Kamala Harris Hosts Roundtable on Black Women's Maternal Health Transcript April 13

Susan Rice: (00:02) Thank you. Well, good afternoon, everyone, and welcome. I'm honored to be here with each of you and with our wonderful Vice President, Kamala Harris, I'm Susan Rice. I'm the domestic policy advisor here at the White House. And we're very glad to have this opportunity to talk about such an important priority for the Biden Harris administration. And that is addressing the unacceptably high rate of Black maternal mortality in this country. Susan Rice: (00:37) We're here today because we wanted to speak directly, but more importantly, we wanted to hear from each of you, your stories, women who have personally experienced this tragedy and who've dedicated your lives and your work to elevating this issue through your research, through medical practice, through your advocacy, through your incredible caring for others who have gone through what you have gone through. Susan Rice: (01:05) Before we dive in, I want to alert our viewers that today's conversation is going to be difficult. We're going to hear personal stories of pain experienced during pregnancy, childbirth, and postpartum. And we understand that some of you watching may have had similar experiences and this may be difficult. And we want to encourage you to watch with self care and to reach out to your healthcare provider if you need additional support. You can also call the national helpline at 1-800-662-HELP 1-800-662-4357, or HELP. It's free. It's confidential. And it's available 24/7 in Spanish and English. Susan Rice: (01:58) In the United States of America, a person's race should never determine their health outcomes and giving birth should never be a death sentence, but America's maternal mortality rates are among the highest in the developed world. And for Black women, they are disproportionately high. Many of these deaths are preventable and that's what makes this wholly unacceptable. So during this Black maternal mortality, Black Maternal Health Week, we wanted to hear directly from sisters like you. Sisters, who understand what this tragedy and trauma means so that we can address these racial disparities in maternal health and ensure that women are treated with dignity and respect and kindness, and that Black women are no longer dying in the United States in and after childbirth. That's our mission. Susan Rice: (03:02) Joining us here today are four amazing women. Heather Wilson, executive director and founder of Kennedy's Angel Gowns. She's also a doula and a mother who herself experienced complications and loss in childbirth and pregnancy. Erica McAfee, founder and CEO of Sisters in Loss. She is also a mother and a doula who too experienced complications and loss in childbirth and pregnancy. Donna Trim-Stewart, mother of [Arica 00:03:46], who was a policy expert here in Washington, on Capitol Hill, and who tragically passed away just one week after childbirth, less than a year ago, at the all too young age of 29. And Dr. Elizabeth Howell, chair of the Department of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania Health System. She too is a mother and has dedicated much of her medical career to elevating the issue of Black maternal mortality and emphasizing the importance of quality care for Black women during pregnancy and childbirth and postpartum. Susan Rice: (04:28) I too am a mother. And I want to thank you all for being here with us today and sharing your stories so bravely. We recognize that this comes with deep pain, but also great compassion for others, whose stories you will lift up and strengthen. And we're grateful for your commitment to elevating the voices of all Black women who feel deeply this tragedy. And so Madame Vice-President, let me turn it over to you. I'm so grateful for your extraordinary leadership. Thank you for all you do every day, but in particular, your longstanding leadership on this issue. [inaudible 00:05:13] Vice-President. Kamala Harris: (05:14) Thank you, Ambassador Rice. And it is my great honor to welcome these extraordinary leaders for this conversation. You all have been on the ground doing the work of connecting with women around our country. You are national leaders, you are powerful leaders on an issue that still requires so much in terms of a priority by all people. Kamala Harris: (05:42) Before we get started, I do want to address the killing of Daunte Wright. He should be alive today and to his family and loved ones, you must know that the president and I grieve with you as the nation grieves his loss. And we stand with you. Our nation needs justice and healing, and law enforcement must be held to the highest standards of accountability. At the same time, we know that folks will keep dying if we don't fully address racial injustice and inequities in our country from implicit bias to broken systems. Kamala Harris: (06:26) Which brings me to the topic of this moment. This week is Black Maternal Health Week, and make no mistake, Black women in our country are facing a maternal health crisis. Black women are two to three times more likely to die in connection with childbirth than other women. And it is important to note that Native women are 2.3 times more likely to die from pregnancy related causes than White women. We know the primary reasons why. Systemic racial inequities and implicit bias. And the consequences are both very real. Many of the women in this room have experienced them firsthand. And as the ambassador said, we will hear their stories, which they speak with great courage, given the pain that they have experienced. Kamala Harris: (07:22) And over the year years, I've heard many stories, stories