WHEN NNEKA HALL was pregnant with her third child, she had a symptom of preeclampsia, a serious pregnancy complication, but her doctor never caught it. Hall felt her daughter hiccuping and worried something was wrong, but the doctor told her she was having a recurrence of depression because of separating from her husband.

“My child was telling me something was wrong. I was reiterating it, and I was unheard,” Hall said.

Her daughter was stillborn.

Unfortunately, Hall’s experience feeling her doctor wasn’t listening to her is not unusual for Black women in pregnancy and childbirth. Hall said she has spoken to Black doctors who have physically driven themselves from one emergency room to another one where their colleagues are working to offer treatment for postpartum preeclampsia, because their patients were not being taken seriously.  

And Black women’s outcomes in pregnancy and childbirth are far worse than their White counterparts. In Massachusetts, a Black woman is nearly twice as likely to die from a pregnancy-related cause as a White woman. Black women are 70 percent more likely than White women to have severe health consequences related to pregnancy and childbirth.

The legislatively formed Special Commission on Racial Inequities in Maternal Health recently released a 74-page report exploring why these disparities exist and what can be done about them. Two commission members, state Rep. Liz Miranda, a Roxbury Democrat, and Hall, the founder of Quietly United in Loss Together Corporation, spoke on this week’s Codcast about the report.

The report concluded that there is no single cause of inequities in maternal health. There are factors related to the health system, families, communities, racism, and poverty. 

For example, the use of a doula – a trained person who can support a woman during childbirth in non-medical ways – can improve birth outcomes. But doulas cost $800 to $2,000 and are not covered by insurance.

Yet Miranda said resources alone cannot explain the inequities, though money and insurance are a factor in accessing care. She noted that her Cape Verdean sister gave birth to a 21-week-old baby who did not survive after a doctor minimized her symptoms. But Black tennis star Serena Williams had her own near-death experience with childbirth and had to personally insist on tests after hospital staff seemed unconcerned. 

“Birthing is the one space that it doesn’t matter how much education you have, where you live, what’s your socioeconomic status. Black women are still dying at two to three times the rate of white women across the country and even here in Massachusetts,” Miranda said. “There is a lot of structural, systemic racism, ageism, and gender issues between Black and White women,” Miranda said. “The other things that make it hard to give birth as a Black birthing person is the weathering of Black people. We are stressed out. The highest income inequality. We’re living in communities that are historically segregated.”

Miranda said many women – particularly women like the non-English speaking immigrants she represents – do not know what resources are available to them. “There’s a lack of cultural competency, there’s a lack of a prenatal workforce that is diverse and has the language capacity to help our diverse communities in Roxbury, Dorchester, Mattapan, Hyde Park,” she said.

Hall said there are volunteer doula programs at hospitals, midwives who accept payment plans, and state home visiting programs, but people don’t know about them. “I’ve given birth in the Commonwealth four times,” Hall said. “The first time I heard about the home visiting program that’s available through the Mass. Department of Health for anyone is when I was working as a contractor for the Massachusetts Department of Public Health.”

The Committee on Health Care Financing recently sent to study, or legislatively killed, two bills that would have set up a licensed, regulated system of professional midwives while requiring that midwives be covered by insurance and paid the same amount as other medical providers for the same services. Today, Massachusetts is one of a small number of states that doesn’t recognize a national certification for midwives, which makes it harder for women to get midwife care.

Miranda, who is running for state Senate, said the lack of progress on various bills related to maternal health indicates the need to increase representation by women and people of color in the Legislature. She hopes that either this session or next session, there will be an appetite to pass an omnibus “birthing justice” bill. “This is not a situation that we can pick or cherry pick which intervention we’re going to do now,” Miranda said. “Speaking as a Black woman, saying that Black women are dying at two times the rate of white women, but Massachusetts is better, does not give me justice.”

“I, for one, am not giving up on Black women, indigenous women, and women of color, because I know if we work to improve their outcomes in birth, we improve the outcomes for everybody,” Miranda said. “And that’s the most important thing. We can get to zero. We can save mothers, we can save partners, and we can save babies in Massachusetts if we focus and center and let Black and Brown women lead in this space.”