For Black Maternal Health, We Need Justice and Equity: A Conversation with Angela Doyinsola Aina

In the United States, Black women are three times more likely to die from pregnancy-related complications than White women. Even after giving birth, they face challenges in receiving postpartum care, which are not disconnected from the history of systemic racism in this country.

Black maternal health is a growing public health concern, particularly at a time when critical public health resources are being stripped away. Amplifying this concern is the maternal health-rights organization Black Mamas Matter Alliance (BMMA), founded just days before the 2016 election.

In this interview, BMMA founder Angela Doyinsola Aina talks about how the group came to be and how is persevering amid this unstable political environment, gives examples of state and local solutions that are working, and what she believes funders need to be doing in this moment.

This interview has been edited for clarity and length.

Rebekah Barber: What led you to found the Black Mamas Matter Alliance?

Angela Doyinsola Aina: I have 18 years of experience in different capacities at the community, academic, state, and federal levels in public health. I’ve always been in and around spaces of Black and African women-led community-based organizations, particularly here in Atlanta. In 2007, I found myself in the mix of the reproductive justice movement, particularly with SisterSong [a national reproductive justice organization dedicated to women of color].

I got a lot of my footing in the reproductive justice space with SisterSong, SisterLove, and other Black women-led organizations in the Atlanta area. I received a field assignment with the CDC [Centers for Disease Control and Prevention], where I was placed in North Carolina and worked at the University of North Carolina’s Center for Maternal and Infant Health and the North Carolina State Department’s Women’s Health Branch, doing a lot of maternal and child health work. On my way back to Atlanta, I was further connected with the reproductive justice and human rights space.

“Public funding entities that have outwardly committed to maternal health equity are now being silent.”

This was around 2013 and 2014 when the Black Lives Matter movement was bubbling up, especially after Trayvon Martin was killed. In 2015, I was invited to a convening organized by the Center for Reproductive Rights and SisterSong. That’s what allowed me to get back into that space and think about ways to get organized.

That early convening was called the Black Mamas Matter Project, and then about five of us stepped up to cultivate what is now called the Black Mamas Matter Alliance. We were officially born in November of 2016, literally days before the 2016 election.

RB: What did BMMA learn from [Donald] Trump’s first term?

ADA: In 2016, we were in shock of that election and administration. We were focused on the same things we’re doing now: building community, galvanizing partners, setting forth agendas, and trying to engage systems to dig deeper and lean toward health equity. We were doing a lot of systems change to improve how care is provided, especially in maternity and reproductive healthcare.

But it wasn’t the situation we’re in now, where there has been a total destruction and elimination of our public health agencies that we have relied on for decades to provide us with the necessary data surveillance information and resources to help prevent and control disease outbreaks.

These systems are not necessarily rooted in what we truly need, which is justice and equity. However, I don’t think many of us were expecting things to unravel at the pace that they have been.

In the 2016 era, people were sticking to the status quo and trying to operationalize the notion of not having to pick a side. Since then, there have been several comprehensive legislative attempts at the federal and state levels to address a lot of the inequities that drive maternal mortality and morbidity—including infant mortality—and to help prevent, at that time, the fall of Roe [v. Wade].

Yet, the decision-makers wanted to wait for the Trump administration to leave to push for more comprehensive pieces of legislation and action. When the Biden–Harris administration came in, things did move forward a bit but not quickly enough. Now we’re reversing back, and a lot has worsened.

We are even seeing a reversal of funding from private philanthropic entities and public funding entities. Public funding entities that have outwardly committed to maternal health equity are now being silent or have not been responsive to supporting and continuing that investment in authentic Black maternal health initiatives.

RB: How are you continuing with your work in the current political climate?

ADA: We’re still committed to our goals, values, and the work that we’re doing, in particular ensuring that the programming and campaigns we undertake still center on and are in collaboration with our primary stakeholders—the global Black, perinatal, maternal, and reproductive health workforce.