of women who were experiencing postpartum depression, only to be dismissed. Stories of women telling their doctors they were experiencing pain, only to be ignored. Stories of women who could not hold their newborn baby because that child had to be on life support or receive a blood transfusion, after blood transfusion, after blood transfusion. Black women deserve to be heard, their voices deserve to be respected. And like all people, they must be treated with dignity. Kamala Harris: (08:10) For years, I've been working to address systemic health disparities and advocating for investments in those social determinants that we know influence maternal health. Things like housing, transportation, nutrition, and the inequities that exist in all of those systems. When we talk about Black maternal health, we're talking about reproductive healthcare, let's be clear about that. We're talking about reproductive healthcare. And another issue that I've spent a lot of time on, on that point, as it uniquely and disproportionately affects Black women are fibroids, which can lead to maternal mortality, especially for Black women. I also introduced, when I was in the Senate, the Maternal Care Act to reduce errors in judgment by healthcare professionals that stem from implicit bias. And last week, President Joe Biden. And I announced the Maternal Care Act is in our budget, dedicating $30 million for implicit bias training for healthcare providers. Kamala Harris: (09:12) Through the American Rescue Plan, we are also lowering health insurance premiums for millions of families. And we are extending Medicaid coverage for people who are postpartum, which is important because we know that Black women are more likely to lose healthcare coverage during their pregnancy than White women. We're so proud to do this work alongside healthcare workers, researchers, physicians, nurses, doulas, and community organizers who have dedicated themselves to this cause. And I just do want to say a point about doulas because I do believe that doulas are some of the smartest on these issues and must be leaders when we talk about what we need to do to train and have folks understand how to approach these issues in a respectful way. Kamala Harris: (10:05) I also want to thank Black Mamas Matter Alliance, who building on a resolution from Congresswoman Alma Adams and myself, that we introduced, before now, started Black Maternal Health week in 2017. This Alliance brought national attention to the issue and lifted up the voice of Black women in the process. Kamala Harris: (10:28) And finally, also want to thank my colleagues in the United States Congress, who have worked on this issue. In particular, Senator Cory Booker, Congresswoman Robin Kelly, Congresswoman Alma Adams, and Congresswoman Lauren Underwood. They have been extraordinary. And again, highlighting the fact that the United States Congress, leaders at every level everywhere, must take on this issue. It cannot be for Black women alone to fight for their rights and to fight for their dignity. And so to the brave women who are here today, again, we thank you. And I will tell you that in this White House, you will always be welcome and your voices will always be heard. Kamala Harris: (11:13) And I'll turn it back to the Ambassador. Susan Rice: (11:15) Thank you very much Madame Vice President. With that, I'd like to ask Heather Wilson to tell us about herself. Heather is a mother, a doula, and executive director and founder of Kennedy's Angel Gowns. Heather lost her daughter Kennedy at 36 weeks. A year later, she gave birth to her daughter, Riley, born at 35 weeks. She since dedicated her life to supporting mothers who've experienced loss in pregnancy and childbirth. Heather, we'd love to hear your story. Heather Wilson: (11:52) Good afternoon. And thank you for this opportunity. I'm honored to be here with all of you. Heather Wilson: (11:59) My journey to motherhood began in 2009. About two years into our marriage, we decided we were eager to grow our family. And so with infertility struggles in the beginning, we continued to continue to try and grow our family. I can honestly recall the excitement we felt when we found out we were expecting. Went to the doctor's office and I thought I had a bad cold. I didn't. I had a baby, who we named later on Kennedy. My pregnancy was beautiful and uneventful until I was diagnosed with preeclampsia. I learned my diagnosis at about my third trimester. I was heavily monitored, but I was told I would be okay, not just by the physicians, but in family members that just wanted to encourage and reassure me. Heather Wilson: (12:54) As we approach the end of my pregnancy, my symptoms grew more intense and my doctor decided that they wanted to deliver Kennedy about a week earlier than expected. They scheduled the birth date for the following week. Unfortunately, we didn't make it to that date. Nearing my delivery date, I didn't feel movement and I alerted my husband. He rushed home and he said, "Don't worry, calm down. You know she always moves to daddy's voice. So as soon as I get there, we'll get some orange juice, and she'll kick. Don't worry." With no success, when daddy got home, we went to the hospital. The medical professionals there did their best to stall us. They would blame it on equipment and say, "We'll get this working. Don't worry." What I realized they were doing was just waiting until the doctor was there to deliver words that no parent deserves to hear. Heather Wilson: (14:01) Deserves to hear. They notified us, words etched in my memory forever. They told us, "Mr. and Mrs. Wilson, there's no heartbeat. Kennedy has transitioned." With sky high blood pressure, my