Erica Garner died on Dec. 30, 2017, just four months after she gave birth to a baby boy and three years after her father Eric Garner died in the chokehold of a New York City policeman.
After having multiple heart attacks (the first came shortly after childbirth), she experienced one of the hundreds of pregnancy-related deaths that year in the United States. She died in a country where Black women are more likely to die due to complications of pregnancy and childbirth than white women, and in a country where the racial disparities in maternal health continue to grow.
These inequities in maternal health outcomes have been shaped by the persistent and pervasive effects of systemic racism.
Despite the efforts of racial justice movements worldwide since the 1960s — from the civil rights movement to the work of Black Africans to break from colonial rule to today's Black Lives Matter movement — improvements to the health of communities of color, particularly women and children, have lagged. These unequal health outcomes have been compounded by the COVID-19 pandemic, which has further exposed how health — and survival — are shaped by gender, racial and class inequities.
We both lead global health organizations (Last Mile Health and Merck for Mothers) committed to improving health outcomes for women and their families. We were both born and raised in West Africa and have practiced medicine in American cities as well as in marginalized communities in Liberia and Nigeria.
As physicians and public health practitioners, we’ve seen how the historical forces of slavery, colonialism, police brutality and racism have made it more likely for Black mothers to suffer disproportionally poorer health outcomes. When health systems falter, as they did when confronting Ebola in 2016 and as they are strained now in responding to COVID-19, it is women and people of color who are most severely impacted.
To build more equitable health systems to serve Black women, we must challenge ourselves, our organizations and our collaborators to recognize, acknowledge and take action against the status quo, which is shaped by systemic racism and the colonial roots of global health.
Specifically, we must transform our approach to maternal health care in three key ways:
►First, we must listen to and invest in the disenfranchised and those working to strengthen everyday systems that will better meet the health needs of Black women. This starts with hiring and training Black mothers and their neighbors — people with lived experience — to be part of the health care team. In the U.S., city-focused coalitions are redesigning how maternity care is delivered with and for Black women. Working with primarily low-income, Black mothers in Memphis, Tenn., has brought significant reductions in rates of preterm delivery through the provision of nurse home visits paired with social support, including assistance with finding jobs.
Community-based approaches don’t just make everyday health systems more equitable, but they also make those health systems more resilient during crisis. In Liberia, during Ebola and now in the fight against COVID-19, the government is working to train community health workers, nurses and traditional midwives in infection prevention and control measures, support providers who are conducting active case finding and referral, and equip them with digital tools for education and continued training. They are continuing to safely provide primary health services — which means mothers and their children can continue to access life-saving care.
►Second, when we think of local community-led solutions, we need to also highlight the contributions of social entrepreneurs and local businesses. In many remote areas in sub-Saharan Africa, the closest health service provider may be a local private provider — a community pharmacist or midwife.
Social enterprises such as Unjani Clinics in South Africa empower and employ Black women as nurses, creating job opportunities, and advancing a sustainable clinic model while increasing access to high quality affordable primary healthcare. Moving beyond philanthropy and development aid towards approaches that invest in growing local enterprises can help bring quality services to previously underserved communities and build more inclusive health systems.
►Finally, we need to hold ourselves accountable to advancing equity at all levels of our work from the frontlines to the board and from funding and design, to implementation and evaluation. We know that it is not enough to be non-racist. We must be anti-racist.
The work of pursuing health equity requires intentional and constant effort. This begins with following the lead of the communities most impacted and building diverse, inclusive teams within our organizations and across the places where we work to advance our missions.
Systemic racism is a public health crisis. If we want to make care more equitable and ensure every mother receives the care she deserves, and if we want to ensure that the COVID-19 pandemic does not exacerbate the racial inequities we see in maternal health, we have to tackle these obstacles together.
We owe this to Erica Garner and the myriad of Black women who are no longer with us.
Mary-Ann Etiebet is the executive director of Merck for Mothers. Since 2011, its programs and partnerships have resulted in healthy pregnancies and safe deliveries for more than 11 million women in 48 countries.
This article originally appeared on USA TODAY: How we stop systemic racism from killing Black mothers