Understanding value and accessing capital in Black maternal health

In Kimberly Jones’s 2020 viral video, How can we win, which comments on looting during the protests sparked by the death of George Floyd, she asks us to consider the why behind peoples’ actions. To explain, she delves into an economic history of Black people in America and the ways in which capitalism and racism are messily entangled.

Capitalism was one of the first ideas acknowledged during opening remarks at the Black Birth Maternal & Infant Health Symposium at Saint Kate- The Arts Hotel in Milwaukee, Wis. last month.

Photo by Anna Shvets

Geraud Blanks, Chief Innovation Officer for Milwaukee Film and one of the organizers of the event, thanked all of the sponsors who showed up.

“Accessibility is the key to inclusion,” Blanks said. The Black Birth Symposium was completely free to participants including parking, lunch and the space.

Blanks went on to share feedback from a 2022 Black Birth Symposium participant, driving home the importance of investment. It read: “I really hope all the medical facilities get on board with this event. They say that this is the most important issue impacting Black women but I didn’t see everyone at the event. Our community watches to see who puts their money where their mouth is. This also helps build trust in our communities. We don’t need another billboard ad, we need your dollars to go to events like this that really make an impact in our communities. We are watching.”

The thread of capitalism held through the keynote conversation with Tiffany Green, PhD, Assistant Professor Population Health Sciences and Obstetrics & Gynecology at UW-Madison and Jeanette Kowalik, PhD, MPH, MCHES, president and owner of Jael Solutions Consulting Services, LLC.

Dr. Green urged Black and Brown individuals to understand their value.

Photo by nappy on Pexels

The Center for American Progress’s piece Women of Color and the Wage Gap points out that, “When looking at women’s wages across broad racial and ethnic categories among full-time, year-round workers, Hispanic women experience the largest pay gap, having earned just 57 cents for every $1 earned by white, non-Hispanic men in 2020.  Black women also experience wide pay gaps, with data on Black women alone revealing that—despite consistently having some of the highest labor force participation rates—they earned just 64 cents for every $1 earned by white, non-Hispanic men in 2020. This number dips slightly to 63 cents, reflecting a slightly larger wage gap, when data on multiracial Black women—meaning Black women who also identify with another racial category—are included in the analysis.”

With these inequities in mind, Dr. Green and Dr. Kowalik acknowledged the difficulty in accessing capital, for both individuals and grassroots organizations.

Dr. Green asked participants to consider not giving away their knowledge. You are a part of the community; how can you take care of the community if you’re not taking care of yourself, she posed. Ask for what you are worth, she further advised.

In the arena of maternal child health research, Dr. Green explained that it is well within reason to ask hard questions to funders and leaders like: What is the budget for this grant? What problems are you addressing? Are you stigmatizing the community? May I co-author or co-create?

Photo by Christina Morillo

An audience participant brought up the phenomena of large funding institutions being insular and wondered who holds them accountable. What is the metric? she wondered.

“Folks like us… with our boots on the ground… doing this work every day, have to fight and jockey to keep ourselves alive,” she pointed out.

The authors of First, Do No Harm: Why Philanthropy Needs to Re-Examine Its Role in Reproductive Equity and Racial Justice address ways in which funders can “embody the equity they aspire to see and build through the operationalization of cultural rigor to advance structural equity and racial justice and to sustain community engagement in research.”

Building upon her previous comment, the participant added that spirituality and emotional intelligence are not valued in science. She called on us to “restore ancient knowledge”, to “transform and decolonize what we consider competence”, and to “honor the people who brought their lived experiences.”

Dr. Kowalik applauded the work of The Birth Justice Fund – Rapid Response Fund (BJF-RRF), an organization addressing the challenges in accessing capital in under-resourced communities. BJF-RRF is a three- year opportunity to advance community power efforts led by Black, Indigenous, and People of Color (BIPOC) birth justice (BJ) organizations to address implicit bias and structural racism and their impact on maternal and infant morbidity and mortality. The second wave of funding opens this month. Apply here.

Dr. Greene said, “Black scholars need a seat at the table. When you have the lived experience, you ask the right questions. That’s what makes the science better.”

Source: United States Breastfeeding Committee.

The authors of Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future echo Greene’s call and write that “public health and policy priorities need to center on listening to Black women, and funding Black, Indigenous, and People of Color (BIPOC) organizations and researchers conducting innovative projects and research.”

More to explore on the intersection between racism, capitalism and research in maternal child health 

Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.