Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, the first national organization dedicated solely to improving the health and wellness of our nation’s 21 million Black women and girls – physically, emotionally and financially, explains the roles of research, policy and trust when accessing reproductive and maternal wellness for Black women. Linda, also known as the Black Magic Woman, reminds us that this work is really about amplifying the message that Black women are deserving of adequate care and that reproductive and maternal care that we can trust is tangible and not something we have to reimagine or wait to be written into a script for television.
MADAMENOIRE had the pleasure of speaking with Linda Goler Blount, president and CEO of the Black Women’s Health Imperative(BWHI), to discuss Black maternal health, trust and the advancement of Black reproductive wellness and how both is in alignment with the Lincoln Listens First initiative that wants to hear Black women.
MADAMENOIRE: Historically trust has been a consistent barrier to Black women and our health and wellness. We’ve seen that amplified by the Black maternal health crisis and even more during COVID-19. How do you envision Black Women’s Health Imperative role in building trust and addressing that obstacle to reproductive and maternal care?
Linda Goler Blount: BWHI has been talking about mistrust for a while, well before COVID, as mistrust keeps us from getting earlier prenatal care, beyond other barriers like insurance and where we live. But black women have known for years that when they’re pregnant they may not be able to expect the best possible care. So during the prenatal period, but particularly during labor and delivery we can’t go in thinking everybody is going to be on our side and that if there happens to be a complication people are going to rush to our aid. We’ve known that for a long time. When it comes to wellness, we just need Black women to understand what they deserve and not to take anything less. BWHI will continue to provide the access, resources and tools, in addition to putting those things in place. Our organization is committed to changing the conversations creating the space to implement the changes we wish to see.
MN: In what ways have you witnessed the lack of trust reflected in how empowered Black women feel when accessing the care they deserve and in what ways is it impacting how they advocate for themselves?
LGB: When I first started, we conducted a study around the general health of Black women through a survey and asking how black women define health, it was purely qualitative. We wanted words and phrases, we wanted Black women to tell us what health meant to them.
About 85percent of the words and phrases that Black women used to define health recycle social things like “I’m calm, I’m at peace, I’m in control.” Ten percent named more financial concerns like “I can keep a roof over my head, I can take care of my kids.” Only about five percent of the words and phrases that black women use to define health had anything to do with physical health or disease state.
It’s like black women are saying I cannot get my mind right, my spirit, or my money right, but I can take care of everything else, and so that sense of control was the central theme, and that is part of the problem with our health. Then when we are engaging in the health care system with providers, even health education and awareness programs, people who mean well and have good intent. We don’t come into those situations with control. We don’t come into those situations with the belief that they’re on our side, that they’re working for us. So Black women have to go into those situations too often being prepared to have to deal with something that we shouldn’t have to deal with, and you know, most of us aren’t thinking Tuskegee or Henrietta Lacks, Black women just know it’s there, it’s in the lore.
MN: Definitely, providers are not there to make decisions about the lives of Black women, they’re there to help them make the decisions. What examples of inequalities or mistrust were evident in your research and how has the Black Women’s Health Imperative mobilized around the findings of the survey?
LGB: Everyday indignities. It’s when Black women walk in the office and you go up to the counter and the person who had the counter looks at you like, “why are you here” or when you’re in the exam room and the doctor walks in and says, “Hey Linda” instead of an impersonal “Hey, Ms. Goler.” There are these things people call microaggressions but they’re not micro. You and I know there’s nothing micro about them.
And so they set us up in this tension around our health, which is not what we need. What we actually need is to be able to go in to talk about our health and engage in a partnership, in a more relaxed fashion. The last thing we need is more stress.
But we have to guard ourselves every time we’re engaging with the healthcare system because we simply can’t expect for it to work for us. We’ll talk about Tuskegee and we’ll talk about James Marion Sims, but we aren’t that far removed from harm when just two years ago they were sterilizing Latinas who were institutionalized in Georgia. We know that stuff wasn’t just 100 years ago, it’s still happening today. BWHI has to try to give Black women the questions and the answers in the end, so they can know the issues to raise to ensure they’re getting the best care possible. We can’t go into the exam rooms with them, but we can prepare them.
