How we can drive down the Black maternal mortality crisis
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Good morning and happy Monday! I hope you're able to stay warm this week. Today we’re focusing on the disparities that Black women face in health care. Our main item is about the Black maternal mortality crisis here in Iowa and what’s being done to address it. We have a guest opinion piece by Celeste Lawson, whose mother died two years ago from metastatic breast cancer — a disease that Black women are more likely to die from than white women. If you're interested in this and other health care topics related to gender issues, register to attend our Fearless Friday from 8 to 9:30 a.m. on Feb. 26 (if you've already signed up for the series, you're good to go!).

I also want to plug our Fearless survey on the status of women one last time. The deadline to submit responses is this Friday, Feb. 12, at 11:59 p.m. I would love to hear your insights on the issues that women face here in the state as well as feedback on this newsletter.

That’s all for now! Have a great week.

– Emily Blobaum, Fearless contributing editor

‘We need to change the conversation’: How three Iowans are working to drive down the Black maternal mortality rate
Olivia Samples is a holistic doula with Kismet Doula Services. Photo by Emily Blobaum.
Black birthing people in Iowa are six times as likely to die from childbirth than their white counterparts.

Olivia Samples has heard that statistic plenty of times. Quite frankly, they’re tired of hearing it. "Having folks die in childbirth should not be an outcome that anyone is OK with."

Samples, who is based in Des Moines, is a nonbinary holistic doula and provides emotional, educational and physical support to families throughout the process of becoming a parent. They specialize in serving Black and queer folks and primarily work in the areas of prenatal planning, labor support, postpartum care and lactation counseling, all while taking social determinants of health into consideration.

Samples and others interviewed for this story use more inclusive phrases "birthing parent" and "birthing people" because not all people who give birth identify as women.

As maternal mortality rates continue to increase in the U.S., studies have linked doulas with improved birth outcomes. In one 2013 study, doula-assisted mothers were only one-fourth as likely to have a baby with a low birth weight and half as likely to experience a birth complication.

In our current health care environment where Black birthing parents face higher risks throughout their pregnancies and aren’t well represented in professional health care fields, having a doula who can identify and relate with your background is becoming increasingly important.

When they completed their certification just over two years ago, Samples was the first Black doula in Central Iowa. Now there are at least six Black doulas in the state.

"In terms of maternal mortality especially, there’s a lot of evidence that working with folks who look like you leads to better health outcomes. That’s why it’s so amazing and beautiful to see more Black doulas entering the workforce," Samples said.

As part of their practice, Samples attends many conferences, workshops and events centered around maternal health, some of which tend to focus on the rates at which Black birthing people are dying.

"That’s valid and should be shared, but Black maternal health in itself does not mean disparity. Maternal health should be joyful and exciting."

After one particular conference last summer left Samples in a puddle of angry tears, they decided that they would make their own conference to help change the conversation and talk about what's working well instead of what's going wrong.

Five months later, the Celebration of Black Kin Conference was born.

The conference, which is based here in Iowa but will be held virtually April 11-17, is open for anyone who is invested in the overall health of the community, because maternal health issues don’t just affect pregnant people, Samples said.


Disparities have existed in maternal mortality for many years. Nationally, Black birthing people are three to four times more likely to die from childbirth.

At the state level, the Iowa Maternal Mortality Review Committee reviews all pregnancy-associated deaths and any deaths of women within one year following the end of a pregnancy, regardless of the cause. The latest report, published in March of 2020, analyzed 39 deaths that occurred in a 2½-year period.

Iowa’s overall pregnancy-related maternal mortality rate is 9.4 per 100,000 live births, below the national average of 17.4 material deaths per 100,000 live births, but still not great. Breaking it down by race and ethnicity, the maternal mortality rate for Black birthing parents is 36.9 per 100,000 live births, 6 for white birthing parents, 9.7 for Hispanic birthing parents and 23.5 for Asian/Pacific Islander birthing parents.

The maternal mortality rate of 9.4 per 100,000 live births is "a small number, but a disparity exists," Nalo Johnson said. "We need to have a better understanding of what’s occurring within the status of Black maternal health in the state."

Johnson is the division director for health promotion and chronic disease prevention at the Iowa Department of Public Health. Her office oversees the maternal mortality review committee.

In addition to the existence of medical racism, public health experts believe there are a variety of factors at play as to why disparities exist. Looking at social determinants of health, like access to affordable housing, quality education, adequate nutrition and health insurance, is gaining in popularity among health care providers.

"There are a lot of things on a systems level that we need to address," Lastascia Coleman said.

Coleman is a certified nurse midwife and clinical assistant professor in the department of obstetrics and gynecology at the University of Iowa, co-founder of the Black Women’s Maternal Health Collective and is the only Black midwife in the state.

"If you’re telling people to walk every day for their fitness but you don’t ask them if they have a safe place to walk, that’s a structural problem," Coleman said. "We give all of these lifestyle recommendations, but we have to follow up and make sure they’re attainable."

Addressing the Black maternal mortality crisis requires innovation at all levels of health care and leadership.

