The Commonwealth has the second-highest maternal mortality rate in the nation, and within the state maternal deaths are twice as high among Black women.

Tamara Wieder, Kentucky state director for Planned Parenthood Alliance Advocates, said the lack of OBGYN's in the state is part of the problem. Wieder is one of the recipients of this year's Healthy Kentucky Champions Award, given by the Foundation for a Healthy Kentucky, and says legislative efforts such as the Momnibus Bill passed earlier this year will make a huge difference in improving women's outcomes.

"These are nonpartisan bills that we can find common ground on in a state that lacks equitable access to care. We can really have a dialog that brings everybody to the table, and that is something that's really important to me," she said.

The Momnibus Bill adds pregnancy to the list of qualifying life events for health coverage, increasing the odds of women receiving prenatal care; and expands programs that provide free lactation counseling, telehealth assistance, and mental health support for new moms. According to the CDC, more than 80% of maternal deaths are preventable.

Dr. Elizabeth Ottman, an obstetrician-gynecologist with Ohio County Healthcare, said perinatal mental health disorders are the most common complication of pregnancy. Several years ago she launched an innovative program to treat women suffering from postpartum depression with the first FDA-approved drug for the condition. She said the state's efforts to expand broadband access have helped more rural women get help.

"It's allowed us to do more and more telehealth and do meetings with patients to make access easier for them, because it's very difficult when you're depressed to pick up the phone and make an appointment and drive to the doctor. It is super difficult when you're a rural community and you have to drive miles to the doctor with a new baby," she continued.

According to federal data, 76 of Kentucky's 120 counties lack an OBGYN doctor.

By Kylie Marsh for the Charlotte Post, with support from the Pulitzer Center on Crisis Reporting.
Broadcast version by Shanteya Hudson for North Carolina News Service reporting for the Charlotte Post-Public News Service Collaboration.

Tomeka Isaac was 35 weeks pregnant in 2018 when she suddenly fainted.

At the emergency room, Isaac and her husband were told that their son, Jace, died in utero. Without time to process, Isaac was also informed that she had HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet) with no further explanation and transferred to an emergency room to be induced.

Bereaved, Isaac investigated her medical records to determine how the baby died and whether it was preventable.

At 40, Isaac was at a heightened predisposition for preeclampsia, or high blood pressure during pregnancy. A 2021 report by the American Journal of Public Health found that Black women were five times more likely to die from heart and blood pressure-related conditions than white women, according to data between 2016-17. The report also found pregnant and postpartum Black women were two times more likely than white women to die of severe bleeding or vessel blockages.

“I checked all the boxes that they say is a cause of maternal death or stillbirth,” Isaac said. “I went to all my appointments, I had access to all other resources that I thought I needed, I had Blue Cross Blue Shield, I was going to a provider that I had been going to for years.” Isaac explained that she isn’t the typical victim of Black perinatal mortality. “When you check all those boxes, we still have a disparity.”

Never during Isaac’s pregnancy was a urine sample collected, and she has no idea why. If it were, doctors would have been able to detect preeclampsia much earlier.

Isaac’s experience is only one example of medical mistreatment or neglect women of color face at exponential rates in North Carolina.

Alexis Garrett knew she was considered a “high-risk” pregnancy because she was overweight and over 35 years old when her son Maui was born in 2020. She was referred to a “high-risk clinic,” Novant Maternal Fetal Medicine.

Garrett is acutely aware of the stigma placed against women like her in healthcare settings. She’d witnessed friends, cousins and acquaintances lose their lives or their babies due to birthing complications in hospitals.

“I try to limit my interactions with the healthcare system,” Garrett said. “I’ve always been kind of leery about it. As I grew older, you know, you hear the whispers and, oh somebody died here and somebody died there,” Garrett said. “[Providers] think we’re faking our pain, or have a higher pain tolerance,” she said. “For this reason alone, we are so unprotected and so unheard.”

One of Garrett’s friends, who also gave birth on the same day Maui was born, ended up losing her baby. Garrett delivered Maui vaginally at 26 weeks.

