Sarah
This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities. I'm Sarah Hexam Hubbard with the Pennsylvania Action Coalition and the Executive Director of the National Nurse-Led Care Consortium. On this episode, Shukriyyah Mitchell-Hinton moderates a conversation about Black maternal health in Philadelphia, and beyond. Shukriyyah is our Senior Director of Outreach and Advocacy here at the National Nurse-Led Care Consortium. She's joined by Imani Davis, a lived experience expert and community specialist for organizations including Strategy Arts and Community Action Network. And Saleemah McNeil, a reproductive psychotherapist and founder of Oshun Family Center in Jenkintown, Pennsylvania.
Imani, Saleemah and Shukriyyah talk about their own lived experiences and their efforts to research, advocate, and raise awareness around Black maternal morbidity and mortality. They talk about addressing these issues through funding, creating and implementing a variety of strategies related to mental health, home visiting, peer support, training and education for health care workers and more. It's important to note that we're bringing you their conversation to coincide with this year's Black Maternal Health Week. Virtual and in person events are starting Thursday, April 11, through Wednesday, April 17th. And to learn more about what we have going on in Philadelphia, the full schedule and more information are available at BMHWphilly.org. That's BMHWphilly.org. Now we'll go to Shukriyyah to start off the conversation.
Shukriyyah
Hello, I'm Shukriyyah Mitchell-Hinton, Senior Director of Outreach and Advocacy at the National Nurse-Led Care Consortium. I'm here with Saleemah McNeil and Imani Davis during Black Maternal Health Week 2024 to talk about our work in the Philadelphia area and beyond. First, we wanted to share a little bit about how and why we got into this work. For me, I was introduced to the concept of Black maternal health and the health disparities that impact Black birth and people during my first pregnancy about 15 years ago. I was a nursing student at the University of Pennsylvania. It was during that time that I was drawn to public health nursing, and knew that I wanted to be a part of the work that seeks to impact Black maternal health and support Black and underrepresented families. Saleemah your reproductive psychotherapist, for our listeners who might not be familiar with what that looks like, how do you support birthing people in their families in that role? What inspired you and led you to your work initially, and then to expand to advocacy, fundraising and reform?
Saleemah
My name is Saleemah McNeil. I'm the founder and executive director at Oshun Family Center, a reproductive psychotherapist and maternal health researcher, a retired doula lactation consultant, overall maternal health disruptor. And I came to this space by way of a head that I will be celebrating, which is my 18th parents anniversary that will happen next month. And that little person that’s not so little anymore, is the reason why I do this work. Being a survivor of a traumatic birthing experience in looking at my postpartum journey really helped catapult me into this field of maternal and child health and wellness. When we talked about advocacy and fundraising, I think I stumbled across those things just in the midst of doing the work. I'm not a policy person. I don't really like politics at all. But it's a necessary task that needs to be done in order for the voices of the people to be heard. Fundraising came because I went viral in 2020. I have no fundraising experience. I posted something on Instagram that I was looking to help combat the weekend of terror that we experienced in the wake of George Floyd, Ahmaud Aubrey, and the aftermath that happened here in Philadelphia. I asked for $5,000 so I can overburden myself with treating the Black population of people who are displaying just such anger and pain. And then from that $5,000 ads we raised over $100,000 that summer. It really was able to create jobs and sustainability for the organization. So thank you for asking.
Shukriyyah
Wow, Saleemah, thank you so much. Thank you for the work that you're doing. Imani, your lived experience expert and the Community Specialist at Strategy Arts. How does your role, your organization tie in here and how did you get into the work?
Imani
I am a mother of three and my oldest is fifteen. And my youngest two are five and I also have a one year old. And I'm sorry, since my little one in the background. After I had my five year old in having not such a great birth experience. I wanted to find out the different things that I could do to assist with Black maternal health and just helping other mothers to have an easier time. A friend of mine actually introduced me to CAN, the Community Action Network. And that's how I got started with going to different groups and becoming a part of the CAN and go into their groups focused on like maternal health and reducing some of those disparities in maternal morbidity and mortality is how I got connected and more aware of the situations that were going on. And also, just within their work just became aware of so many different opportunities, but also aware of how dire the situation is, and how many hands on deck are needed to help with like, let's say, health and reducing these disparities.