"There isn’t one answer to reduce Black maternal mortality," Johnson said.

Other solutions identified by Coleman, Johnson and Samples are as follows:

  • Raise awareness and welcome new perspectives. "Acknowledging that there is a disparity is a good first step," Johnson said. "These disparities have existed for many years, but the difference is now we’re having conversations about them."

  • Address implicit bias and medical racism. "We have a lot of deep-seated things within our health care system that we need to address," Coleman said. "We need to be more thoughtful about how we interact with patients in general and we need to have a full-stop moment to reflect on how we do things and whether they’re the right thing."

  • Support innovative practices like certified nurse midwife and doula services. Hiring a doula or a midwife isn’t cheap. Doula services can range from $500 to $3,500 or more. "The people who need doulas the most don’t have access to them right now," Coleman said. The Iowa Department of Public Health is currently in the planning stages of a pilot program that would provide culturally congruent, community-based doula services at three targeted Title V maternal health clinics in areas of the state with the highest proportion of Black populations.

The bottom line is that people are unaware of what’s going on, Coleman said. "This needs to become a priority. We have to do something. We can’t sit around."

Editor’s note: This story primarily focuses on maternal mortality and how it affects Black people. It’s clear that Black birthing people experience the highest maternal mortality rates, but it’s also apparent that there is a general racial disparity at play. I plan to produce more pieces in the future on how people of other races and ethnicities are affected. If you or someone you know has experienced disparities in maternal care, please reach out to me at

A tribute to my mother
This past Jan. 19 marked the second anniversary of the death of my mother, Lois Spinks Lawson, due to metastatic breast cancer, breast cancer that kills.

Although my mother was small in stature, she had enormous strength, both mentally and physically, even on the days leading up to her death. Her strength often surprised family members and the doctors and nurses tending to her care. She always lived her life in such a manner whereby she believed that there wasn’t any obstacle too great, or challenge too difficult, as long as she had faith. In the end, it was her faith in a higher power that comforted her as she courageously lost her battle with an aggressive disease and crossed over to the afterlife.

Although there have been many sleepless nights wherein I dreamed about my mother, I try to elevate the best memories when thinking about our time together. However, I increasingly find myself wondering whether there was more that I could have done to extend her time on earth. My father and I continue to share our thoughts about the loss of my mother and he tries to console me with the understanding that life is about faith and science. Faith in a higher power that has the final say over when we depart this domain and travel into the ultimate domain. However, while in this domain, the higher power has enriched, and continues to enrich, our daily lives with ways and means to enhance our ability to live out our lives. Central to the best usage of these ways and means is knowledge.

As a licensed educator, I believe the higher power has provided us with the ability to seek and share knowledge. Therefore, I also believe the death rates due to metastatic breast cancer can be reduced over time with increased knowledge, meaning increased public awareness and scientific investment. While data reveals that white women are more likely to be diagnosed with metastatic breast cancer than any other race, the data also reveals that African American women, such as my mother, experience the highest mortality rates from the disease.

Regardless, a cure must be found for all people stricken by this disease. Although my advocacy has thus far led to a proclamation that was signed by Gov. Kim Reynolds recognizing Oct. 13, 2020, as Metastatic Breast Cancer Awareness Day in Iowa, my work is not yet done. Our work is not yet done. We must apply our faith and reach out to our state legislators, and others, to pass legislation that measurably enhances public awareness concerning the challenges and opportunities for reducing – and someday eliminating – metastatic breast cancer via faith and science.

Because I have witnessed my mother’s undaunted will to embrace life despite the fact that she understood that there was no cure for her illness, I will forever remember her as my shero … and fearless!

Celeste Lawson is a master educator with more than 20 years of classroom experience teaching students at the elementary, secondary and postsecondary levels. In addition, she is a freelance writer who focuses on various aspects of education and cultural diversity.

Left: Liz Tovar. Center: Mary Dillon. Right: Kelcey Brown.
In the headlines

Worth checking out
America's mothers are in crisis (New York Times). Five steps to shake that feeling of imposter syndrome (NPR Life Kit podcast). Her quinceañera was going to be the biggest day of her life — then came lockdown (National Geographic). How women are changing the philanthropy game (New York Times). Meet Janet Yellen, ‘the most prepared woman in Washington’ (Fortune). Isolation, financial hardship: Pandemic adds barriers between Iowa domestic abuse survivors and aid (Ames Tribune). Thirteen women on being driven from the workforce (The Cut). My daughter’s diagnosis pushed me out of the workforce years before the pandemic (The Cut). The myth that gets men out of doing chores (The Atlantic). Tampa Bay Buccaneers' female coaches about making history at Super Bowl (Good Morning America). What’s keeping men from doing more at home? Actual caregiving experience (Fortune). ‘Unity with purpose:’ Amanda Gorman and Michelle Obama discuss art, identity and optimism (Time). Three American mothers, on the brink (New York Times).
There are a plethora of resources available about the Black maternal mortality crisis. Here are a few worth checking out if you’d like to learn more about the issue:

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