Why Black maternal health is still in crisis (and how we fix it) | Dr. Kanika Harris

[00:00:00] Kristin Tully: Welcome to the Couple of Care podcast. I'm Kristin Tully, founder and chief scientist. this podcast, we invite maternal, infant and family health thought leaders to share their perspectives and work around research and experiences. It's key for implementing more meaningful support for families and those who care for them. It's a joy to welcome Dr. Kanika Harris. Dr. Harris is a behavioral health scientist, filmmaker, and executive director of the National Association to Advance Black Birth, national nonprofit committed to improving birth outcomes for black and indigenous families. She previously served as the senior director of Maternal and Child Health for the Black Women's Health imperative. work focuses on promoting maternal health equity through research, workforce development, and storytelling. She received her master's degree in public health and international development from Morehouse School of Medicine and her PhD in health behavior and health education from the University of Michigan. She is also a mother. I am so grateful for you Kanika to connect, and to just talk about, supporting people together.

[00:01:20] Kanika Harris: Absolutely welcome. It's great to be here. To be in partnership with you. Yes.

[00:01:28] Kristin Tully: so just share a little bit, what are you up to now?

[00:01:32] Kanika Harris: What am I up to? So this is my. Second year as the Executive Director of the National Association to Advance Black Birth. we have a long legacy in history, really over 30 years of being one of the first, Birth, training resources for, communities of color. So the organization used to be called, international Center for Traditional Childbearing, run by Mama Shafi Monroe.

[00:02:03] Kanika Harris: And then she branched off to do more work, and the name was changed to nab, but with that legacy, she was the first to hold birth worker trainings for Birth workers of color, when Donna was out and there wasn't really a space for birth workers of color, she held some of the first trainings for birth workers of color to support birth workers.

[00:02:27] Kanika Harris: So we have a long legacy there. we're most known for our black birthing bill of rights, which is, A resource for clinicians, birth workers, patients, families to use. That is a beautiful piece of art and activism really to, advance the rights of birthing people. And just a reminder of the rights that you have as a birthing person.

[00:02:54] Kanika Harris: And a reminder for clinicians and, birth workers as well of how we navigate this terrain together. So we are proud that now we have, an imprint and we have a deck of cars that's very beautiful that you can use. We're doing, trainings our first ever. Trainings of the Black Birthing Bill of Rights in California with, nurses in conjunction with, a one, association of Women's Obstetrics and Neonatal Nurses, women's health, obstetrics and Neonatal Nurses.

[00:03:31] Kanika Harris: That's always a tongue twister for me. we're doing a lot. We're also working in the, policy space. We have a collective called the. Midwifery Policy Collective where we're working with, other organizations like Elephant Circle, birth Center Equity, national Association of Certified Professional Midwives, innovation for Medicaid, Institute for Medicaid Innovation.

[00:03:58] Kanika Harris: I think I'm missing one other group. Excuse me. But we're working as a collective to advance midwifery policy, across the nation state by state. So a lot happening.

[00:04:13] Kristin Tully: Thank you so much for sharing that history. What a legacy and. to honor and to live. And how positive and affirming and so calling people forward. The Black Birthing Bill of Rights is, I think it's such a wonderful tool.

[00:04:30] Kanika Harris: Yes. Thank you.

[00:04:32] Kristin Tully: And you made a film.

[00:04:35] Kanika Harris: Oh my God, how did I do that? that was a long time in the making, another long legacy. Yes. We, I made a film with my, co-director who's also a midwife, Stephanie Etan. we started this journey back in 2017 to create a film that really hones in on. I guess the full spectrum of what we experience in this country birthing, especially as black birth workers.

[00:05:07] Kanika Harris: What makes the film unique is that, all the subjects are protagonists in the film, actually work in maternal health. So you have Shalon Irving who, unfortunately passed away and her story is well known. And through ProPublica, because she was a, an EIS officer, an epidemic epidemiologic intelligence officer.

