Miccaela Berry-Smith Gives an Overview of the Reproductive Justice: Reproductive Justice (Part 2 of 2)
Micaela Berry-Smith comes from a long line of people involved in medical vare beginning with her great, great, great grandma who served as a midwife when she was enslaved in Kentucky in the 1800s.
by Jonathan Gramling
Micaela Berry-Smith, the program manager of maternal and child health initiatives at the Foundation for Black Women’s Wellness, has deep family-tree roots in the area of medicine, roots that stretch back to at least the early 1800s in Antebellum Kentucky. She also counts the late Julian Bond, the former NAACP board chair as a distant cousin. So it just seems natural that she would be an advocate for reproductive justice.
In terms of maternal and child health outcomes, whil;e some may experience a greater impact than others, the factors that cause the large disparities that Black women and their children face are experienced across the board regardless of socio-economic status.
“I am married,” Berry-Smith said. “I have housing. I have stable transportation and food. I have family around me. And I was so stressed out that I was diagnosed with preeclampsia in my second pregnancy. And that came as a surprise. I didn’t have hypertension or high blood pressure issues beforehand. But the stress of my work — not because I am not happy, but because I want things to be better for other Black women — weighed upon me. And I was affected by that. I know that Serena Williams and Beyoncé also were diagnosed with preeclampsia during their pregnancies. It’s just these women who are viewed as leaders who are trying to make change for everyone else. And we just carry that burden on our shoulders. A lot of times, hospitals and some providers deem preeclampsia or other health issues that affect Black women as the ‘Black Body Problem’ or a ‘Poverty Problem’ or a ‘Low-Income Problem.’ But it’s really not just the stress. It’s also just racism.”
One of the most important factors that impact healthy medical outcomes is the doctor-patient relationship. If things that could be considered racist are happening during pregnancy and afterwards, it creates a gulf between doctor — and other medical personnel — and patient that can be very detrimental to the patient.
Even if the medical personnel have an honest intent to provide top-notched care, racial ignorance and worse can prevent that care from happening.
“I remember my very first doctors appointment for my first pregnancy,” Berry-Smith recalled. “And the doctor asked where my husband was. This is in the midst and height of COVID-19. You couldn’t have anyone come into the room with you. I said, ‘He’s out in the waiting room waiting for me to be done because we know only one person can be in here.’ And she said, ‘No, does he live with you?’ I know that’s not on My Chart. I asked her why she wanted to know that. She replied, ‘I just want to know what type of support you have in the home.’ I said, ‘Then that is the question you should ask.’”
There are other questions that can get in the way because of why and how they are asked.
“What is killing each individual Black woman are these small, nuanced biases like that nurse asking me if my husband lives in the home or assuming that I smoke or assuming that I need to take multiple STI tests throughout my pregnancy because you just assume that all Black women are promiscuous,” Berry-Smith recalled. “Those are the biases that are harming us during pregnancy. It’s not the, ‘Okay, you are showing these things, so you need a c-section or you are showing these things, so you need an induction.’ It’s just the individual, personalized racism and biases from providers.”
And this gulf that is created causes the patient to drift away as well.
“If I don’t trust my provider, I may not go to my doctor’s appointment,” Berry-Smith said. “I’m not going to show up at the hospital until I need to have this baby. That is harmful because you get there and you might need an emergency c-section and there are some things that could have been taken care of where you could have had the vaginal birth that you desired.”
And assumptions can also impact the woman directly in terms of the pregnancy experience.
“I’ve had clients who have said, ‘Hey, I’m in a lot of pain,’” Berry-Smith said. “’Can I have a narcotic or this kind of pain medication?’ And they are asked millions of questions because they are automatically assumed to be an addict. Their pain is not heard. And a lot of times, it’s thought in the medical field that Black women don’t feel pain unfortunately, because of the history of obstetrics and the violence in that. Black enslaved women were the guinea pigs for understanding how to have a safe c-section or how to use forecepts. Pain medication wasn’t given to them because we weren’t viewed as human. And so a lot of those practices sometimes still happen today.”
And it’s about knowing that the doctor is on your side and not on the system’s side.
“It means the freedom to choose, the freedom to be able to share that without fear, whether you want to continue to have children or you don’t want to continue to have children,” Berry-Smith said. “I think one of the biggest fears for any Black woman or any Black person in the medical field or system is feeling that your doctor is a mandated reporter. If you are struggling with addiction, but still have pain during childbirth, how can you navigate that healthwise with your provider without having CPS called or without being thrown in jail. It’s the freedom to be a human within limits, of course. When I say limits, if you do need support, if you do need to go to rehab, it’s to have the ability to go with passionate care and not with a bias of racial judgment.”
While medical procedures are sometimes needed during the birthing process, there are many instances where “things go as planned” and additional medical care is not needed. A part of reproductive justice is giving birth in a culturally-influenced environment.
“I know that if you are a healthy woman and you are having a healthy baby, how beautiful it is to have control over your environment in terms of where you bring that baby into the world,” Berry-Smith said. “And so reproductive justice is part of that, bringing birth back into the community. Historically in Africa, Black women have their babies surrounded by the elder women in the community. They are supported by women and their family. They have a whole ceremony and it is beautiful. But here when we have a baby, we have to go to the hospital. Sometimes it is necessary. And the beauty is you are able to have you doula and a midwife. But nonetheless, you are going into a system where you feel like this is a problem because it is where they treat illnesses.”
Reproductive justice is about women deciding if they want children and if so, how many. It’s about them having control over their bodies.
“The freedom to not have children is a part of reproductive justice,” Berry-Smith said. “The freedom to contraception. The freedom to be able to say, ‘I would like my tubes tied.’ Or ‘I would like to have an elective hysterectomy because I don’t desire to ever have children.’ Unfortunately there are rules and regulations to that too. In certain states, you have to already have had a child in order to have a hysterectomy. Or you have to have a medical reason to have your tunes tied. But also the cultural competency of contraception is part of reproductive justice because some women are forced or coerced to have a hysterectomy or even untold that they have had a hysterectomy after a baby. In fact, I had a conversation with three of my doulas yesterday because we are seeing a pattern at a hospital where if you have over five children, they are strongly encouraging you to get a tubal ligation. One of these women who was strongly encouraged — she was having her seventh child — is an immigrant. But she identifies as Black. And it is in her culture to continue to have children until her body says, ‘You’re done.’ She doesn’t believe in contraception. And so reproductive justice is saying, ‘She doesn’t have to get her tubes tied. He doesn’t have to take contraceptives. As long as she is safe and the children are safe and she is healthy, why are you regulating how many children she can have?’ It is all that encompassing.”
What it all comes down to is Black women having control over their bodies and the decisions that impact them.
“If you also don’t want to have contraceptives, then you need to be able to freely talk to your doctor about family planning if that is something that you need to know or even better education about your menstrual cycle and when you are fertile and when you are not fertile,” Berry-Smith observed. “That can also be out there. A lot of women, grown women, don’t even understand that. And that is part of reproductive justice, education. And that is part of the Foundation, empowering, energizing and educating the next generation of well Black women.”
Even in this day and age, it’s still all about freedom.
