Most of you can probably relate to what I'm feeling right now. My heart is racing in my chest. My palms are a little bit clammy. I'm sweating. And my breath is a little bit shallow. Now, these familiar sensations are obviously the result of standing up in front of a thousand of you and giving a talk that might be streamed online to perhaps a million more. But the physical sensations I'm experiencing right now are actually the result of a much more basic mind-body mechanism. My nervous system is sending a flood of hormones like cortisol and adrenaline into my bloodstream. It's a very old and very necessary response that sends blood and oxygen to the organs and muscles that I might need to respond quickly to a potential threat.
But there's a problem with this response, and that is, it can get over-activated. If I face these kinds of stressors on a daily basis, particularly over an extended period of time, my system can get overloaded. So basically, if this response happens infrequently: super-necessary for my well-being and survival. But if it happens too much, it can actually make me sick.
There's a growing body of research examining the relationship between chronic stress and illness. Things like heart disease and even cancer are being shown to have a relationship to stress. And that's because, over time, too much activation from stress can interfere with my body's processes that keep me healthy.
Now, let's imagine for a moment that I was pregnant. What might this kind of stress, particularly over the length of my pregnancy, what kind of impact might that have on the health of my developing fetus? You probably won't be surprised when I tell you that this kind of stress during pregnancy is not good. It can even cause the body to initiate labor too early, because in a basic sense, the stress communicates that the womb is no longer a safe place for the child. Stress during pregnancy is linked with things like high blood pressure and low infant birth weight, and it can begin a cascade of health challenges that make birth much more dangerous for both parent and child.
Now of course stress, particularly in our modern lifestyle, is a somewhat universal experience, right? Maybe you've never stood up to give a TED Talk, but you've faced a big presentation at work, a sudden job loss, a big test, a heated conflict with a family member or friend. But it turns out that the kind of stress we experience and whether we're able to stay in a relaxed state long enough to keep our bodies working properly depends a lot on who we are. There's also a growing body of research showing that people who experience more discrimination are more likely to have poor health. Even the threat of discrimination, like worrying you might be stopped by police while driving your car, can have a negative impact on your health. Harvard Professor Dr. David Williams, the person who pioneered the tools that have proven these linkages, says that the more marginalized groups in our society experience more discrimination and more impacts on their health.
I've been interested in these issues for over a decade. I became interested in maternal health when a failed premed trajectory instead sent me down a path looking for other ways to help pregnant people. I became a doula, a lay person trained to provide support to people during pregnancy and childbirth. And because I'm Latina and a Spanish speaker, in my first volunteer doula gig at a public hospital in North Carolina, I saw clearly how race and class impacted the experiences of the women that I supported.
If we take a look at the statistics about the rates of illness during pregnancy and childbirth, we see clearly the pattern outlined by Dr. Williams. African-American women in particular have an entirely different experience than white women when it comes to whether their babies are born healthy. In certain parts of the country, particularly the Deep South, the rates of mother and infant death for black women actually approximate those rates in Sub-Saharan African. In those same communities, the rates for white women are near zero.
Even nationally, black women are four times more likely to die during pregnancy and childbirth than white women. Four times more likely to die. They're also twice as likely for their infants to die before the first year of life than white infants, and two to three times more likely to give birth too early or too skinny — a sign of insufficient development. Native women are also more likely to have higher rates of these problems than white women, as are some groups of Latinas. For the last decade as a doula turned journalist and blogger, I've been trying to raise the alarm about just how different the experiences of women of color, but particularly black women, are when it comes to pregnancy and birth in the US.
But when I tell people about these appalling statistics, I'm usually met with an assumption that it's about either poverty or lack of access to care. But it turns out, neither of these things tell the whole story. Even middle-class black women still have much worse outcomes than their middle-class white counterparts. The gap actually widens among this group. And while access to care is definitely still a problem, even women of color who receive the recommended prenatal care still suffer from these high rates.
And so we come back to the path from discrimination to stress to poor health, and it begins to paint a picture that many people of color know to be true: racism is actually making us sick. Still sound like a stretch? Consider this: immigrants, particularly black and Latina immigrants, actually have better health when they first arrive in the United States. But the longer they stay in this country, the worse their health becomes. People like me, born in the United States to Cuban immigrant parents, are actually more likely to have worse health than my grandparents did. It's what researchers call "the immigrant paradox," and it further illustrates that there's something in the US environment that is making us sick.
