Coverage of maternal health threats overlooks black expertise

In August, ProPublica investigative reporter Nina Martin shared a Washington Post story about Beyoncé and Serena Williams’ serious pregnancy-related health complications, along with a challenge to her journalism colleagues via Twitter:

In response, Twitter users suggested dozens of black individuals and organizations who could help flesh out future maternal health coverage.

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As reporters cover the US’s startling pregnancy mortality statistics, they encounter what ProPublica termed “one of the widest of all racial disparities in women’s health”: black women are three to four times more likely to perish from pregnancy-related complications than white women. Since Williams’ story broke, there’s been a crush of explainers or quick takes from writers who have little experience covering maternal health.

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“It’s been a fast conversation evolution,” says Martin. In 2017, Martin and NPR’s Renee Montagne covered the death of CDC epidemiologist Shalon Irving, who researched racial disparities and died from hypertension weeks after giving birth. Martin concedes that few journalists can work the 10 months she and Montagne took on that story. Still, she says, “a lot of people are jumping in.”

In their haste to cover an urgent health crisis, reporters risk perpetuating another racial disparity: a dearth of black experts in maternal health stories. Black experts—be they midwives, nonprofit staff, sociologists, or public-health researchers—often have relevant lived experience or have cultivated deeper relationships with black patients and communities. The factors that underpin this lack of black expertise in stories are complex. Some, such as competing definitions of “expertise” and barriers that constrain numbers of black advanced-degree holders, are specific to an expert’s field. Others—deadline pressures, the challenges of reporting on technical material, unconscious bias—implicate news outlets.

My job is to be well-sourced and to look for sources who have been overlooked, and that tends to be black women.

Privileging physician or researcher voices has consequences for the racial makeup of sources. Most OB-GYNS, some 77 percent, are white. If journalists unconsciously favor quotes from people with doctorates, they’re picking from a tiny cadre—about 2 percent of US residents have a PhD—and the subpool of black doctorate-holders is infinitesimal. Birthworkers such as doulas and case managers appear far less frequently in news coverage, which perpetuates the adage that “doctor knows best.”

Monica McLemore is among those who tweeted source names to Martin. McLemore—a nurse, assistant professor at the University of California San Francisco, and a member of the Black Mamas Matter Alliance—says seemingly unconnected biases can mean that many sources go underrepresented.

There’s the supremacy of medicine and physicians. It’s rare you hear from a nurse, a midwife, or a patient,” says McLemore, who adds that experts quoted in stories “are often people without [relevant] published papers, without data, or who haven’t sat with a woman” who has experienced things like miscarriage, stillbirth, or postpartum hemorrhage. “And they are almost never social scientists or other thinkers in fields like critical race theory, which studies race and power,” McLemore says.   

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Cultivating sources is a journalistic imperative, says Nation contributor and freelancer Dani McClain, who has written extensively about reproductive health and shared her own pregnancy-complications story. “My job is to be well-sourced and to look for sources who have been overlooked, and that tends to be black women,” says McClain. Sometimes, that means abandoning the much-quoted authority, the accessible source, or the person with a media relations machine backing them. It also means widening her source circle by engaging a variety of people in purposeful conversation without the pressure of a deadline.

The reality, she says, is that people “talk to who they know, who they feel comfortable with, and who they are directed to. When I needed to know about maternal health, I called Monica Simpson at [reproductive justice organization] SisterSong, who said you really need to look at birth workers.”

McClain reads other longform journalists and also studies that scrutinize, for example,  how notions of race might impact health-care providers’ work. She recommends the work of Martin, Miriam Zoila Perez, and Linda Villarosa, whose April New York Times Magazine feature focused on quotidian racism’s cumulative impact on black women’s maternal health. Few high-profile stories about the maternal health crisis are written by black journalists, says McClain.

I’ve turned down interviews because what journalists often want to hear is stories of scarcity, that black communities don’t have enough housing stability, economic stability, or food access, without talking about why.

Public health research itself holds an argument for more black sources and reporters on the health beat. “Racial concordance” refers to instances when patients and health-care providers come from the same racial or ethnic background. Research shows that patients of all races report higher satisfaction with doctors who share these characteristics. If black patients are more at ease with a black health-care provider, that provider may gather different, better information—which makes such a provider a more valuable source to journalists.

Jessica Roach, an independent scholar and former nurse, believes that journalists don’t listen enough.

“I’ve turned down interviews because what journalists often want to hear is stories of scarcity, that black communities don’t have enough housing stability, economic stability, or food access, without talking about why,” says Roach, who founded Restoring Our Own Through Transformation, a Columbus, Ohio nonprofit that provides doula services, mostly to black clients. Roach questions whether journalists want to hear more complicated narratives, report on both structural inequality and how communities of color help themselves, and consider successes.  

When asked if talking frankly about racism in maternal health makes black researchers less “quotable,” ProPublica’s Martin demurs, saying that the idea of racism as a key factor in maternal health has become “mainstream.”

“By focusing everything on race and racism, I think the story can get stuck,” says Martin. “I’ve wanted to walk this line between it being part structural and [acknowledging] what makes bad doctors bad is not just that they’re racist. They’re bad because they don’t know what they’re doing, because they’re not doing what they need to do to keep everyone safe. But I don’t want to let systems off the hook.”

Talking to media about racism as something baked into health care means Roach is never sure if those comments will make the final cut in an article. Journalists may not be more comfortable explicitly naming racism than the average American and aren’t immune from racism themselves. And there’s the ever-present question of expertise and evidence when the conversation turns to race, says Roach.

“While I have expertise, so do the patients, the people who are inside the hospital room, the ones who are doing the home visit,” says Roach. When journalists ask her how she proves racism’s impact, Roach’s answer, she says, is, “400 years of history, and talk to our doulas.”

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Cynthia Greenlee is a historian and senior editor at Rewire.News, a nonprofit publication devoted to coverage of reproductive health, rights, and justice. She received a master’s in journalism from the University of North Carolina and a doctorate in American history at Duke University.