Shukriyyah
Thank you Imani. We are grateful to have you here and doing this work as well. So let's just jump right in and talk about this Black maternal health crises that we have here in the United States. More than half of the maternal deaths happen in the postpartum period, while after a birthing person has gone home. And NNCC the National Nurse-Led Care Consortium has two nurse home visiting programs, the Philadelphia Nurse Family Partnership, and the Mabel Morris Family Home Visiting Program. Through home visiting, we are meeting families in their homes and in their communities. And evidence has shown that home visiting programs positively impact birthing people in their families. Imani, we've talked about this before home visiting really affected your life and your family's life. Can you talk a little bit about that?
Imani
After then my oldest daughter who is now five, I kind of was in a place where I was stuck in the house because unfortunately, I had her right before the pandemic happened. So I was looking for different programs that I could get into and I became aware of Nurse Family Partnership. I was put on a waiting list and thankfully it wasn't too long. I was contacted by a wonderful nurse, nurse Aviana. And she's no longer with the program. But she was a great help to me. Being at home during the pandemic, it was a really hard time because, of course I have this little not even a toddler yet she was about nine months. And it became quite an instance of being stuck in the house and not being able to get out much except for like local parks. And even with that still being really cautious and afraid of just interacting with the public, having a home visiting nurse and she wasn't able to visit. But it was virtual, was a great help to my mental health. It was a great help to my family. And also just those meetings with her, which is such a relief to be able to connect with someone, even though it wasn't in person. I felt like she was right there with me. She made things so easily to talk to, to get in contact with her. She didn't make me feel any type of way if I contacted her if you didn't have a visit if I just wanted to talk, if I just needed resources, she was always able to send me things, drop things off. And I can honestly say I've been an advocate of the program and telling other mothers about it because it was so helpful to me and my family just to have that personal connection with someone knowing that they care, knowing that they can help me with resources and also, on the health side just answer questions and be available for me. That was so very helpful to me and my family during that time. And also, since I have the little one. We're back started again with the home visiting program.
Shukriyyah
Thank you Imani. And I know that your experience in terms of Black maternal health does not just stop there. You're also doing some work with the Early Warning Signs Program. Can you tell us a little bit about that?
Imani
Yes, it's actually through the Department of Public Health. It was started with a grant for Merck for Mothers. This program has been going on for a few years now. But basically what I do, I'm a co facilitator of the Early Warning Signs training, we've provided many different trainings to different facilities. The last one was for the school district. The trainings are to help mothers advocate for themselves and also to teach others who are in their immediate circle, whether it be birth and partners, parents, birth workers, nurses, anybody who can come in contact with a Black and Brown birthing person to help them be aware of signs that could lead to more dire conditions, or even potentially save their life because as you stated, a lot of the deaths unfortunately do happen in the postpartum period and after that six week period. So these early warning signs trainings are basically given to people who can help women advocate for themselves and to look out for signs which would lead to morbidity and mortality.
Shukriyyah
Thank you Imani. Saleemah, you're working on a study that is ongoing right now, that includes Early Warning Signs. But it's so much bigger than that, who are your partners and how's it set up.
