In Oregon and the rest of the country, Black infants are more likely to be born underweight, and both they and their mothers have a lower chance of surviving that first year of life than white and Hispanic ones.
A package of bills in the Oregon legislature seeks to support perinatal health by expanding access to doulas, protecting young families from housing loss and eviction and expanding the Oregon child tax credit, among other things.
Kaylee Tornay, investigative reporter with InvestigateWest, recently wrote about Black maternal and infant health and joins us to explain.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Black women nationally are three times as likely as white women to die in childbirth, and Black fetuses and infants’ diet rates far outpacing those of nearly every other race. Oregon mirrors these trends. Black infants are more likely to be born underweight. And both they and their mothers have a lower chance of surviving their first years of life than white and Hispanic ones.
Democratic State Senator Lisa Reynolds from Washington County has introduced a package of six bills aimed at supporting perinatal health in a variety of ways, including expanding access to doulas. Reporter Kaylee Tornay wrote about these bills and one Oregon mother’s story for InvestigateWest, and she joins us now. Welcome back to the show.
Kaylee Tornay: Thanks, Dave. Thanks for having me.
Miller: Can you first just introduce us to LaTasha Williams?
Tornay: Sure. LaTasha is a mom. She’s a human resources professional. She is a longtime Oregon resident, although she has recently moved up to Vancouver. And she shared with us her story of two high risk pregnancies that she experienced in the last five years, where the level of care that she received led to very different outcomes.
That first pregnancy was in 2020 and ended in the loss of her child. The second resulted in a safe delivery of a healthy baby boy. Her story highlights some of the common hurdles that Black women face when navigating pregnancy and perinatal care, as well as the solutions that can help to improve outcomes.
Miller: For the pregnancy in 2020, this was during the COVID shutdowns when access to medical care was really restricted. How did that affect what happened to her?
Tornay: She was dealing with risk factors including high blood pressure and gestational diabetes, which are conditions that can be dangerous for both the mother and the fetus. She also experienced what’s called cervical insufficiency or incompetence, which is when the cervix is weakened and prone to opening too soon in the pregnancy.
So she had one initial ultrasound and then wasn’t able to schedule another one until after 20 weeks. That was, I think, largely impacted by the pandemic’s first few months, where that type of preventive and prenatal care was really locked down as hospitals were focused on COVID. Eighteen to 22 weeks is a pretty standard window for an ultrasound. But LaTasha’s risk factors could have warranted more frequent follow-up to ensure that she was staying healthy and in the best position to preserve the pregnancy. So she was mostly left to manage those symptoms on her own.
Miller: What ended up happening to her baby?
Tornay: As I mentioned earlier, LaTasha’s pregnancy only lasted about 20 weeks before her water broke and she went into labor. Her daughter, Essence, had not gotten the chance to develop enough to survive more than just a few minutes outside of the womb. Her parents were able to hold her and make some mementos. But she did end up dying, and LaTasha said that was truly a devastating loss for her and her husband.
Miller: How does her story fit into the larger picture of maternal and child health for Black women in Oregon and around the country?
Tornay: That’s a great question, and I feel like your introduction to this segment really covered a lot of the data that points to these wide disparities where Black women experience these types of high risk symptoms in pregnancy more often. And their pregnancy-related mortality across the country is much higher than almost every other racial group. You mentioned some of the data from Oregon. Black babies are more likely to be born underweight, which can be linked to increased risk of mortality. And we also honestly see similar disproportionately high rates of pregnancy-related mortality in Indigenous populations as well. And it’s a very entrenched problem.
Miller: You note that LaTasha has an MBA, and that national studies have found that class and education don’t necessarily lead to better outcomes for Black women. What do these studies show?
Tornay: Increased socioeconomic status and higher levels of education do not improve outcomes for Black women much. [It] is one of the key facts that researchers and advocates point to as indicators that we need to be looking at other factors tied to structural inequity.
Researchers who study this say those factors do include, likely, the prevalence of chronic disease, unequal access to healthcare, and the quality of care that Black women are more likely to receive when they seek out prenatal care.
Miller: One of the reasons you wanted to highlight LaTasha’s story is because right now, as I noted briefly in my intro, Democratic state Senator Lisa Reynolds has introduced six bills that she calls an omnibus package. Omnibus is this classic term for a bill that does a bunch of stuff. Can you give us a sense for what these bills would do?