placenta is separated from my uterus. Looking back, I wasn't told of the dangers of this complication or the outcomes affecting black women like myself. I prayed to God that God would bless me with the baby. He blessed me with an angel. All the hopes and dreams we had for Kennedy were going in an instant. The world just stood still as my family was shuffled off to a room to protect me, because this had now turned into a life or death situation. In the aftermath, we struggled to pick up the pieces without direction, support, and resources. I felt so alone. We tried to navigate the recovery and grieving process the best we could, and that was holding on to each other. Because of employment benefits not including additional time for traumatic loss, my coworkers sacrificed their own leave and donated to me so that I could be home and have this time to grieve and heal. Outside of the maternity ward, in my room, I could hear the celebration of other families. I could see the balloons that said, "It's a boy, it's a girl", but I was going home with empty arms. Heather Wilson: (15:44) My husband and I knew at that point that we had to do our part to ensure that families had the space and support needed in the event that they would lose a child. In an effort to serve others, we launched a nonprofit called Kennedy's Angel Gowns, in memory of our little angel. People from all over the country visit Kennedy's Angel Gowns and donate their used wedding gowns so that we can sew and convert them into handmade burial gowns for babies. I actually have one here. They're made for boys and girls in varying sizes. And they come with mommy and me bracelets, one that the mom wears and one that the baby is buried with. Heather Wilson: (16:28) As an individual, I don't have the power to change healthcare and legislation and increase bereavement leave or allow free counseling. But through my organization and becoming a bereavement doula, I've had the ability to support up to 10 families a week. We help up to 10 families a week bury their children. That number, it's unreal, and that's just my small organization. We provide these gowns and we hold their hand through the process, pre COVID. At this point, we're doing our doula work through the phone or through video. Heather Wilson: (17:10) In 2018, we donated the first cuddle cot. For those of you that are not knowledgeable about what a cuddle cot is, it's a cooling bassinet that slows down the decomposition process and gives parents and families the gift of time. It's something I wish I had with Kennedy, was time. I didn't want my first hello to be my final goodbye. If we could stop time, we would have, but at least now if we can get these in every hospital, it would help those families have time. Thus far we've donated nine. They were originally made in Europe, and now the United States is starting to manufacture them. In 2019, we donated a private and serene bereavement suite to a local hospital. We named it the Butterfly Room, because it reminds us of Kennedy. This is the first space of its kind in Virginia. It was a groundbreaking solution to complex issues and lack of privacy for those parents dealing with loss at the time. Heather Wilson: (18:12) One in four women will be forced to navigate the loss of pregnancy or child loss without resources they deserve. One in four. If a mother manages to walk away with their life, they're likely walking into an existence of the shell of a life they once had prior to their loss. This is the greatest country on earth. We should not continuously lose so many mothers and babies to preventable circumstances. The United States has some of the poorest maternal outcomes in the modern world and systematic failures. Racism contributes to even higher rates of death in black and brown women. We have to make changes for mothers like us on this stage. We have to look at the legislation, the healthcare, accountability, and incentives and rewards, and adherence to those standards of care. As a mother, I can't help but use my experience to fuel change to support others. Through sharing my story and supporting families through Kennedy's Angel Gowns, I hope for a better tomorrow. And I stand with everyone on this stage as we do everything we can to do our part in fighting black maternal mortality. Thank you for letting me share Kennedy's story. Susan Rice: (19:34) Thank you. Madam Vice President. Kamala Harris: (19:42) Can you talk a bit about... And I think both you and Ms. McAfee can do this, but the significance of doulas and the kind of work that you do; some people are familiar, some are not, but you are often in a uniquely trusted position to help mothers, whether they go to full term or have had the tragic experience that you've had. Can you talk a little bit about the skill that you bring to that work? Heather Wilson: (20:14) It's the support. It's having an extra set of eyes. It's not always what you think, it's not always helping you to bounce on a ball. And specifically with a bereavement doula, me as someone who's been through this, it's helping you to get through the process, to make sure that everything is in line with how it should be, making sure your voice is heard, especially those African-American women. But not only that, the aftercare. It's doing laundry, so you can take a break and get some rest. It's putting your breast milk in the refrigerator. It's wraparound services, and every single person should be afforded that. It's so much more to it. Susan Rice: (20:57) And with black women in particular, what is that conversation as a bereavement doula? What are the questions? What's the source of the anger and the sadness, and what are those conversations? Heather