Saleemah
So the change of heart study that we came up with you I and other members from the maternal wellness village a few years ago sitting around that table that I referenced quite often in West Philadelphia, coming up with the solutions to help reduce and ultimately eliminate Black maternal morbidity and mortality. And through those efforts, we have entered into community based participatory research CBPR collaboration with Temple University to help combat those issues. So we are funded for five years. And with that program, we get the opportunity to attack on each level what the issues are as it pertains to Black maternal morbidity and mortality. Overall, we want to improve heart health, because that is one of the top five reasons that Black women perish and then one year postpartum. We also have an institutional level and interpersonal level, the institutional level really focuses in on our diversity, equity and inclusion efforts to help providers become more aware of their positions, and the overall miseducation of a nation. So they can understand that treating Black bodies, although similar to the general population of humans, very different in our individual experiences. And that's why it's really important to have Black led curated research that's done on Black bodies to help bridge the gap and create a safer haven. Because as we know, our tenure with the health system as Black and Brown people have not been great. We've been utilized and practiced on in terms of research in order to help advance the human race when it comes to the dominant culture. And so when we look at those things, and how we curated the study with Temple, the research that we're doing, has three different levels, the institutional, interpersonal, and individual level, and on our interpersonal level, we have doulas, lactation consultants and mental health professionals. In those capacities, we help rep our families and services, because we truly believe that building out your village does help in the fourth trimester to reduce those negative outcomes.
Shukriyyah
Thank you so much for describing the change of heart study. I'm so grateful to be in partnership with you and the community with you, as we go through this study and are supporting the women and the families in our community. You testified at a city council hearing, what was that experience like? And how does that highlight some of the obstacles at the government level to making progress.
Saleemah
My duty as a constituent is an overall maternal health advocate activism and disrupter is to show up and help our legislators know and understand our plight. Therefore, I do participate in these opportunities to highlight and uplift the work that we're doing. So I testified for city council a few weeks ago, and for me, the experience was very frustrating, because I sat on a panel with women who are doing work in the community. There were other panelists, I have literally had been on several different hearings, and we've been on the panels together. I've done several of these talks. And it seems like we are not moving the needle in the right direction, because we're talking about the same things over and over and over again. But we have the solutions. And although there are new legislators and they need to learn, they need to understand we already know what the problems are. Those things have been overstated. Why are we still talking about the problem? Why aren't we talking about how the solutions that are being implemented are actually effective and showing the efficacy in the program's? Why are we not talking about how we can leverage resources and give funding to organizations that are on the ground doing the work to help highlight and uplift the community. So those things for me are very challenging because I think it's a gross misuse of time of executives who come down there to share our stories of ourselves and our clients. When we already know what the issues are. Utilize us in a different way utilize us to talk to different legislators who can actually support with funding this maternal health issue, because reproductive justice and rights and birth equity issue is a bipartisan issue. We need both sides, the left and the right to come together to know that Black birthing bodies are worth fighting for.
Shukriyyah
Saleemah, you sound frustrated and understandably so I too am frustrated. It's important that we share our stories. But how do we move beyond just sharing our stories? Imani, you've also had frustrations with elected representatives and making your voice heard.
Can you tell me a little bit about that?
Imani
The frustrating part is being able to connect with the politicians and policymakers in regards to having just a meeting. Unfortunately, I guess due to time constraints and their schedules, it's been a very difficult time trying to get a meeting with them just to sit down and express myself and let them know how positive of an impact the home visiting program has been to me and my family and also helping just in general with mental health, with the health of my children. We've been trying for months now and have not been successful in being able to get a meeting with them. So we're still trying and still being diligent in that but I would love to just have an experience where I can let them know how important it is to help out Black and Brown birthing women, especially during the postpartum period.
Shukriyyah
Speaking of legislators and policymakers just this week, state representatives, Curry, Mayes, and Cephas is introduced the Pennsylvania Momnibus, which is a set of bills seeking to address the Black maternal health crises. Saleemah, you mentioned that this isn't the first time some of these bills have been put for what's happened in the past that it didn't become law. Do you expect things to go differently this session? How will you address this? When you go to Harrisburg later this month for Black maternal health week to advocate and meet with the lawmakers?