While also helping them understand that, no matter what it is, whether you’re seeking abortion care, prenatal care or trying to get your diabetes managed. If you don’t like the care you’re receiving, get another doctor. You would not take poor service from your cable repair guy, do not take it from your doctor or your nurse, because you deserve better.
Part of what we are doing organizationally from a systems perspective is helping providers understand what that means, because providers are quick to blame Black women. But we are just as quick to hold the very same providers accountable for how they care for Black women.
MN: Over the years the Black maternal health crisis has become more present in policy spaces. How has the Black Women’s Health Imperative approached policy work and as an organization that has been grounded in this work for over three decades, are there any patterns that you’ve noticed in the work?
LGB: My personal take on this, I think is maybe I’m a little bit different from some people. I mean we do a lot, but a lot of folks in the space do policy work and their approach is that this is the right thing to do. Whether it’s the Jeanette Acosta Invest in Women’s Health Act of 2019, focusing on cervical cancer or Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2021, Black Maternal Health Momnibus Act of 2021, or even Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act. Policy feels like the right thing to do.
I’m not usually fond of quoting white men, but this is one of those cases where I have to quote Churchill, who says “you can always count on Americans to do the right thing, only after they’ve exhausted every other option”, so when it comes to our health, policy seems like the right thing.
We’ve been talking about this for years, for decades. My approach to policy and what we’re looking at as an organization, let’s look at National Committee for Quality Assurance (NCQA), let’s get race, ethnicity and gender as a part of those quality measures. Then that will determine how much money the providers make, if we can get outcomes by race, gender and ethnicity into those measures, then I don’t have to worry about policy anymore. Because providers will choose to make money, and they will choose to do the right thing if they think it’s going to impact the amount of money that they make from a hospital system on down. We will continue to do work on these on this legislation because it absolutely is the right thing to do, but nobody until now has been looking at NCQA and saying well okay let’s just look at quality by race and ethnicity, nobody’s bothered to disaggregate the data and once you do, then you see the differences so obviously we’ve got to have some changes in those guidelines.
MN: The other side of policy work is referred to as an achieved liberation or a success, what does successful policy work look like to you and how would you identify effective policy?
LGB: Imagine where we’d be policy wise if reimbursement were tied to outcomes by race, ethnicity and gender. I guarantee we would see the black maternal mortality rate drop dramatically. We would see medically unnecessary hysterectomies suddenly disappear and we wouldn’t read about Black women dying from complications from birth. If reimbursements, the provider’s money, was on the line, maybe we would see a shift.
Right now, there’s no consequence, there’s no repercussion. If I’m a white physician, and my black patient died shortly after giving birth, you know it’s too bad, but it doesn’t matter, and it’s a part of my job to make it matter and that’s our policy work. Our policy work is to make it matter.
MN: You’ve shared your thoughts on the practices of the systems creating the barriers and causing the harm, as well as the policies that will hopefully hold them accountable. We also discussed the importance of trust. What is it about your organization that makes it a space where black women can trust you with their reproductive and maternal wellness?
LGB: I would say the number one thing is that we are the women, we are black women, and so we have come from and share the lived experiences of the very women we’re trying to help. By helping other women we’re helping ourselves.
I’ve got folks on my staff dealing with the same issues that we read about in the newspaper every day. We’re no different from anybody else, so to some degree it’s self serving work that we can help ourselves and we can help other black women at the same time.
The other thing is there is not another Black women led organization or organization period that’s using data, science and policy that actually incorporates the lived experiences of Black women to try to shift outcomes, change practices, create programs and implement policy.
We’re committed to this work and Black women know they get whatever they see in print from us. Black women know our work comes from a position of a shared experience and from a position of honor, respect and value for black women.