[00:05:34] Kanika Harris: And, she served for the CDC, and she passed away, unfortunately, three weeks postpartum. And then we have myself, who's also featured in the film, As someone who had a near miss, which means I almost did not make it in childbirth. And, a also experienced stillbirth. And then we have Ebony Marcel, who is the director of Community of Hope, which is the only freestanding birth center in Washington, DC and her journey through, infertility.

[00:06:09] Kanika Harris: And becoming a mom. So it's three journeys of motherhood, but they're also intergenerational. and what I like about the film over the last, eight years is you just see the transformation of healing that takes place in those eight years. through the stories some reconciliation, You see the joys, you see the miracles.

[00:06:35] Kanika Harris: So it doesn't start and end at, the heart moments are the heartache, but you see the full grasp of what's happening. And we've been really overwhelmed with the, Interest in the film. So over Black Maternal Health Week, it will be shown around the country, I think over 15 times. We obviously cannot make all those screenings.

[00:07:00] Kanika Harris: We will make some, but we've been able to, have different organizations, universities host the screening over Black Maternal Health Week. So we're really excited about that.

[00:07:14] Kristin Tully: That's amazing

[00:07:16] Kanika Harris: Yeah.

[00:07:17] Kristin Tully: And thank you for sharing, including, that this is personal for you and for so many of us in this space, striving to better support folks. and another way that we're connected, is that you're an advisor for couple care with the bassinet

[00:07:39] Kanika Harris: absolutely. Yes,

[00:08:02] Kanika Harris: I had the wonderful experience at the A one conference in California to sit with the bassinet, work with the bassinet, work with the little baby who I wanted to take home. Not a real baby. The baby doll, I think her name was Florence. She was wonderful and just really get to experience, how innovative, but just as well.

[00:08:07] Kanika Harris: I don't like to always use the word innovative because it's just this is just what we should have. and to say that we have to be quote unquote innovative for something that should just be simple and designed for women, with women in mind in the first place, or birthing people of mine in the first place, that, it's just an amazing,

[00:08:32] Kanika Harris: Tool that really meets the needs of the mom. with my own experience, I was explaining to your research assistant who doesn't have children yet. And she was just curious as to and I was like, let me tell you why this is so amazing. And I was like, because I had twins. And when you have your baby and you're like sore and you've just had a C-section, you may not be eating well yet.

[00:09:03] Kanika Harris: you can't exactly get out the bed yet, but then there, but you wanna nurse your baby, right? You want to. have the experience of making sure your baby latches so you have that extra stress, but you can't always get your baby when you needed the baby. And then you have to fill out this chart of diaper changes and how many times you've nursed because when you're nursing, there's this added pressure of in those first couple of days, wanting to know that the baby is getting enough through.

[00:09:35] Kanika Harris: How many times they are using the bathroom and so they make you log it and I was like, it's very complicated. And she was like, they make you do all that. And I was like, yes. And you can easily give up because if you're having to chart every time you nurse and every time the baby goes to the bathroom, but you can't get to the baby, because of your incision and it's painful and you really don't have any, independence and autonomy, it can make the whole process frustrating.

[00:10:07] Kanika Harris: So really having. that bassinet and seeing how it worked, it was so exciting. Not that I wanted to have another baby or a c-section, but I just wanted to like the experience of having that. And it doesn't mean also that you have had to have a c-section. Like it's good whether you've, had what I would call a belly birth.

[00:10:32] Kanika Harris: or not, or a vaginal birth. it's very helpful to have that kind of independence on autonomy. I think it works well for nurses who don't wanna be concerned, who may be experiencing burnout, who may be short shifted. And just the relationship between you and the care team is less frustrating because they may get annoyed trying to always respond to you, and you may get annoyed because they're not responding to you.

[00:11:01] Kanika Harris: So just having that autonomy again is really helpful. I was so excited to experience it and see how it works and see how to grab the baby and, Such a needed, crib or tool in all the hospitals if you're having hospital births, like how can we really make hospital births more, more patient centered?

[00:11:28] Kanika Harris: and how can we make it so that, the care team. can help us and we're working in sync with each other and I think the bassinet in the couple of care is just a huge, piece of that puzzle.