Wilson: (21:12) Not being heard. Susan Rice: (21:13) Not being heard. Heather Wilson: (21:14) Is the number one thing I hear is, "They're not listening to me." And oftentimes it's too late. And I can say that there were times that I felt that way too. You're not listening to me. I know my body better than anyone. I'm telling you that there's some concerns. My first doctor was awesome. I switched to a second doctor that was a specialist group. And I returned right back to my first doctor because I wasn't being heard, they weren't doing things that me as a non medical person knew; you should be testing my urine every time, because I had preeclampsia with my first pregnancy, and in six months they hadn't. And that was the way that it was found was protein in my urine. So it's those missteps of being that voice when you don't know. If it's your first pregnancy, you don't know what the protocol is. And so you don't know to ask those questions. That's what your doula's for, to make sure that every T is crossed, every I is dotted, and that you're getting the care that you well deserve. Kamala Harris: (22:23) Thank you. Heather Wilson: (22:24) Thank you. Susan Rice: (22:25) Madam Vice President, I'd like now to introduce Erica McAfee, another doula and mother, and the founder and CEO of Sisters in Loss, which is a podcast series for mothers who've experienced loss in pregnancy and childbirth. Erica was on life support following the birth of her son, Maxwell. She's also experienced early miscarriage and stillbirth at 39 weeks in previous pregnancies. Erica, we'd love to hear your story. Erica McAfee: (23:00) Oh, thank you. Good afternoon. Thank you all for allowing me to share. My journey to motherhood begin with losing two babies as you mentioned, and almost losing my life with my son. I lost my first son due to his lungs not being developed at 39 weeks and showing signs of preeclampsia. I went to the hospital to be induced because of my high blood pressure and me building up fluid all over my body. I labored, I pushed, and then the doctors made a decision to complete a caesarian. I remember it like yesterday, being rolled into the operating room, seeing the bright lights and the doctor saying happy birthday to my baby boy, but he didn't cry. I knew something was wrong as the folks ran to his side to try to revive him. And 41 minutes later, he passed away. They pronounced him dead. They rolled him into the recovery room with me and basically told me to say my goodbyes. Erica McAfee: (24:05) The hospital I was at was gracious enough to move me and my family to a different floor. They put a marker on the door to let people know that I had a son that passed away, and they allowed me to spend as much time with him as I needed with taking pictures and doing hand prints and footprints and making molds and really creating those memories that I would need later on after we actually funeralized him. They gave me all the resources that I need, a chaplain, a funeral home list, where could I cremate him if I wanted to cremate him. And even at that hospital, they had a memorial service quarterly, where they were able to honor babies who passed away during childbirth. Erica McAfee: (24:49) After many months of grieving and therapy, I tried again, because I knew I wanted to become a mother. This time I got pregnant with a little girl. Throughout that pregnancy, my doctors made sure they did all the first trimester screenings to ensure that this baby would not have the same outcome as my son, but it did not. At 18 weeks, I went into preterm labor due to cervical insufficiency or having an incompetent cervix, and I lost my baby. I came to the ER and they said there was nothing they could do at 18 weeks because my pregnancy wasn't viable, which is at 24 weeks gestation. So I started to go crazy again, because I'm leaving the hospital empty handed. I'm grieving the loss of my first son, but also grieving this loss of my daughter. And I ended up going back and finding support groups online, really navigating really what grief and healing and loss look like for myself. Erica McAfee: (25:53) And then I was at a place where I wanted to try again to become a mother again. And I did. I was able to get pregnant, with a son this time, the same doctors who delivered my son and my daughter were both the two primary OBGYNs I saw throughout that entire pregnancy. And at 19 weeks, I ended up going through a major surgery and got a cerclage placed, which is a cervical stitch, to ensure that that pregnancy prolonged. And I went through that pregnancy without any major complications up until 32 weeks. At 32 weeks, I arrived at the emergency room and I immediately knew something was wrong. I wasn't in labor, but something just was off. The doctor that delivered my stillborn son was the doctor who was on call that day. And if she wasn't there that day, if she didn't know me, she didn't know my story, she didn't listen to me, I wouldn't be here sitting with you all today. Immediately within 15 minutes of me arriving in the emergency room, she rolled me back and I was on the operating table for a crash emergency C-section. Erica McAfee: (26:58) I had a full placenta abruption. I lost so much blood that I had to have eight blood transfusions. I was on life support and my family was called in. My son was able to be born. He was resuscitated at birth. And as a result of his not having oxygen at birth, he does have special needs and a disability. He was diagnosed with cerebral palsy at one years old. And then also as a part of the life saving mechanism for doctors to save my life, they had to give me a partial hysterectomy at 28. So I was faced with this bout of