Reproductive justice organization ROOTT (Restoring Our Own Through Transformation) and executive director Jessica Roach tackle a growing health crisis
Jessica Roach has been preparing for her role as a leader in reproductive justice since she was a little girl. Back then, in the tiny village of Irondale, Ohio, she would spend time with her great-grandmother, a healer who assisted Jefferson County women in childbirth.
“There were always women and their children around,” Roach said. “I didn't understand what that meant until later, just understanding what role she played in the community.”
Roach went on to become a nurse and supported friends as they gave birth, terminated pregnancies and adopted children. But it wasn't until after she had her third daughter, Julian Calderone, that she was compelled to become a doula and home birth midwife.
“Seeing the differences in each one of my children and the differences in my experiences in those pregnancies, and those births, and the follow-up care … [I thought], ‘There's something not right about this,'” she said.
Roach had given birth to her first daughter, Jordan Roach, as a teenager. Though she was immediately told by medical professionals that she was at risk for a preterm baby (born before 37 weeks), high blood pressure and gestational diabetes because she was African-American, she had a healthy pregnancy. She credits her amazing experience to her support system, which included her great-grandmother, grandmother, father and uncles.
But seven years later, her second pregnancy was a different story. She was told she had an incompetent cervix, a condition that can lead to miscarriage or premature delivery. She developed preeclampsia, a pregnancy disorder characterized by high blood pressure, and delivered Jaden Calderone at 34 weeks. The only explanation given was, “You're just at risk because you're African-American.”
“It just really didn't make any sense to me,” Roach said. “I was really upset, and I was angry, and I had some issues with postpartum depression.”
“By the time I got pregnant with Julian, something clicked,” she continued. “I ended up having a home birth. … I had a midwife and I did prenatal yoga. I ate well. I went back to my roots.”
Julian Calderone was born at 42 weeks, weighing 8 pounds and 15 ounces, with no major health concerns.
“That's when I became much more deeply involved [in reproductive work],” said Roach, co-founder and executive director of Columbus reproductive justice organization ROOTT (Restoring Our Own Through Transformation), which is hosting events as part of Black Maternal Health Week, April 11-17. “It was like waking up.”
Roach is not an anomaly. Black women are, indeed, at a higher risk for difficult pregnancies than their white counterparts — with often deadly results. According to the latest national data from the Centers for Disease Control and Prevention (CDC), black women are three to four times more likely to die from pregnancy-related causes than white women. And in 2015, the infant mortality rate — defined as the death of a child before 1 year old per 1,000 live births — for black women was 11.3, twice as high as the rate for white women.
In Ohio, the infant mortality disparity is even worse. According to the Ohio Department of Health, in 2016, the infant mortality rate for black babies was 15.2 — more than twice as high as the rate for white babies. And, according to preliminary data obtained by Columbus infant mortality initiative CelebrateOne, black babies were three times more likely to die in Franklin County in 2017.
Research has shown the reason for the disparity is not biological, but rather the result of health care, social and economic determinants. And at the root of those determinants is racism.
According to the Greater Columbus Infant Mortality Task Force Implementation Plan, “Studies show that health outcomes are influenced by a ‘neighborhood effect' in which health outcomes vary based on where an individual lives. These inequities stem from a long history of racially passed policies and practices. Neighborhood factors include access to ‘life-enhancing' resources such as health care, housing, education, employment, social relationships, transportation and food supply.”
In Columbus, the neighborhoods with the most inequities are also the neighborhoods with the highest infant mortality rates. The city identified Franklinton, Hilltop, Morse/161, Near East, Near South, Northeast, South Linden and Southeast as having infant mortality rates up to three times higher than the Franklin County rate.
And, as documented by the Kirwan Institute for the Study of Race and Ethnicity at Ohio State, some of the most vulnerable neighborhoods in Columbus suffered historic, race-based disinvestment through systematic practices like redlining.
Recently, there has also been a focus on racial bias in health care, regardless of social and economic status. According to a 2016 study by the New York City Department of Health and Mental Hygiene, black women with at least a college degree still had higher rates of life-threatening conditions during delivery than other races who never graduated high school.
Furthermore, a national conversation around the treatment of pregnancy-related health conditions (also known as maternal morbidity) in African-American women was recently invigorated by professional tennis player Serena Williams' near-death experience after giving birth. As outlined in a Vogue article earlier this year, Williams suffered shortness of breath and requested a CT scan for blood clots — based on her past health issues — but was initially disregarded. When the hospital eventually obliged, blood clots were found in her lungs.
There are similar concerns regarding racism's influence on infant mortality rates. According to the Columbus Infant Mortality Task Force, “The lifetime stress of living as a minority in our society has an adverse effect on birth outcomes.”
Roach believes she experienced this phenomenon firsthand with her second pregnancy. Despite having a degree, a nursing career and stable housing, she still delivered a preterm baby. It wasn't until later she considered the impact of racism-related stress.
“My whole life had been this environment of really high levels of toxic racism,” she said. “My interaction with law enforcement, my interaction with peers, … noticeably being treated differently [and] feeling like I had to perform at 120 percent versus my counterparts that only had to perform at 80 [percent]. And that was just the work environment.”