[00:11:47] Kristin Tully: Thank you so much for sharing the reflections. Yeah, I think that a common thread to me is, putting people. First, and what do

[00:11:58] Kanika Harris: do? We all to know and to feel and then to have access to, to be safe and well, and so many things are far from that. And so many things help and And after my two vaginal births, like things are uncomfortable, but it doesn't have to be so hard. It's always a lot, even when things,

[00:12:22] Kanika Harris: go as, as we hope and, we prepare for and we're supportive. it's a lot and nothing makes that. Easy. but so many things can at least not get in the way and

[00:12:34] Kanika Harris: so having something, designed for you and yet

[00:12:39] Kanika Harris: human-centered design, I think is just a really helpful to be having all that collective expertise and then, following through on that.

[00:12:49] Kristin Tully: So yeah. Thank you so much for

[00:12:51] Kanika Harris: Yes. Yeah. And I think it's okay for us to invest to, move our care forward into advance. Like sometimes we just get stuck and like the way things are, or we've been using this bassinet for many years and it's just like. Yeah, but let's advance how we can, support, new families and let's advance how we can support birthing people and let's advance, like you said, human centered care and, putting the patient at the center.

[00:13:30] Kanika Harris: And that's what the bassinet does and I'm really honored, to be a part of the team.

[00:13:35] Kristin Tully: Thank you so much.

[00:13:37] Kanika Harris: Yeah.

[00:13:38] Kristin Tully: And,

[00:13:39] Kristin Tully: so what are you excited about? these are. Extremely difficult times, and disproportionately and I think having hope, when you said that your colleague, their organization's name includes HOPE in it. I think that's the most powerful things, because to drive and to have things to look forward to and to know that things can be real, it's not. but. What are you currently thinking about in this day? About.

[00:14:13] Kanika Harris: I didn't know with the new administration what things would feel like. initially they felt really hard, and really uncertain and. No one really knew where to turn, what to do. I'm excited about feeling like things are, a little more settled and that I feel like we have come together to support one another.

[00:14:45] Kanika Harris: So I feel like in this climate, which has been really rough, for maternal health, for health equity, for, black and brown birthing people, what gives me hope is that I feel like a year in, a year and a half in we've, we found our footing. I feel like we have leaned into each other.

[00:15:08] Kanika Harris: I feel so much joy and connection in, just collaboration, comradery between organizations working together to make sure that we support each other, to make sure that we survive, to make sure that we're getting the work out. And I'm starting to really see those silver linings, those Those miracles, just funders that are also just coming through to make sure that we are staying afloat.

[00:15:40] Kanika Harris: I was really in a dark place when the administration turned over and just a lot of hopes that I had for being a new ed just became extremely stressful. Some funders I was talking to went silent, not because they didn't wanna support, because they just didn't know which way to turn yet.

[00:16:03] Kanika Harris: And so things were just, yeah, just really scary and I'm feeling like, not as anxious. Not as worried and just leaning in now to what we have to do to stay forward, to stay moving forward. And I feel like even with our small nonprofit, we've been able to support and lean into other organizations, organiz, other organizations have been able to collaborate and support us.

[00:16:36] Kanika Harris: And so it's been. for the first time I'm feeling very supported and I'm feeling, very lucky to be able to collaborate. And, I feel like it's helping us become stronger and figuring out ways to support and collaborate that, help grow organization and keep organizations, keep us afloat. Like working with you on publications and you helping me.

[00:17:02] Kanika Harris: Get the black birthing bill of Rights more visible and working with other organizations who, may have additional capacity to support some of the work we're doing. and then we're, we've been collaborating on, small summits or small collective events together. just, that's been really hopeful and I'm seeing,

[00:17:26] Kanika Harris: Us really stay the course no matter what. And just lots of new innovation and, at this point not being phased because we know the work has to happen. We know that as we are saying over and over again, no one is coming to save us. So making sure we're in a place to show up for each other and show up for birthing people in this country.

[00:17:52] Kristin Tully: Thank you. That's really powerful and the community that I hear you describing, as such a strength and. I hadn't really thought about how this, how hard times are an opportunity grow in that way. Yeah.