Saleemah
I can't speak to why it didn't become law. But this Momnibus that was 2.0. This may introduce I have a lot of excitement about because this is predicated on some federal bills that have been introduced. So to see that we'll have a Pennsylvania version of the Momnibus that will expand Medicaid, doula reimbursement in diversity, equity and inclusion for our hospitals is really important. There's about five bills that are introduced in that package. And what we need overall is the support from both ends. I enjoy going to Harrisburg to be able to advocate because we have the opportunity to prep the community to better understand what we could be advocating for. We lean in on the educational part of it, because I'm also learning as well as a community member as a constituent. How do we interact with these legislators? How can we get a meeting with them? What is the process to do it? And when you get in front of them, and you have 15 minutes? What are the most important things for you to get out? What are you looking for support with and I really enjoy being able to thrive in those environments with educating the community on how we can talk to our legislators, because ultimately, our tax dollars pay for them, they work for us. We are the constituents. And so we have to be able to get in front of them. Like Imani is saying it shouldn't take so many grand efforts to get in front of your legislators. Because if they are not talking to us to understand what the plights are of the people, then what are you actually working for? That's a disconnect.
Shukriyyah
Absolutely. I 100% support that statement. You also mentioned diversity, equity and inclusion. Let's talk a little bit about that the state has pushed forward DEI training focused on maternal care has been effective.
Saleemah
Well, we know that as nation Diversity, Equity and Inclusion (DEI) trainings have been undertake Black live minority led organizations are also under attack. It is the shifting of affirmative action and also putting us in a space of we're being discriminatory because we're trying to uplift and empower voices of Black and Brown communities that have been impacted by the injustices that have gone forth within our health system. So when it comes to diversity, equity and inclusion, we have people who are on the left and on the right, who think that if they agree that DEI training is applicable, that we should have it automatically makes people racist. Those two things are not synonymous. We're all a part of a very failed system, we have been miseducated as a entire nation. And so we have an unlearning process and relearning process that has to take place. And that requires training. There are so many of us that work in the DEI space, that know the efficacy and understanding of this and the psychology behind change. There's a pre contemplative phase, there's a contemplative phase, there's the execution phase. And if we can move people into a contemplative phase where they are now understanding, hey, you know what, I do play a role in this. And as a DEI, an instructor, I tell people all the time, my goal is to call you in. Because we're in this together, I am also a part of a system that has been ingest to my people, which means that I'm also a part of that problem. My goal is to bring people along with me, so those people can better understand that. No, it doesn't mean that you're racist. If you can see that the textbooks that are physicians, clinicians, and other support people are taught out of say that Black woman's skin is thicker, say that we can experience pain at different rates and our white counterparts, which is just simply not true. Based on our own human experiences, I need you to understand what my experience in this Black body is. So you can best treat me as a collaborator of my health care. So there is another bill or a third effort for this DEI training and inclusion, that we're hoping to garner some support because that literally means life or death.
Shukriyyah
Absolutely. Thank you Saleemah for that and Imani, you mentioned a little bit earlier about your own mental health and your experiences given birth to your children. And Saleemah I'd be remiss if we didn't talk about mental health is you are a reproductive psychotherapist. According to the key findings in the 2020 Philadelphia Maternal Mortality Report in over 45% of the pregnancy associated deaths, mental health played a significant role. So this question is for both you and Imani. Saleemah, what are some of the other systemic barriers that you're seeing, particularly to addressing maternal mental health? And Imani, we're gonna start with you. So what were some of the barriers for you in terms of addressing your mental health?