infertility before 30, and then raising a child with a disability that I didn't know what the outcome would be. But I knew that there were other black women who experienced a traumatic birth, pregnancy complications like me, and I wanted to hear their stories. I wanted to amplify their voices through podcasts. So I started Sisters in Loss back in 2017 to share those stories really... Erica McAfee: (28:03) Sisters in Loss, back in 2017, to share those stories really behind the statistics we talked about here today, and really help black women replace silence with storytelling around their pregnancy loss and fertility complications. The stigma and shame that comes with sharing loss stories prevent black women from achieving the healing they need to thrive in their new normal. Sisters in Loss holds that space for people to present those stories in a resourceful and culturally acceptable way, to assure black women that they're not alone on this journey. Erica McAfee: (28:33) Heather Wilson was my first podcast guest, and through our shared experiences we've become great friends and really sisters in this fight. Sisters in Loss is streamed in over 50 countries, has over 700,000 downloads, and is an online support community for black and brown women to come and gather and get the healing they need to really thrive after loss. Erica McAfee: (28:57) Since the pandemic has started, we have all been at home, and a lot of our sisters wanted some additional training. So we have trained and certified over 150 doulas and birth workers to provide childbirth education, breastfeeding and chest feeding support, birth, postpartum, and bereavement doula services, in their local communities to have a greater impact, but also to have those connections to community resources. Susan Rice: (29:27) Erica. Powerful. Kamala Harris: (29:32) In the podcast, what are the questions that come up most frequently? Because you have created such an important vehicle, like you said, that you were replacing silence with storytelling. Reminding them of the power of their voice. Erica McAfee: (29:52) Absolutely. Kamala Harris: (29:53) And what comes up most often in those stories? Erica McAfee: (29:57) I think the main thing that comes up is that people have not had the opportunity to share their story, like we're doing here, in its entirety. So once they are able to do so, they feel a sense of relief. They feel a sense of comfort. They feel this safe space to be able to say, I know that someone on the other end that's listening is going to hear something from my story and become healed from their underlying condition, whether that is uterine fibroids or endometriosis or PCOS, which a lot of black women face. They share those stories openly and transparently and really provide a healing place for themselves, but also those who are listening. Kamala Harris: (30:38) And are there commonalities around how they tell you their experience in the healthcare system? Erica McAfee: (30:43) Absolutely. Everyone, very similar to what Heather said, has said that they are not being heard, that they're not being listened to. And I wanted to share that part of my story because I know that if that OBGYN did not listen to me, I not be here today. I would have been gone because my family was called in. So we just need to be listened to and heard, especially when it comes to pain throughout the reproductive system. Kamala Harris: (31:10) So I anticipate that there are women and their families who are watching this, who are pregnant now. What advice would you give them about how they can empower themselves in the system? And they're powerful. I don't mean to suggest they don't have power, but give us some tools. What are the tools? Erica McAfee: (31:30) Absolutely. Absolutely. Yes. So I always tell people that they have to create the right birth team for them. So whether that looks like maybe getting a second opinion if they had an underlying condition, changing and switching providers, and then ensuring that a doula or midwife is a part of their entire birth team. And they're all working together with the fertility specialist, the OBGYN, to ensure that they have a healthy outcome. Kamala Harris: (31:57) Why is the doula piece important? Why is the midwife piece [crosstalk 00:32:01] Erica McAfee: (32:02) Doulas are so important because not only do we provide the emotional and informational support, but we help and teach our clients how to truly advocate for themselves in the settings, whether they're in the emergency room, or in their OBGYN clinic, or in a hospital setting, we teach them exactly what to say, how to do, and how to move through and navigate the system as needed. Susan Rice: (32:26) Thank you so much, Erica. Erica McAfee: (32:27) You're welcome. Susan Rice: (32:28) Your leadership is really inspiring. I'd now like to introduce Donna Trim-Stewart, who's a proud native of Trinidad and Tobago. She's a mom and a grandmother, and she's the founder of Empowering Awakening Resource Center, which offers support to children and young people, to build the skills that they need for adulthood. Donna lost her daughter, Arika Trim, a former Capitol Hill staffer who died a week after childbirth. And she is now the primary caretaker of Arika's son, Djai. Donna, thank you for being here. Donna Trim Stewart: (33:09) Thank you. Thank you for the opportunity to share a story. We didn't see this coming. Our lives were forever changed. It is not only have we lost Arika, but it's the unexpected way we lost her. Arika who was called to serve... Sorry, I'm sorry. Arika was called to serve at the highest level of public service, that in the office of the First Lady Michelle Obama. She continued being