At a rate of 14%, Black infants are twice as likely to be born weighing less than 5.5 pounds than white infants (7%); the highest rate of any ethnicity. Similarly, the rate of premature births for Black infants, 14.6%, is the highest for premature birth rates, which can also contribute to low birthweight.

The U.S. Department of Health and Human Services Office of Minority Health reports that Black women have the highest rates of obesity compared to other groups in the United States, and that about 4 out of 5 Black women are overweight or obese. Last year, the Brookings Institute published research analyzing the distribution of grocery stores in several large U.S. cities. Grocery stores are less likely in Black-majority neighborhoods, regardless of the average household income of those communities. Feeding America reports that 1 in 5 Black people in America were food insecure in 2021, Black families’ poverty rate of 17.1% was higher than compared to the nationwide rate of 11.5%.

With a comprehensive view of the prevalence of these health conditions in the Black community, one can get a clearer picture of the source of the poor treatment, and poorer health outcomes, for Black mothers and their babies.

When having her daughter Hiro in 2021, Garrett was dealing with even more stress due to the murder of her partner, Horace McCorey. There are many stressors of daily life that have serious physiological health impacts on Black birthing people.

Author and doula Sabia Wade wrote about the effects of “weathering,” or the impact of stressors, in the 2023 book “Birthing Liberation: How Reproductive Justice Can Set Us Free.” For example, Wade reports the heightened frequency of Black people’s involvement with the criminal justice system, including deadly interactions, and high rates of unemployment especially following the COVID-19 pandemic in 2020.
A 2023 report from the United States Department of Justice states that an estimated 1 in 19 Black adult U.S. residents was under correctional supervision in 2021.

The U.S. Bureau of Labor Statistics reported that unemployment amongst Black adults was 11.4%, despite the average rate (among all demographics) of 8.1% in 2020.

“We don’t know if these people have hoods on when they treat us,” Garrett said, alluding to traditional headwear of Ku Klux Klan members.

Garrett’s second pregnancy presented just as much difficulty. At a routine checkup for her daughter Hiro, Garrett was again pressured for a Cesarean section.

“At this point, I was getting an attitude,” she said. “There [weren’t] any measures being taken to try to get this baby from being born early.”

Garrett had been informed she had a “low cervix,” also sometimes called an insufficient cervix, which can also lead to premature birth. Her friend was given a cervical stitch, also known as a cerclage.

“I’m literally telling them ‘You will not make me have this baby. I will not be bullied into having this baby.’”

Eventually, Hiro’s heart rate dropped to dangerous levels, and Garrett started passing clots. The baby was delivered by emergency C-section at 23 weeks.

After delivering, Hiro was whisked away to the NICU. Garrett also noticed that little Hiro had a large scar on her back, and one around her arm. Garrett was told that the scar around her daughter’s arm was possibly from the umbilical cord being wrapped around it, and the scar on her back was from a bacterial infection from her placenta. Garrett is distrustful and feels completely dismissed.

“Every question I ask, I’m getting deflective answers,” she said. “The scar looks like a third-degree burn. Somebody screwed up.”

To make things worse, when Garrett complained about the scar, a doctor suggested plastic surgery.

Thirty-six hours after her c-section, the hospital’s wound team informed Garrett her skin was necrotizing: a fast-spreading bacterial infection that causes tissue death. However, the no one explain what necrotizing meant as she spent 38 days in the hospital recovering before leaving “half-dead” with a walker.

“I have to live with these scars,” Garrett said.

Earlier this year, the North Carolina Maternal Mortality Review Committee reported that bias and discrimination contribute to traumatic and near-death experiences. It can manifest in terms of race or ethnicity, weight, geography, substance use, history of incarceration and other factors.

For example, Black neighborhoods are targeted by the tobacco industry more than other ethnic groups, according to the American Lung Association. In 2017, Reuters reported that poor Black neighborhoods tend to have a higher proportion of smoke shops per capita than other neighborhoods. Smoking can increase the rate of premature births and low birthweight. Similarly, higher density of liquor stores has been found in Black neighborhoods.

