Serena Williams: We're leaving the hospital after we had a lot of complications, but look who we got. We got a baby girl.

Dr. Melissa Harris-Perry: In September of 2017, after giving birth to her daughter, Olympia, Serena Williams experienced serious complications. She had difficulty breathing, which set off alarm bells for her because doctors had discovered blood clots on her lungs back in 2010. She was acutely aware of the danger should they reoccur. She made a request for a heparin drip, and it was ignored, but a coughing fit led to surgery after it burst the stitches from her C section.

After the surgery, Serena still felt unwell and asked again for a heparin drip, and a CAT scan but she recalls her nurse saying that the medicine made her quote "Talk Crazy." Eventually, her doctor did order a CAT scan and discovered a blood clot on her lungs, which required yet another surgery. To be clear, these were complications which could have taken Serena Williams life but thanks to her unrelenting self-advocacy, mama and daughter left the hospital in good health a week after Olympia was born. I don't know about you, but I have been enjoying Serena's social media posts of that adorable child ever since.

The United States has the highest maternal death rate in the developed world. According to the CDC, this maternal death rate is nearly three times higher for Black mothers than for white mothers. These are not immutable realities, which we simply have to accept. Today is the first day of Black Maternal Health week and Raven Freeborn is the Director of Policy organizing and partnership at Mamatoto Village, an organization creating career pathways in maternal health and providing accessible reproductive support for Black women.

Raven Freeborn: We are serving Black women and birthing people here in the District of Columbia. We are in a place where resources for Black women and birthing people have not been equitably shared. Mamatoto village focuses on creating career pathways in maternal health for Black women and birthing people and being a affirmative and respectful provider of care for people who have been forgotten or left out of the medical system.

Dr. Melissa Harris-Perry: For years where I would have conversations about the most shocking health disparities around race and gender was often focusing on infant mortality and in more recent years, there has been a focus not only on infant mortality, which remains but now also on Black maternal health. Help us to understand, and my listeners to understand, both what Black maternal health is and how it is connected to infant well-being and infant mortality.

Raven Freeborn: In the beginning of what people were noticing around family health or maternal child health, conversations, research, attention and policy was directed to infant health. Then as information came out about the disparities in Black maternal health, we began to shift our attention, but Mamatoto village has been standing right at the heart of the conversation to say that we need a three Generational approach. Not only are we directing our attention and care to the birthing person. We're directing our attention and care to the gestation, the pregnancy, and we are directing our attention and care to the environment, that would be the third generation.

What has made it possible for this person to come to this moment in time, and their lifespan, where we need to have conversations about safety, vulnerability and risk? We're taking actually all of that to say this is what Mamatoto village is stepping into, a three-generational approach to serve the person, the family system, and the environment.

Dr. Melissa Harris-Perry: When you talk about the environment, that has been a particular focus around maternal health disparities because sometimes, again, when we've discussed these health disparities, there is a swift desire for people first encountering it, to devolve race into class and economic access. "Oh, this can't really be about Blackness or this can't really be about the experience of certain kinds of persons. This must really be about lack of access to prenatal care or lack of access to health insurance," but then it turns out these disparities are pretty sticky, even when there is significant access to traditional health care.

Raven Freeborn: Absolutely. In public health, we talk about the social determinants of health. The vulnerabilities, the risk factors, and the protective factors at any moment in your lifespan, where you may be transitioning through health or where you may have New Health realities to face but we have to consider the social determinants of health. We also have to consider the social conditions. These are the environmental conditions of a family system, what they have access to, but also what they can confidently and competently navigate in that system of access.

It's not just enough to say it's available, it must be something that can confidently and competently be navigated by a person seeking care, but then that third thing, and I think you captured this, Melissa, is the material conditions. It's how we think of the issue, how we think of the problem. When people want to dissect it, and to say, "It can't be raised, it can't be class status," we say, it's all of those conditions, because we see figureheads, and celebrities speaking out about their experiences with pregnancy and potential maternal morbidities and also, we know what the data is telling us about what's happening to Black birthing people across the country.

Dr. Melissa Harris-Perry: How has the COVID pandemic affected both the reality of Black maternal health and the awareness around it?

Raven Freeborn: So much of what has happened and is happening is an attempt to get people to push through the pandemic. We've persisted alongside and we've adjusted our care models to be respective of what people are navigating all people are experiencing this level of concern and facing it at a global unknown, we see that there are increasing investments. For example, the Build Back Better Act, the Infrastructure plan includes maternal health provisions that are in the Momnibus, this suite of legislation that is really pivotal to Black maternal health care, that needs to pass. We see that COVID-19 has made it so that we're able to speak more acutely about what accessibility looks like and what needs to be in place within the infrastructure to ensure that the investment gets to the people who need it.

Dr. Melissa Harris-Perry: What's happening with them Momnibus?

Raven Freeborn: The Momnibus is still alive, we need people to know that. We are still seeking for the full Momnibus package, that's 12 pieces of legislation, to pass. We need this whole intersectional approach to address those material conditions and social conditions and the social determinants of health. The Black Maternal Health caucus is still looking for the full passage of the Momnibus.

Dr. Melissa Harris-Perry: We've talked about this a bit on the show before but remind us who some of the legislators are, who are carrying the weight of the Momnibus and trying to, in fact keep it alive. I'm appreciative of the language, keep it alive and viable as a as a potential legislative suite.