Tornay: Yes, so broadly, these bills are trying to narrow some of the disparities that you and I have been talking about today in birth outcomes and perinatal health that run, not just along racial lines but, also [along] socioeconomic and community lines as well. So they aim to increase support for pregnant patients and young families in a variety of ways, including preventing housing loss, expanding the child tax credit and increasing access to substance use treatment in the prenatal stage. One of the bills is also focused on culturally-responsive care, including expanding access and coverage for doula services, which LaTasha told us she had benefited from personally.
Miller: How does this suite of bills fit into what’s happening around the country?
Tornay: The omnibus concept in Oregon definitely grew out of the work of the Congressional Black Caucus, and states around the country have introduced legislative packages that mirror these sorts of goals to improve outcomes, reduce disparities and increase supports that can keep families healthy and whole.
Miller: How much would this package cost in Oregon?
Tornay: That’s a great question. It is a little bit TBD. The total cost for all of these proposals isn’t quite established. The Legislative Fiscal Office is still analyzing the costs for a few of the bills, but we do have estimates for certain portions of it. For example, the doula bill includes a provision to create what’s called a “perinatal provider fund” that would do things like supporting education, certification and training for doulas. That is proposed to be funded at $6 million. Another proposal to expand the Oregon Child Tax Credit is currently estimated to cost about $25 million. Some of these numbers are still a little bit subject to negotiation from what I’ve been told.
Miller: Are these bills moving forward? We just heard from Dirk about one of the legislative deadlines. Are they moving?
Tornay: Yes, they are all still alive and in various stages of debate. They’re scheduled for public hearings and work sessions in various committees.
Miller: I want to go back to LaTasha Williams’s story. What went through her mind when she found out that she was pregnant again, in the fall of 2021?
Tornay: She told me she was terrified because she did not want to experience another loss. She didn’t want to tell people about the pregnancy or celebrate it or get her hopes up. But this thing happened where she kind of ended up channeling her fear into self-advocacy, and took the time to pursue care and seek out a Black OBGYN who she felt would be more informed about the nature of her fears, her medical needs and even maybe her cultural preferences. She also connected with the doula, as I mentioned, who served as an advocate for her throughout the pregnancy and delivery, and even after she was getting settled in with the new baby.
Miller: What kind of care did she end up getting? In particular, I’m wondering how the care was different from what she had gotten or maybe not gotten a year-and-a-half earlier?
Tornay: Overall, I think the difference, in what I heard from her and her care team, was that she was much more closely monitored. Cervical insufficiency, the [condition] that led to her delivering Essence so early, really requires that there’s not a surefire way of treating it or preventing pregnancy loss. But bed rest and careful monitoring are really important to reducing the risk.
Then she also had become preeclamptic in the second pregnancy. I certainly don’t want to make it sound like it was an easier pregnancy this time around. If anything, it was even harder, where she had a bout of Bell’s palsy. She was retaining a lot of water. But honestly, she just received a lot more frequent and rigorous care during her pregnancy. It was a really responsive regimen to her needs that helped her stay as healthy as she could be and also led to her baby being induced, at a certain point, when it was becoming unsafe for her to remain pregnant at that time.
Miller: As you noted, one of the bills that lawmakers are considering right now would increase the likelihood that Oregonians would have access to doulas, and they would do that in a variety of ways. As you noted, that was one of the differences in her care in these two different pregnancies. What did she say specifically about what having a doula meant to her?
Tornay: It’s a kind of overwhelming process, especially with the trauma that she was carrying from her most recent pregnancy prior. She described a sense of emotional support as being one of the key factors that her doula contributed to her pregnancy. But she also served as an advocate. So LaTasha was induced, [which is] a stressful process. And she said that her doula really was able to advocate so that she was able to still have a positive experience and include some of the things that she wanted to do during the birth. Then her doula also helped her with breastfeeding afterwards, which is another important service not every doula necessarily provides, but in her case, was an option. That also made a big difference to help her just get off on the right foot with breastfeeding as well.
Miller: Kaylee, thanks very much.
Tornay: Thank you.
Miller: Kaylee is an investigative reporter with InvestigateWest, a nonprofit news outlet that covers the Pacific Northwest. She joined us to talk about her recent article about efforts to improve maternal and baby health in Oregon.
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