a voice [inaudible 00:33:48] through public service at the US Department of Agriculture and the US House of Representatives. And at the time of her untimely death, at [inaudible 00:33:59] the American Hospital Association. She also, along with myself, started the nonprofit in Tobago for students, EARC, that you just mentioned. Donna Trim Stewart: (34:10) Family was very important to her. She loved hanging out with her brothers, singing, dancing, and playing music. Being the only girl, they were super protective of her. She was my daughter. She was my friend. My fashion partner and so many more... I'm sorry. Kamala Harris: (34:33) Take your time. Take your time. Donna Trim Stewart: (34:43) Our 2019 Christmas gift was Arika announcing her pregnancy. We were all very excited to have a baby in the house. As excited as she was, she was always very concerned about the disparities that black women face in pregnancy and childbirth. For her doctor's visits, she had a notebook, and she would say to me, "I have my 20 questions list. I don't want anything falling through the cracks." She did everything on her part for it not to have ended this way. Donna Trim Stewart: (35:16) The baby was due to come in August. And on June 10th, she said the baby was hardly moving. And so she called the doctor, and she was going to have them check on the baby. Later that evening, she called and said they told her the baby had very little fluid around him, and they would keep her to monitor her and the baby. On June 16th, they did an emergency C-section. On June 19th, she was discharged. She talked about how hard it was having all these concerns about leaving the baby to come home. She would talk about feeling tired, between the pumping every three hours and having to go to the NICU every day to see the baby. Donna Trim Stewart: (36:06) In January 2020, she passed out and mentioned it to her doctors. It happened again the day after the C-section. I was in the room with her. I heard her saying, "You all need to figure out why I keep passing out." No one listened. Her voice wasn't heard. On June 23rd, she was getting ready to visit the baby and she passed out again. This happened twice within an hour. She called the doctor's office and was told the doctor would call her back. We decided instead to head to the ER. And on our way, she started having seizures in the car. We made it to the ER, and a couple of hours later, she was gone. I have so many questions. Why was she sent home two days after an emergency C-section, given her prior medical history? Why wasn't she taken seriously? What happened when they took her back there? Was she attended to immediately? This is one of the things that plague me daily. One day, we will have to answer some of these questions to her son, Djai. Donna Trim Stewart: (37:28) As a result of this, I've decided that I don't want to be silent. I refuse to be silent. And this cannot be allowed to continue to happen. And I'm hoping that we can help to provide doctors and nurses and practitioners to advocate in hospitals of black expectant mothers and recent mothers. I'm hoping that there'll be a task force for black maternal healthcare, including looking at ways to educate health professionals and make sure our voices can actually be heard. Better home monitoring when you send black women home because Arika was sent home, and she wasn't monitored. A black mothers patient bill of rights and funding for full insurance coverage for OBGYNs to do mobile health home care visits for black mothers. Thank you for this opportunity to share this. Kamala Harris: (38:34) Thank you so much. Thank you for your courage in the midst of your pain and all of the specific points that you made about what some of the solutions look like. There's the maternal mortality review committees that we need to standardize across the country. Because too many families that I've talked with on this consistently ask why aren't my questions being answered about what happened. We need to collect... We need to review these cases, when a woman dies in childbirth or shortly thereafter. We need to collect the data. We need to answer the questions by doing the work to figure out what happened, so that we can avoid these tragedies from happening as we go forward. Kamala Harris: (39:36) California, actually, in 2006 created a whole initiative. It is called the California Maternal Quality Care Collaborative, and it has been very successful in driving down maternal mortality. In North Carolina, they have the Pregnancy Medical Home Program they started in 2011 that also increases birth outcomes with the work that they're doing. But I couldn't agree with you more that all of these approaches have to exist in recognition of the seriousness and the unnecessary outcomes that we are seeing that could be prevented, were we to take more seriously the issue and study it. Thank you. Donna Trim Stewart: (40:19) Thank you. [inaudible 00:40:22]. Susan Rice: (40:22) Thank you so much, Donna. I'd like now to turn to Dr. Elizabeth Howell. Dr. Howell is chair of the department of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania health system. Dr. Howell, you've truly dedicated your medical career to working on combating these extraordinary disparities in maternal health, with a focus on the quality of care that black mothers need before, during, and after childbirth. Look forward very much to hearing your perspective. Dr. Elizabeth Howell: (41:02) Good afternoon. Thank you for the invitation to be part of this landmark event. Thank you, Vice-president Harris. Thank you, Ambassador Rice, for your leadership on this really very important issue. And thank you to the wonderful women I'm