Raven Freeborn: First giving a credit to our current vice president, Vice President Kamala Harris, who was a part of the and still is a part of the Black Maternal Health caucus, as well as Representative Lauren Underwood, Cory Booker, and, of course, Ayana Presley are folks who are pivotal pieces in moving this legislation and also there are people who are introducing legislation alongside the Momnibus because it it is not just enough.It is what we need in this moment and there's even more.

Representative Gwen Moore is going to be introducing the Mamas First Act, which Mamatoto village has sponsored and reviewed, and we're very excited to see this piece of legislation come through, which addresses accessibility and coverage within the maternal health care model.

Dr. Melissa Harris-Perry: Interesting that the first two lawmakers you name are Vice President Harris and Representative Underwood. I just want to draw attention to this and ask you a question because neither Vice President Harris nor Representative Underwood have themselves given birth to biological children. That's not part of their experience, although they may be mothering and parenting in other kinds of ways. Why does maternal health matter to everybody, even if you have not yourself and maybe will never give birth?

Raven Freeborn: That's really drawn wisdom from the reproductive justice movement, which is, it is about the ways in which we see each other and the choices that we are able to make and carry through in our lives. Whether you have a womb or you do not have a womb, whether you are someone who is parenting biologically or by adoption or extension of your kinship, family, maternal health is a reflection or the way that we're looking at Black maternal health, I'll specify, is a reflection of the tenets of reproductive justice that says that people have to be able to make choices.

They have to have those choices be honored with their autonomy and also the competence and confidence to carry those decisions through within your support system. Biology, the choices you make aside, maternal health just as reproductive justice is for all of us who are caring for each other.

Dr. Melissa Harris-Perry: As you discuss reproductive justice, I know a core tennet of reproductive justice has been also the right and the choice to terminate a pregnancy. How does abortion, and particularly the attacks at the state level, and maybe quite soon a Supreme Court decision that could reverse Roe v Wade, or at least certainly substantially change it, how does that impact Black maternal health?

Raven Freeborn: All reproductive realities that we face in life including abortion, termination, loss, miscarriage are a part of maternal health because it is about our ability to make the choice that we want for ourselves and in people, in our communities. When there's an attack on abortion care and abortion access, it is absolutely an attack on the autonomy of Black women and their family systems to make choices for themselves and how they choose to carry forward their life with may that be with a pregnancy or not. Reproductive justice, maternal health, and abortion access are moving in the same spectrum of reality because it is about what we can do for ourselves and what we have the ability to follow through on.

Dr. Melissa Harris-Perry: Let's talk one bit more about Mamatoto Village in terms of career pathways. Tell me more about what kinds of health care providers you're working to create pathways for and to support. What does a Mamatoto provider look and sound and practice like?

Raven Freeborn: You'd would recognize a Mamatoto Village provider when they are someone who can speak to and incorporate affirming and culturally congruent care practices into their models of support within that community and in their interactions with the patient. At Mamatoto Village, when we are creating career pathways, we are first recognizing that there is language right now, that is popularized around the Black maternal health crisis. However, Black women are not a crisis. There's a history of births, traditions, and cultural diasporic rites that we have carried for a very long time.

Going all the way back to the southern granny midwives, when those cultural practices were in place, to be able to honor and respect the people who were a part of your birth care plan, your pregnancy plan, and even addressing the termination and loss that you may be experiencing. Mamatoto Village takes in part that history to address every bit of us as we are seeking care.

We are acknowledging the system of care most likely looks towards doctors and physicians as the figurehead of what it looks like for a pregnant or birthing person or someone who is seeking to become or end a pregnancy, that is the figurehead. We also know that certified professional midwives and certified nurse-midwives are a part of that care. We know that it's doulas and it's doulas of every pregnancy reality. I've served as an abortion doula, a birth doula, and a postpartum doula.

It is also therapists are folks who are able to attend to the healing and use healing art as a part of the narrative of care for pregnant and birthing people. Mamatoto Village is widening the pathway for Black women and birthing people to come through again, visibly, I guess that's the best way to say it, to be visible in the way that we care for ourselves and others.

Dr. Melissa Harris-Perry: Give me a vision of what a just world looks like from the perspective of the work that you're doing. Not that there's some end state and you need to get there, but what does it look like if we had a truly just and respectful and holistic world for maternal health in this country?

Raven Freeborn: The beautiful thing about being in the movement is that we're well prepared to answer this question because the movement is addressing and doing the work for the next seven generations. We say that in seven generations, we believe and we affirm that our kinfolk, our descendants, will be in a community of care that recognizes both their cultural practices to begin, celebrate and end life and also provide them with the economic and social measurements to take full part in their life. They can make choices and those choices are respected, they are affirmed. There's a system of accountability that does not produce punishment or does not produce coercive exploitation.

Babies are born, pregnancies are honored at every reality that they may face if that's termination or loss. We're able to move within this system of care alongside another. We're not having to resist against medical racism or against structural inequity. We're actually building the institutions and the infrastructures that provide us the most dignified affirmative care that extends our lifespan to exactly the point that it needs to extend to.

Dr. Melissa Harris-Perry: Raven Freeborn is Director of Policy organizing and partnership at Mamatoto Village. Thank you so much for talking with us today.

Raven Freeborn: Thank you for having me.

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