“If our bodies are toxic, how is it that we're going to grow a child?” she continued. “We don't have the conversation around maternal mortality and morbidity. We don't have the conversation around higher risk of postpartum hemorrhage, of pulmonary embolism [or] of postpartum depression because of all these toxic stressors that we're talking about.”
Those racism-related stressors can show up in unexpected ways during delivery. Roach witnessed that four years ago when she coached a woman in labor in Toledo by phone.
“I could hear her crying in the background,” Roach said. “And after she got through a contraction she said, ‘I don't want to let go. Nobody's gonna love this baby the way that I do. … The minute he's out here he's just another black man.' At that point, it's like, ‘I know that there's something else that has to be done.'”
In 2014, Mayor Andrew Ginther created the Greater Columbus Infant Mortality Task Force in response to the staggering infant mortality rates in Franklin County. The CelebrateOne coalition of community partners was formed to carry out the task force's recommendations to reduce the infant mortality rate by 40 percent and to cut the racial health disparity gap in half by 2020.
So far, micro-pilot programs have provided homeless pregnant women with rental assistance, and residents of vulnerable neighborhoods have been trained and certified as community health workers — to name just a couple initiatives. Currently, CelebrateOne is focused on eliminating preventable, sleep-related infant deaths, reducing preterm births and connecting disconnected citizens to resources.
Looking at the numbers, the task force and CelebrateOne have a long way to go to meet their 2020 goals. In 2014, the Franklin County infant mortality rate was 8.4. By 2016, the rate was even higher — 8.7. (2017 figures are not yet available). And the racial health disparity is getting worse. In its 2014 plan, CelebrateOne said the infant mortality rate for black babies was two-and-a-half times that of white babies in Franklin County; preliminary data for 2017 show the rate for black infants is now three times that of whites.
“What we realize is we have fantastic programs and entities, [but] certain moms aren't getting to [them],” CelebrateOne Executive Director Erika Clark Jones said at a panel on eviction and infant mortality at Kirwan last month. “Or they're not quite designed for our moms to succeed and thrive.”
To help fill those gaps in programming, Roach and Monique McCrystal founded ROOTT in July 2017. With a focus on addressing the impact of institutional racism on black maternal and infant health, the black women-led advocacy organization offers affordable doula services, health-care provider trainings and organizational consultation.
“There are many organizations out there that do great work,” McCrystal said. “[But] it's not enough, because if it was, we would see a shift. And you cannot create a healthy family environment for a woman who is carrying blame and shame and fear and anxiety that she never gets permission to talk about.”
To that end, ROOTT doulas validate their clients' environmental stress, and also work to dispel the myth that individual behaviors are to blame for racial disparities.
“We've spent a long time living off this narrative that, ‘If only women would just…,' and magically things would get better,” said Dr. Joia Crear-Perry, founder and president of the National Birth Equity Collaborative, which is also working to reduce black infant and maternal mortality. She pointed to needed systems-level changes, from the way data is collected (marital status, an unproven risk factor for infant mortality, is still being tracked), to doulas failing to be covered under Medicaid in Ohio and other states.
“We have data to show that [doula service] works,” said Crear-Perry, who also serves on ROOTT's advisory council. “And we know it intuitively. If you have support throughout pregnancy, you're going to do better.”
ROOTT's full-spectrum doulas assist clients at any and all stages of pregnancy, from preconception to postpartum. They also provide support with abortion and adoption. They facilitate body positioning, meditation, yoga, connection to community resources and more.
“The first thing we do is we listen,” said intake doula and administrative assistant Danielle Jackson. “That's important for our clients because this may be the first time that … they're working with someone that is honoring what they're saying.”
“We also support moms as they're going to and from prenatal appointments,” McCrystal said. “[It's] just to be an additional voice in the room to make everybody slow down, [and] to make sure her questions get answered.”
For first-time mom Anshea Martin, McCrystal's support during labor was invaluable. “I definitely wouldn't have been able to do it without her,” said Martin, who delivered her son, Kai, 10 months ago. “At some point during my labor, they had concerns and wanted to change my birth plan. But [McCrystal] was great in reinforcing it and just having a positive attitude, and not letting the doctors force their hand.”
Martin said both McCrystal and Roach helped guide her through the breastfeeding process and continued to provide support once Kai came home from the hospital. “I still text them to this day [and] show them pictures of Kai walking and different things,” Martin said. “It's great to have that connection still. It didn't feel like this is a business they're running. It felt more like this is a community.”
Roach said building a strong network with her clients postpartum is part of creating “safe and sustainable environments,” and witnessing those success stories and building families is a source of joy.
Collectively, ROOTT's staff has provided services to more than 250 clients throughout their careers. “We don't have the high percentages of preterm and low-birthweight babies,” said Roach, who is also pursuing a master's degree in public health. “We don't have the cesarean section rate. We don't have the issues with maternal mortality or morbidity. We have never lost a mother.
“The model works. … It's for us, by us. Who better to dictate what it is that's needed for our bodies than those of us that are actually living inside of them?”
This article has been updated to include the full names of Jordan Roach, Julian Calderone and Jaden Calderone.