sharing the stage with, for your courage to share your heartbreaking stories. Dr. Elizabeth Howell: (41:22) The elevated rates of maternal death for black and brown women are unacceptable, but death is just the tip of the iceberg. For every maternal death, over 100 women experience a severe complication related to pregnancy and childbirth, something we call severe maternal morbidity. It impacts over 50,000 women in the United States every year. And we're talking about life-threatening conditions, just like what you just heard about, blood clot, strokes, a woman loses so much blood following delivery, she has to have a hysterectomy. And similar to maternal mortality, black and brown women have elevated rates of maternal morbidity. Dr. Elizabeth Howell: (42:03) ... Black and brown women have elevated rates of maternal morbidity. And this excess morbidity and mortality for black women extends to the postpartum period with elevated rates of depression and mental health issues, hypertension, cardiac disease, readmissions to the hospital, and death. Dr. Elizabeth Howell: (42:21) And as you've heard with these stories today, this crisis extends to birth outcomes. Black infants are more likely to be born premature. They're more likely to be born stillborn. They're more likely to be born low birth weight, and they're more likely to lose their life in the first year of life than white babies. And black very preterm infants, those that are born at less than 32 weeks, are more likely to have significant complications at birth that put them at an increased risk for neurocognitive and developmental delays through their childhood. This maternal healthcare crisis places black and brown mothers and babies, families, and communities at a disadvantage over the life course and perpetuate disparities for generations to come. These disparities are deeply rooted in structural racism. Dr. Elizabeth Howell: (43:12) An important part of this story is the fact that over 60% of these maternal deaths and a significant portion of this maternal morbidity are preventable, making quality of care a critical lever to address this issue. Yet many black and brown pregnant women do not receive high quality care. I've been studying this problem for two decades, black and brown women often receive care in delivery hospitals that have worse maternal outcomes for both white and black mothers. And even within the same hospital, black and brown mothers are more likely to have a severe maternal morbidity event, even after accounting for patient risk factors like insurance, high blood pressure, obesity. And as you've heard, many black and brown women describe profound trauma during the labor and delivery experience, discrimination, feelings of disrespect, and no feeling heard. Dr. Elizabeth Howell: (44:10) There are several steps we can take to reduce these disparities before, during, and after pregnancy. And in closing I would like to applaud the administration, Vice President Harris, for tackling this public health crisis. Allowing States to extend Medicaid coverage from 60 days to a full year postpartum through the American Rescue Plan is critical, as over half of these deaths are occurring in this postpartum period. In providing more than $200 million through the President's discretionary budget to tackle disparities in maternal morbidity and mortality, by bolstering maternal mortality review committees, funding rural maternity obstetric strategies programs, encouraging states to create medical homes for pregnancy care, and funding efforts to diversify the workforce and implement implicit bias trainings. These are all critical steps we need to take to improve maternal outcomes overall and reduce disparities. Dr. Elizabeth Howell: (45:09) At the University of Pennsylvania Health System with our nearly 19,000 deliveries, and in Philadelphia, a city which is 42% black, we have taken on this challenge and are committed to closing the gap. I'm hopeful that the bold actions of this administration coupled with the work of community organizations, healthcare organizations, policy makers, researchers, and the voices of black and brown women, will give pregnant women and all birthing people from every community a fair chance. Kamala Harris: (45:40) Thank you so much Dr. Howell. So Dr. Howell, in the Maternal Care Act that now is in the President's budget, the main focus is implicit bias among healthcare professionals. And so the resources that we're putting in are designed to create and then resource training programs for healthcare professionals at every level. Can you speak a little bit about the kind of implicit bias that we are seeing and how it needs to be addressed? Dr. Elizabeth Howell: (46:10) Well I think we've heard from these stories about the fact that over and over again, we hear women of color saying they're not being heard, they're not being listened to. They have symptoms and no one is giving them the attention that they need or dealing with the problem. And the thing that we have to realize is that we all have biases, right? And the idea that we have to sort of acknowledge them, take a moment, and then change our behavior. And the goal from these trainings is really to help us recognize our biases and to do something about it. And implementing these at hospitals and healthcare systems is a really important first step. I hope that we also add tradings around explicit bias. Kamala Harris: (46:50) Yes, absolutely. But can you talk a little bit about what the training involves? Like let's start with just physicians, what are physicians taught to address implicit bias? Dr. Elizabeth Howell: (47:00) So we actually are just going through this, our department and our