“Even when we’re well-educated, even when we’re the ones providing the care, it’s still not enough to keep us free from how we’re treated in this system.”

That’s inclusive of doctors, nurses, midwives, and doulas of all types, but in particularly those from our communities across the African diaspora. Not only are we the ones who are being impacted directly by these issues and these statistics that unfortunately drive negative maternal and infant health outcomes, but we are also the ones who are doing the work.

I’m thinking about the situation with Adriana Smith, who is a Black woman and was a nurse. [After a medical emergency] she is fully brain-dead and is being kept alive because she’s pregnant [and her state of Georgia has an abortion ban]—I don’t even know how much of a bigger picture can be painted to showcase the intersection of racism and sexism that Black women face.

She was providing care for others, but in the same system that she’s working in, because of so many factors, she is currently experiencing what many Black women are facing that contribute to these maternal mortality rates.

Even when we’re well-educated, even when we’re the ones providing the care, it’s still not enough to keep us free from how we’re treated in this system.

RB: What are some solutions at the local or state levels that are working?

ADA: I’m proud that during Black Maternal Health Week, we were able to not only get a resolution passed at the city level in Atlanta that recognized the Black Maternal Health Week campaign from April 11 through 17, but for the first time this year, we were able to get Black Maternal Health Week recognized at the state level in Georgia. We had been trying to do that for the last five years.

Across the nation, over 22 Black Maternal Health Week resolutions were passed at the state level, and BMMA curates the language that goes into a resolution. That gets shared with stakeholders to utilize as a tool. The fact that so many stakeholders across the nation have utilized it to inform their Black Maternal Health Week resolutions at the local and state levels showcases the impact and continuity of the work we are doing.

State representatives have also passed something similar in Vermont. They’re calling it Black Maternal Care Awareness Month, which they passed and recognized for in April. I, along with some members of my policy team, spoke with representatives in Vermont who are working with stakeholders in the state to also focus on and address their system issues that have been contributing to negative maternal health outcomes.

Several states have also implemented their own state-level Black Maternal Health Momnibus Acts. These are promising first steps. But as these policies and legislations are being passed at the state level, we still want to ensure that there’s advocacy, engagement, and action happening to continue the work and ensure that, as it’s implemented, it’s not causing more restrictions in how people are able to provide services and care.

“Too often, philanthropic entities don’t do a lot of due diligence to ensure that initiatives claiming to be about Black maternal health and health equity have a proven record of doing that work.”

I say that because we’re seeing an interesting phenomenon with how doula policies and doula reimbursement is being implemented in different states. It’s having some varying outcomes. On paper, these things sometimes appear to be a positive first step, but when you further look into it, it looks like questionable legislation that could have negative outcomes, similar to what has happened with midwifery care in this country.

We’ve seen before how creating licensure or “standards” in accreditation has had negative outcomes. We need to be careful about this when we’re imposing it on doula services, especially when the doulas who are doing the work are not being consulted. When those stakeholders are not consistently at the table, engaged in the formation of state-level policies, those policies tend to significantly miss the mark and further contribute to a lack of access to doula services.

RB: What do you need from funders and philanthropy right now?

ADA: We need them to do a better job of vetting and evaluating the grantees and the initiatives that they claim to be doing, especially in the area of Black maternal health.

Unfortunately, whether it’s intentional or not, so much public funding has been removed that it has left a lot of entities at the academic, health department, nonprofit, and even small-business levels all clamoring for the same pots of money.

Too often, philanthropic entities don’t do a lot of due diligence to ensure that initiatives claiming to be about Black maternal health and health equity have a proven record of doing that work. Vetting your grantees is critical. That’s number one because otherwise it makes doing this work in a collaborative way more difficult.

It’s also critical for philanthropic entities that understand this work to speak to it in a way that helps other philanthropic entities and investors support this work, not just in Black maternal health but in women’s health and reproductive health more broadly.