But here's the thing: this problem, that racism is making people of color, but especially black women and babies, sick, is vast. I could spend all of my time with you talking about it, but I won't, because I want to make sure to tell you about one solution. And the good news is, it's a solution that isn't particularly expensive, and doesn't require any fancy drug treatments or new technologies. The solution is called, "The JJ Way."
Meet Jennie Joseph. She's a midwife in the Orlando, Florida area who has been serving pregnant women for over a decade. In what she calls her easy-access clinics, Jennie and her team provide prenatal care to over 600 women per year. Her clients, most of whom are black, Haitian and Latina, deliver at the local hospital. But by providing accessible and respectful prenatal care, Jennie has achieved something remarkable: almost all of her clients give birth to healthy, full-term babies.
Her method is deceptively simple. Jennie says that all of her appointments start at the front desk. Every member of her team, and every moment a women is at her clinic, is as supportive as possible. No one is turned away due to lack of funds. The JJ Way is to make the finances work no matter what the hurdles. No one is chastised for showing up late to their appointments. No one is talked down to or belittled. Jennie's waiting room feels more like your aunt's living room than a clinic. She calls this space "a classroom in disguise." With the plush chairs arranged in a circle, women wait for their appointments in one-on-one chats with a staff educator, or in group prenatal classes.
When you finally are called back to your appointment, you are greeted by Alexis or Trina, two of Jennie's medical assistants. Both are young, African-American and moms themselves. Their approach is casual and friendly. During one visit I observed, Trina chatted with a young soon-to-be mom while she took her blood pressure. This Latina mom was having trouble keeping food down due to nausea. As Trina deflated the blood pressure cuff, she said, "We'll see about changing your prescription, OK? We can't have you not eating." That "we" is actually a really crucial aspect of Jennie's model. She sees her staff as part of a team that, alongside the woman and her family, has one goal: get mom to term with a healthy baby.
Jennie says that Trina and Alexis are actually the center of her care model, and that her role as a provider is just to support their work. Trina spends a lot of her day on her cell phone, texting with clients about all sorts of things. One woman texted to ask if a medication she was prescribed at the hospital was OK to take while pregnant. The answer was no. Another woman texted with pictures of an infant born under Jennie's care. Lastly, when you finally are called back to see the provider, you've already taken your own weight in the waiting room, and done your own pee test in the bathroom.
This is a big departure from the traditional medical model, because it places responsibility and information back in the woman's hands. So rather than a medical setting where you might be chastised for not keeping up with provider recommendations — the kind of settings often available to low-income women — Jennie's model is to be as supportive as possible. And that support provides a crucial buffer to the stress of racism and discrimination facing these women every day.
But here's the best thing about Jennie's model: it's been incredibly successful. Remember those statistics I told you, that black women are more likely to give birth too early, to give birth to low birth weight babies, to even die due to complications of pregnancy and childbirth? Well, The JJ Way has almost entirely eliminated those problems, starting with what Jennie calls "skinny babies." She's been able to get almost all her clients to term with healthy, chunky babies like this one.
Miriam Zoila Pérez: This is a baby girl born to a client of Jennie's this past June.
A similar demographic of women in Jennie's area who gave birth at the same hospital her clients did were three times more likely to give birth to a baby below a healthy weight. Jennie is making headway into what has been seen for decades as an almost intractable problem. Some of you might be thinking, all this one-on-one attention that The JJ Way requires must be too expensive to scale. Well, you'd be wrong. The visit with the provider is not the center of Jennie's model, and for good reason. Those visits are expensive, and in order to maintain her model, she's got to see a lot of clients to cover costs. But Jennie doesn't have to spend a ton of time with each woman, if all of the members of her team can provide the support, information and care that her clients need. The beauty of Jennie's model is that she actually believes it can be implemented in pretty much any health care setting. It's a revolution in care just waiting to happen.
These problems I've been sharing with you are big. They come from long histories of racism, classism, a society based on race and class stratification. They involve elaborate physiological mechanisms meant to protect us, that, when overstimulated, actually make us sick. But if there's one thing I've learned from my work as a doula, it's that a little bit of unconditional support can go a really long way. History has shown that people are incredibly resilient, and while we can't eradicate racism or the stress that results from it overnight, we might just be able to create environments that provide a buffer to what people of color experience on a daily basis. And during pregnancy, that buffer can be an incredible tool towards shifting the impact of racism for generations to come.