No one can deny that there is a maternal health crisis, with many U.S. women experiencing pregnancy-related complications and even death.

Ending Wednesday, Black Maternal Health Week emphasizes the particularly high risk for Black women, who are more likely to die from a pregnancy-related cause than white women. But while these preventable deaths are alarming, many advocates say there’s more to maternal health than Black death. Some are looking to creative solutions that don’t rely solely on medical practices.

In that vein, Rewire.News talked to three people—a tech worker with a vision, a painter and breastfeeding advocate, and a public health professor who’s thinking about geography and preterm birth. Each experiments with telling maternal health stories in her own way, and at least two want to shift the Black maternal health crisis narrative to emphasize on Black life, community self-help, and #BlackJoy.

Whitney Robinson: Hacking the way to a happy, healthy pregnancy

When Whitney Robinson looks at the after-care forms that hospitals typically give new parents, she often shakes her head.

As a product manager, the Durham, North Carolina, resident specializes in “user experience”—making sure products are easy to understand and use. The mother of three sees very little that’s easy to use about these health-system documents, much less pleasurable.

“Your first week going home with a baby, you don’t even know where the forms are. You are too tired to read them,” Robinson said. “We may give women information that there’s a doula in your neighborhood, but there should be no expectation that a new parent should have to do anything to reach out.” In contrast, she cites the work of doulas, who maintain a regular schedule of visits, come to the home, and may even bring meals.

Robinson thinks that technology can help people—especially Black women—”hack their pregnancies” and focus on getting the information they need, making their own decisions, and experiencing joy when much media coverage about Black people and pregnancy concentrates on dire statistics about death, poor health care, and disrespect from providers.

In the first phase of what she’s calling The Renée project, she’s traveling to cities across the nation to talk to people about their pregnancy experiences, brainstorm what they needed, and develop a tech resource that can fill the gaps. She envisions these “jam sessions” as something like community block parties—where there’s something to eat, music, the kind of storytelling that happens when the vibe is right, and everyone walks away with something (in this case, a chance to think about their own lives and a cute succulent plant as a parting gift).

At a recent Durham group, six women wrote their birth stories and then talked about everything from a recent miscarriage to an ectopic pregnancy that led to the discovery of cervical cancer.

Robinson is planning other sessions later this spring in New York and Baltimore.

What will come out of these groups? Robinson is not sure yet. It could be anything, as long as this collective generation of ideas inspires it. She’s considering an app that sends daily meditations or prayers. She wonders if an app could prompt pregnant users to document their joyful moments, amid the many discomforts of pregnancy and distressing news about the racial maternal mortality gap. But she’s leaning toward a game of some sorts, building on her previous experience creating a game to help explain disaster relief.

“Delight is important. I don’t want to create an app that says, ‘My baby is the size of a mushroom today.’ But I believe that ‘gamification’ of pregnancy can happen, and the whole process may lend itself to a game, since there are stages. You can do things like create an app to incentivize going to appointments or get a free massage when you are at the end of the first trimester. But games incentivize naturally. When you hit that goal, you are motivated to hit the next one.”

Robinson has personal experience relying on technology during a challenging time. She turned to social media after her first pregnancy ended in miscarriage in 2011.

“I was 25. I was healthy. My blood pressure was low. I waited to have sex until I was married. I did all the things my parents said to do. I really wanted my baby, and though my pregnancy wasn’t planned, when it all went south, I found myself fighting to keep a child my body was pushing out.”

“I didn’t even realize I was part of a statistic then [of either the high rates of Black women experiencing pregnancy complications]. I didn’t know anything about pregnancy,” Robinson said.

But it was an epiphany during her second pregnancy, which ended in the successful home birth of her son, that helped bring about this project. It hit her after four months of bed rest; pushing back against being categorized as “high-risk” due to her previous pregnancy loss; and a transformational relationship with a midwife who shunned “one-size-fits-all” methods of prenatal care.

She went on Facebook and did an informal survey, asking about 30 people about what they needed during pregnancy. One hundred percent said more support.

Lauren Turner: turning the negative into nurturing art

Lauren Turner—otherwise known as Ren the Doula—remembers when a relative told her not to flash “that titty” in front of the woman’s husband. Meaning, don’t breastfeed publicly or in the presence of family, male members most of all. 

She recalled the moment with shock and outrage, especially because she had tried to breastfeed discreetly, often wearing undershirts or even feeding her child in a car. It was profoundly disempowering for the young mother: Because if breastfeeding, literally a physical and biological act of creating a healthy family, couldn’t be done inside family spaces, where could it be accepted?

Turner, a Baltimore artist who has trained and worked as an abortion and birth doula, didn’t want to wallow in the disappointing encounter. “I’ve gotten my voice from some negative moments,” Turner said, including family and friends questioning her decision to choose home births.

“But every time my daughter would breastfeed, I would get a high. And that helped me come out of what I was told was ‘close to’ post-traumatic stress disorder and postpartum depression” after a particularly hard second delivery in which she didn’t have the support she craved.