[00:18:12] Kanika Harris: Yeah, definitely. I think, We've almost had to, grow in that way and not be, I don't think, I don't feel like I was ever in a super competitive space. But, some people would describe, the landscape of maternal health in this country as very niche, very siloed, very competitive. And I think we've had to really, lay all those feelings and thoughts down in order to collaborate and work together and move forward.

[00:18:48] Kanika Harris: And it's forced us to have to grow in a different way and think differently, to stay afloat. Yeah.

[00:18:55] Kristin Tully: Yeah, gosh, with the, I would love to have the field work us out of jobs, Like that.

[00:19:04] Kanika Harris: Yeah.

[00:19:05] Kristin Tully: There is so much that's needed and so much opportunity and so much, expertise to leverage that. I don't think that'll happen in our lifetimes, but that would be amazing if things were optimized if people were cared for and supported and, that we had a robust system that we didn't need to, Intervene so much, or advocate because if we had a learning system that was continuously hearing what matters most and making space for that, and then acting to constantly improve that's my dream. and so the competitiveness that's, something I hope can be drastically reduced, because we need each other.

[00:19:55] Kristin Tully: It's the opposite, like we're so much

[00:19:57] Kanika Harris: Yeah, and

[00:19:58] Kanika Harris: maternal health is so multifaceted. I would like to see us break out of our silos even more. So when I say that, there's one thing to work together with maternal health organizations, but that's not gonna get us out of this. how are we working closely with schools and, our, all the social determinants that we know, drive.

[00:20:23] Kanika Harris: Our situation in this country, like how are we working together with, grocery stores and our food sources and, the food justice and the, and education systems and like all the systems that we know feed into our health and wellbeing, to become mothers and to also parent. I would like to see how we can connect those worlds more.

[00:20:52] Kanika Harris: Yeah.

[00:20:54] Kristin Tully: And what are. Measures of success, or how would we know if this system's working well? how do we know if, what might we measure to know if we're getting towards thriving is I think what we all want is to set people up, right? To have a, strong. Life course approach as you just described, in all aspects for, I, I think maternal health is really about, health and the health of our societies.

[00:21:29] Kristin Tully: And so that

[00:21:30] Kanika Harris: Absolutely.

[00:21:31] Kristin Tully: question, how do we know if we're advancing towards the.

[00:21:36] Kanika Harris: Yeah.

[00:21:36] Kanika Harris: How do we know if we're advancing towards that? That's a great question.

[00:21:41] Kanika Harris: I think it's, it's so multifaceted in terms of making sure housing is improving. Employment rates and, like long-term security is improving. like incarceration. Incarceration rates are going down.

[00:21:58] Kanika Harris: education. Is improving across the country. And that's a little tricky one 'cause it's not like I believe in standardized testing and all these other measures of education, but, that we have a healthy, thriving youth population. That we're seeing less suicide rates, we're seeing less, rates in terms of like drug overdoses.

[00:22:26] Kanika Harris: When I think about, I sit on a maternal mortality review committee, and just looking at the gamut of, of, maternal deaths, we are dealing with a lot of maternal mental health issues as well. a lot of just mental health issues before moms are pregnant. and I won't say a lot, but I will say this is what's coming up and, some of the cases over the years.

[00:22:57] Kanika Harris: and so how are we addressing those? How are we. Decreasing our homeless population. How are we addressing mental health? how are we addressing places for youth to thrive? How are we addressing places for elders to thrive? so I think all those will turn the numbers around and sometimes we think of it in reverse, and I wish funders would.

[00:23:26] Kanika Harris: Like being this for the long game, but it's always very specific, a very specific problem with a very specific outcome. But once we see those things happen, we will see maternal health and infant health improve. We won't see it in the reverse, so we won't just magically. Focus on birthing people and babies and see the rates improve.

[00:23:56] Kanika Harris: that's not what's gonna make it better. And I think I say this all the time and people are huh, okay. let's just go back to what we're doing and I don't know what's gonna get us to. Not just be cogs in the will, but to get the whole thing, the whole machine going, which is that life course perspective.