The American Heart Association reports that approximately 60% of Black women aged 20 and older have a cardiovascular disease, and 60% have high blood pressure. Factors leading to these conditions include family history, being overweight, diabetes, smoking and high cholesterol.

In 2022, the incarceration rate for Black women was 64 per 100,000, 1.6 times the rate for white women, according to The Sentencing Project, a non-profit that advocates to minimize incarceration in the U.S. North Carolina has a “habitual felon” statute in which any person convicted three times can be given harsher sentencing.

Heightened stress and anxiety, poor mental health, chronic conditions, financial burden, and strained relationships among incarcerated people and impoverished communities can adversely affect birth outcomes.

A study by the University of Pennsylvania found states that implemented three-strike laws like North Carolina saw immediate worsening of birth outcomes among Black infants, especially those from poor backgrounds. Those effects didn’t impact white infants.


Kylie Marsh wrote this article for the Charlotte Post.


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New Yorkers will vote on the state's Equal Rights Amendment in November.

Proposition 1 enshrines protections against discrimination based on age, disability, gender identity or expression, sexual identity and pregnancy outcomes. Although it is not explicitly stated, it codifies abortion rights into the state's constitution.

Despite wide support, the Archdiocese of New York and Republican state lawmakers are against it.

Sasha Ahuja, campaign director for the group New Yorkers for Equal Rights, said New Yorkers want the amendment passed.

"New Yorkers feel the threat," Ahuja contended. "They know that our rights are not as safe as they thought they were. New Yorkers are looking at the states that have rolled back access to reproductive health care and abortion; 22 states in total."

A Guttmacher Institute study showed an increase in people traveling to New York to get an abortion. New York lawmakers from both parties are not entirely happy with the amendment's wording. Democrats worry voters will not understand the amendment codifies abortion rights. Meanwhile, Republican lawmakers worry the nonspecific language might lead to gender-affirming care without parental consent and transgender athletes' participation in school sports.

Amending the state constitution is not easy since it requires the state Legislature to pass the bill twice, consecutively. The amendment has been subject to legal challenges that almost kept it off this year's ballot. The lawsuit was from a Republican state Assemblymember alleging the Legislature committed a technical error in passing the amendment. Ahuja noted such challenges have been a common occurrence when reproductive rights are on the ballot.

"We've seen attacks like this in states like Florida and Ohio, states all across the country that try to get these measures off or make it harder for people to vote," Ahuja stressed. "And we saw that same thing play out here in New York."

The District of Columbia and four states have codified abortion rights in their state constitutions since the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization in 2022.


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About one in eight new mothers report having symptoms of postpartum depression and the rate of women diagnosed at delivery was seven times higher in 2015 than in 2000, according to the Centers for Disease Control and Prevention.

Dr. Elizabeth Ottman, OB/GYN at Ohio County Healthcare, said many rural Kentucky women lack the resources and support needed to address perinatal mental health disorders.

"I started in 2019 really getting into treating perinatal mental health," Ottman explained. "The program at Ohio County was for Zulresso infusion and it was the first drug approved by the FDA for postpartum depression."

Ottman noted the drug is now available in a pill form. Symptoms of postpartum depression may include feeling persistently angry or sad, having trouble bonding with your baby, insomnia and loss of appetite.

Dr. Donna O'Shea, OB/GYN and chief medical officer for population health at UnitedHealthcare, said risk factors include any woman with a history of anxiety or mood disorders and a family history of depression. She added women from under-resourced communities are also at risk.

"There are some women who have little or no social support," O'Shea pointed out. "If someone has a history or is currently using substances like drugs or alcohol, that they will face higher risks with the pregnancy and after a pregnancy."

Carole Johnson, administrator of the U.S. Health Resources and Services Administration, said the Biden administration has launched a new maternal health mental health hotline to help new parents, noting data show new moms fare better when they get help at the onset of symptoms.

"We have trained counselors who are available to help just be a safe space for new parents, pregnant women," Johnson emphasized. "To have a conversation about what they're experiencing and get the support that they need. "

Call 1-833-TLC-MAMA to speak to hotline counselors 24 hours a day, seven days a week.