Though it took a while to arrive at the idea, Turner illustrated and designed a coloring book, Breastfeeding With Affirmations.

The affirmations are what Turner herself wished she had heard from family and particularly her mother. One of the book’s 35 pages is ringed by outlines of tulips and proclaims: “Breastfeeding is an intimate experience. I feel confident breastfeeding my baby wherever we go”—a direct response to her relative’s naysaying. Another pictures a woman in a chunky necklace and professional work clothes—though she’s also wearing two breast pumps while tapping away at a laptop. Users can color in daisies and lilies as symbols of growth, nature, and fertility. A child, with a curly Afro, pretends to breastfeed a doll in yet another; the latter image expresses Turner’s commitment as a Black artist making birth-themed art that depicts Black people.

“You can go on Instagram and see all of these amazing pieces about birth and even Black people birthing. When I went online to find this art, I realized that almost none of the artists were Black. I realized that people want to show diverse images of birth, and why wouldn’t they want to paint us? Black people are beautiful.

“But I feel it’s more a marketing tool for [non-Black artists and birth workers]. I mean, some of these artists wouldn’t say hello to me on the street. Creating the coloring book was my trying to inspire other Black women artists.”

Turner, who attended an arts high school in Baltimore and has painted for most of her life, has also created other art and creative tools to support breastfeeding parents: a bingo card that includes terms such as “power pumping,” “colostrum,” and “relactation,” and is a baby-shower favorite; “skin-to-skin” stickers; acrylic paintings; and birth-themed affirmation cards for coloring, which have been hung in hospital rooms during delivery.

Shawnita Sealy-Jefferson: Exploring the possible connections between housing instability and preterm birth

Where you live matters. It can shape how much health care you get, its quality, and whether you breathe clean air, lead paint, or dangerous fumes. In cities such as San Francisco, pregnant people who experience housing insecurity—whether they are homeless, live in transitional lodging or shelters, or public housing—are more likely to experience preterm birth than others who live in standard or more stable housing.

Ohio State professor Shawnita Sealy-Jefferson understands this. As an epidemiologist interested in how racism and inequality affect health, she wondered whether this decade’s housing crisis played a role in preterm birth. She reviewed previous research about housing and birth outcomes, noting a 2015 study that found neighborhoods where more residents were late paying their taxes also had higher rates of preterm birth, low infant birth weight, and infant death.

She turned to Detroit, where so many foreclosures—many of them due to illegal and artificially inflated property assessments—followed the Great Recession that some pundits called it an eviction “conveyor belt.”

She told Rewire.News via email that the Midwestern city was an “ideal place to study neighborhood effects on adverse health outcomes given the striking racial residential segregation, urban blight, and economic disinvestment, combined with the extreme racial disparities in preterm birth in this area. An increasing body of literature suggests that residential segregation is a fundamental (or root) cause of racial disparities in health because African Americans are more likely to reside in disadvantaged neighborhoods (with concentrated poverty, disinvestment of resources, and infrastructure decay) than whites.”

Residential segregation has been particularly persistent in so-called Chocolate Cities, such as Detroit, with large populations of Black residents and intense racial and economic stratification.

Co-written by Dawn Misra and published in the International Journal of Environmental and Public Health Research earlier this year, her study found that living in a neighborhood with many tax foreclosures might be associated with more risk of giving birth early. But there was a caveat. That connection seemed to apply only to Black women with less education. Those with higher education—especially those who had earned more than a high-school diploma—didn’t seem to be affected.

Sealy-Jefferson, who attended graduate school in Michigan, said there’s not one answer as to why education may protect women who live in blighted neighborhoods. They might have more resources to counter the effects of residence in a distressed location. Perhaps women with more schooling are more likely to follow instructions and recommendations for a healthy pregnancy. Education also often functions as a socioeconomic variable; they may have more money, better jobs, or access to insurance. And, finally, she noted, economically struggling neighborhoods may be targets for gentrification; people who live in such an area may be newcomers and not exposed to any long-term effects of residence.

As almost always happens, a study leads to more questions. It’s not clear how education and neighborhood interact to affect preterm birth, but Sealy-Jefferson is committed to more research that interrogates how place shapes health. 

“I’m interested in producing scholarship that shows that the ways in which our society is organized to privilege some and disadvantage others matters for the risk of adverse birth outcomes among African American women,” she said. “I would suggest that public health researchers who study underserved and historically marginalized populations find, support, and mentor trainees from these communities and amplify the voices of these community members, in terms of what really matters for their risk of poor health.”

“Only then will we have novel research questions that give important insights on what truly matters for the health and well-being of these high-risk populations,” Sealy-Jefferson added. “From here, we will be able to design intervention studies that actually achieve health equity. We have had too much health disparities research focused on clinical, behavioral, and biologic factors and not enough emphasis on the structural and institutional racism that is killing people every day. We have to always be led by social justice because that’s our moral imperative in public health.”