lack of engagement of birth equity thought leaders in the framing, planning, strategy, or execution behind these occasions.
The National Birth Equity Collaborative (NBEC), founded by Dr. Joia Crear-Perry, a Black woman OB-GYN, is a local, national, and transnational organization working in research, technical assistance, training, policy, evaluation, community-power building, health communication, and more to ensure that all Black mamas, birthing people, babies, and their villages thrive. In 2016, before the National Healthy Start Association Annual Conference, Dr. Joia Crear-Perry and a group of colleagues created NBEC as an acknowledgment of the need for Black women-led application of human rights frameworks in the perinatal health space. Human rights doctrine insists that we recognize the highest attainable standard of health for all people as freedom and entitlement. The term reproductive justice (RJ) was coined by a groundbreaking group of 12 Black feminist scholars and advocates in 1994, who are considered the founding mothers of the movement: Toni M. Bond Leonard, Reverend Alma Crawford, Evelyn S. Field, Terri James, Bisola Marignay, Cassandra McConnell, Cynthia Newbille, Loretta Ross, Elizabeth Terry, ‘Able’ Mable Thomas, Winnette P. Willis, and Kim Youngblood. NBEC’s work builds on reproductive justice; acknowledging human rights as inseparable from the advancement of health and well-being for Black birthing people, their families and villages.
Defining Birth Equity
At the time of NBEC’s genesis, no definitions existed for birth equity. NBEC built upon existing definitions from The Centers for Disease Control and Prevention and The World Health Organization, while uplifting the work of Black women scholar-activists in reproductive justice and health equity. The injustice suffered by those birthing people is a mirror of injustice and marginalization happening in the larger structures of our society.
Former American Public Health Association (APHA) President, Dr. Camara Jones, posits that health equity is the assurance that conditions for optimal health are available for all people, based on the premise that all people are valued equally, and injustice is both recognized and rectified. With the guidance of Dr. Jones and others at the National Association of City and County Health Officials and APHA, NBEC defines Birth Equity as the assurance of the conditions of optimal births and well-being for all people with a willingness of systems to address racial and social inequalities in a sustained effort.
If organizers of birth equity events are truly interested in the fruition of birth equity in our lifetime, paradigmatic shifts in funder philosophies must occur. What if funders centered the community and Black women-led frameworks on conversations around birth equity? If you center the realities of the most marginalized—that Black and Indigenous mothers and babies have the worst outcomes in Maternal and Child Health in the United States—you make room for all other racial and ethnic groups to grow and prosper. How does the exclusion of the innovators in the field comport with equity when White-led organizations are continuously centered? Maternal health funders must acknowledge and address injustices in funding distribution and the perpetuation of research and programming that looks for solutions outside of the marginalized community. Justice-centered approaches to funding and programming will establish a narrative that does not perpetuate this continued marginalization but promotes asset-based solutions for improving maternal health. Black women’s thought leadership is the chief asset.
As we are facing a preventable, sustained, and worsening Black maternal health crisis, it is important for us to examine the role of legacy. This is critical, as it points directly to the legacy of philanthropic redlining and white supremacy that seeks only to capitalize on the experiences of Black women and birthing people on the back end, signifying a sense of inclusion, without trusting our community’s leadership to create solutions that will meet our needs. We encourage funders to center the organizations, experts, and practitioners, on the ground who have innovated birth equity and justice centered-solutions. As our colleagues Jennie Joseph and Kimberly Sears-Allers noted during one summit, Black women-led organizations have been innovating in birth equity and birth justice long before philanthropic attention. It is critical to recognize this innovation, fund these organizations and support further sustainable investment in these organizations. It is not time for funders to try and reinvent the wheel that Black maternal health thought leaders have created and pushed forward for generations. Instead, we challenge philanthropy and well-meaning organizations to shift the narrative of erasure and instead innovate by highlighting black women’s thought leadership and frameworks and fund this work as an innovation.
It is philanthropic redlining that has, in many ways, erased the contributions of Black researchers, birthing people, and thought leaders, and has sanitized our messages in service of respectability to uphold the status quo under the white gaze. We need more innovative, radical, rigorous, and well-resourced solutions. The cultural arrogance and ignorance involved with giving money to the same groups who have caused or prolonged health disparities will not serve us.
We must ask, what is your goal as a funder? It has been two years since America’s “Racial Reckoning”, where many White-led organizations stated their claims to raise their organization’s racial consciousness. What progress do these organizations have to show toward this goal? What lens is equity being viewed from? What framework is being applied to advance birth equity? These actions do not align with what you are telling the world you are doing. Why must we beg to be a voice in conversations that claim to center us? Do events supporting birth equity demonstrate a “willingness of systems to address racial and social inequalities in a sustained effort?” As White-led organizations consistently diminish the voices of authority on Birth Equity that are Black birthing persons, they further confirm the point and the need for this work that, Black birthing people and their families are being left out of life or death conversations.
We urge philanthropists and birth equity supporters to see this time as an opportunity for you to build true, equitable relationships with organizations that have been doing this work long before the national spotlight.
We must be reminded of Black women’s statements that “All white-governed institutions cannot serve as the benefactors, oppressors, and redeemers of Black women’s genius…You have no answer that Black women don’t already possess.”
Inas Mahdi is the Vice President of Equity-Centered Capacity Building for the National Birth Equity Collaborative.