health care system is going through, and the city of Philadelphia is having implicit bias trainings for all obstetric providers right now. And there's a group that comes in to sort of talk to us about, they're like, let's first understand the context and the history of structural racism. How has it impacted black and brown women's lives over the last 100 years? Why might they have issues with trust around the healthcare system? Let us understand. So they go through education. Dr. Elizabeth Howell: (47:32) Then they talk about, okay, let's go through how your brain is, how you're recognizing, how these things without you realizing it might actually just occur. So they train us on that. And then they talk about, okay, let's take a moment and let's figure out, it's very interesting your first reaction to something. If you take a breath, if you take a moment and you sort of size it up, you could realize that sometimes that's not the right reaction to have. And that you need to, especially in a setting of maternity care and with women of color, you need to sit down, and talk, and listen to them. Understand where they're coming from, understand their life context, and work to provide them the highest quality of care you can. Susan Rice: (48:15) Are there other, you were kind to mention some of the steps that the administration has taken in our budget and the rescue plan, are there other policy moves that you think we could take that would be helpful? Dr. Elizabeth Howell: (48:27) Well I also noticed that you guys have increased funding for a Title X family planning. So whenever I really think about, that we need to think about this is the care continuum. Before, during, and after pregnancy we need to do everything we can to optimize contraception. We need to do everything we can to allow women to optimize their health before they become pregnant. Manage that chronic hypertension, manage that diabetes. We need to think about innovative antenatal programs like the medical home for pregnant women that you mentioned. There are lots of new programs that we need to invest in. Dr. Elizabeth Howell: (48:59) Labor and delivery, we need to think about standardization of care. Making sure that every woman who comes in with hypertension is treated with the most recent evidence-based practices, and make sure that that's done for everyone. But we also need to monitor our quality measures and trends, and make sure that we look at them by race and ethnicity and by insurance, so that we can know that we're giving it the right care and optimizing care for everyone. And then finally postpartum. I think the move on extending Medicaid is just critical to try to give women access to this very, very needed care. Susan Rice: (49:33) Thank you so much. Kamala Harris: (49:35) No, I think that's right. And this is about what we, we're pleased and proud of what we're able to do at this stage in terms of this administration, but there's also a role to play for states and local governments. Because for example, the funding is going to also require that the states participate in that in terms of the extension of coverage. And then again, I appreciate the point you made that this is, it really is, it's about it's about pregnancy, but it is also about reproductive healthcare. Because again, when we talk about uterine fibroids, there are certain issues that impact specific populations of women that contribute to what we'll see throughout the system. And so it's across the board, but about reproductive health care. And in this case, addressing the reproductive healthcare needs of black women, specific to the issues that uniquely affect black women in the healthcare system. Susan Rice: (50:35) Well Madam Vice President, I want to give you an opportunity to make any closing remarks you want to make, but I also just want to say how grateful I am to each of you for your bravery, for your leadership, for your compassion for your fellow women. And for sharing your stories so that so many I hope who are listening and watching understand that we have a real struggle to ensure that each of us are treated with dignity and respect, and that we are heard, and that we look out for one another. Madam Vice President? Kamala Harris: (51:10) Before we got on camera we were talking a little bit as a group, and to the Ambassador's point, listen, it's really important for folks to understand you are not alone, and don't let any situation or circumstance make you feel alone. When we feel we are alone, it tends to make us feel that we don't have power or agency in a moment. And so when you are in that doctor's office, or that clinic, or that hospital, or that emergency room, know you are not alone. That you carry the voice and the support of so many women you may not meet, who want you to be heard in that room. And so we have the experts who can talk to you specifically about the kinds of things that you should be asking when you are in that room and demanding the answer, and know you have a right to get the answer. It is their job to answer your questions. And if they are not doing their job, that shouldn't be your problem. Like we were saying, then maybe it's time to switch the healthcare provider. Kamala Harris: (52:25) But the point of this conversation, and I've really appreciate, Erica, what you said, is that let's replace silence with storytelling. But everyone should tell the story, and not just those who have experienced it, but everyone else should tell the stories so that we can make sure that we take seriously this issue. We elevate it in a way that ultimately we end this issue of black maternal mortality. So thank you all for your courage and for your leadership. Thank you.