[00:24:23] Kanika Harris: but the data really says that as you mentioned, that if we are looking at maternal health as a measure of the health of our society. And a measure of the symptoms that we see in our society. Then how are we working on this whole, on these issues as a whole and using those as a measure for maternal health instead of, it's important to focus on moms and babies and birthing people and babies.

[00:24:52] Kanika Harris: Of course. That's huge. But what about the other end? Yeah.

[00:24:58] Kristin Tully: Yeah, enabling conditions and like what's the.

[00:25:02] Kanika Harris: Enable, yeah. Enabling conditions for us to thrive in pregnancy and birth and thrive postpartum and becoming a parent. Like how are we enabling those conditions for, many funders focus on the areas of zero to five or early childhood, health. And so how are we really ensuring that zero to five happens and that those children thrive and their, and yeah.

[00:25:37] Kristin Tully: and making sure to take care of the caregivers, meaning, the parents or the grandparents, whoever's the core and the healthcare. Team to, again, to be able to support infant, like for their own sake. first of all, and because infant health is maternal health

[00:26:00] Kanika Harris: yes, yes, you're right. Infant health is definitely maternal health. And then just looking at also, Just how we diminish caregivers overall. So once we start taking care of, once we start taking the caregiving, us as caregivers and the caregiving industry, seriously paying livable wages for.

[00:26:29] Kanika Harris: Childcare providers making it free. 'cause when we're looking at childcare, it's a lose situation. childcare providers aren't making a ton of money, but it's also too expensive for parents at the same time. So it's no one's winning. childcare providers have insurance costs, overhead costs.

[00:26:52] Kanika Harris: They can, only take care of a certain amount of. Babies or children at a time, and then that lends into them having to hire other people. And it's just it's just this kind of game that doesn't work for anyone. and so once we start really investing in our care system, meaning. Investing in non-paid work.

[00:27:14] Kanika Harris: If you are a parent or a caregiver, but then also investing in caregivers, then I think that's a huge part of helping us thrive

[00:27:26] Kristin Tully: Yeah. Thank you for, this is it's so deep because

[00:27:29] Kanika Harris: Very.

[00:27:30] Kristin Tully: like how do we value people? who, who do we value? because then it shows,

[00:27:39] Kanika Harris: Yeah. Yeah.

[00:27:40] Kanika Harris: What is the labor that we value in this country? Yeah. And we've seen other countries do it well.

[00:27:49] Kanika Harris: and I feel like part of, I'm not. I'm not like, kudos to those countries. You're doing it right. You're doing the right thing. Because honestly, at the bottom of all of this is, systemic, racism and classism and all the isms.

[00:28:08] Kanika Harris: And so I feel like when I think of countries like maybe Norway or Sweden, they're very. Homogenous. So they're taking care of their own. what's so crazy about the United States is that we will, they will, the United States will sacrifice, they will have sacrificial lambs to keep a certain level of oppression.

[00:28:34] Kanika Harris: And, that's what makes it so hard for us to do the right thing and to get out of this. Because this country has always functioned on oppression, to thrive. And getting out of that and facing that is, is a huge part of moving forward.

[00:28:56] Kristin Tully: Exclusionary by design.

[00:28:59] Kanika Harris: Yes, definitely. Yeah. Exclusionary, of course marginalized by design. Yes. Which only of course benefits a few.

[00:29:10] Kristin Tully: yeah, yeah. Intentionally

[00:29:11] Kanika Harris: much to, learn undo and re

[00:29:17] Kanika Harris: Yeah. Yes.

[00:29:20] Kristin Tully: Well, thank you Dr. Harris. Thank you so much for sharing your insights and your current work. It's so admirable. Big fan for a long time.

[00:29:31] Kanika Harris: So am I. I'm a bigger fan.

[00:29:34] Kristin Tully: I, I really appreciate you, being in community with me and offering guidance and to, make space to share reflections like these.

[00:29:44] Kanika Harris: Absolutely. Thank you so much.

[00:29:47] Kristin Tully: Great, thank you.

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