Imani
Awareness definitely is key. Because unfortunately, a lot of women are in the postpartum period, you're dealing with the baby, you're so focused on the baby, you're not even thinking about yourself, or your mental health. We also do talk about dating, early warning signs training, when women are not feeling well, if you're having thoughts of hurting yourself, or hurting someone else, or just not feeling normal. I also think lack of accessibility, or connection is really hard to take the time when you're taking care of a baby, and yourself, to stop and say, Well, hey, I need to see a therapist. And then even if you're going through that process, how can you be connected to a therapist, if you don't have those resources, or if you don't have someone to say, hey, here's someone who's good to talk to. Thankfully, I was aware of being able to contact the therapist because I know I'm susceptible to depression and anxiety. So just for preventive measures, I definitely wanted to have someone to talk to in that postpartum period. But I feel like a lot of women don't have that connection, they don't have someone to advocate for them, they don't have the time to sit and make different calls and reach out. Sometimes you might not be able to get an appointment for months, and then you're left without any connection to any type of psychotherapy or psychologist or any type of help. That's where Saleemah comes in and organizations like Oshun, they are very helpful in our community with connecting women with doulas and health care and mental health professionals. And unfortunately, insurance, I think that can be a big barrier because a lot of times people are having state insurance and certain practices just don't take it. So again, you're left without. You're left without the connection, you're left feeling helpless or hopeless.
Saleemah
Thank you for sharing that. As a member of the Maternal Mortality Review Committee, when the reports come out, we debate back and forth to figure out what we could have done differently to help circumvent this outcome for this family. And mental health accessibility, reducing systemic barriers, and insurance with managed care organizations are the top three ways that we can all collaborate together to reduce those barriers so the families have access to the services. Every therapist, doula, front desk person, and back desk person are all trained or will soon be trained as their new hires in perinatal mood and anxiety disorders, not because everybody will treat perinatal mood and anxiety disorders, but to be aware and understand the signs. So you know how to respond to that person, when you see that you may say something that's a little off, you have more education and understanding as to why that's happening for them. So to address those barriers, we have created a centralized location where Black and Brown people can come get the services that are near and dear to their heart and not feel that they're being judged, stigmatized, or labeled as crazy. We deal with regular people going through hard times, they need help with their transitions from one phase of life to the next over the years. Like being a doula and lactation consultant, I used to be a part of a home visiting program. And seeing all of that I realized that mental health was the piece that was missing. Because I will often wonder, okay, I can advocate to get this person housing, I can educate to get them food, we give them diapers, and wipes and all of the things, but I was scratching my head as to how these people would recidivate so much. When I was working in a correctional facility now, like what is missing? What is the barrier to them being able to successfully access these resources, and it is the mental health of the person, because you can be guided to all of the resources but if mentally, depression is saying stay in the bed that day that you might miss your appointment with your case manager for welfare or Social Security or a housing program, right? And then we start to label them with words of like noncomplying or non-adherence. And because mental health was so pervasive, especially in the Black community, we know that it exists, we know that it's here, but we didn't want to treat it because then that means that you're crazy. But no, I tell people all the time. I am a therapist for the culture, which means when you show up, you're going to get an experience that is similar to a centralized Black or Brown experience.
Shukriyyah
Imani. I'm so glad that you brought up Oshun, and Saleemah I am just so proud of your organization and the work that you're doing to see progress really being made at the community level, where community members are taking care of other community members. So it's important that we talk about that progress that's being made. Can you talk a little bit about the impact of having people with lived experience at the table? So this question is for Saleemah, and then we can throw it to Imani.
Saleemah
We tell the stories that help people understand. Unfortunately, we have to share our personal experiences and our trauma sometimes for people to get it. And I'm also almost sick and tired of it. When I testify in front of the council people I said, I'm specifically not telling my story again, because I believe most of you have heard it, have read it, we don't need to build on the trauma that has already been experienced. But we can build on the lived experiences of those people, as they are putting forth solutions. People who have been experiencing, they have ideas or how or what can be created. So they never have to go through that again.
Imani
Before answering, I also wanted to thank Saleemah for creating a wonderful facility like Oshun and being able to help out community members, and that stemming from your lived experience, knowing that it's a necessity to be able to help other mothers in our community. But like you said, unfortunately, it comes down to sometimes having to relive your own trauma or just state the traumatic experiences that you've been through. A lot of times I do address some of the experiences that I had when I did the early warning sign trainings just to let other mothers know. You know, sometimes you may have a certain health experience or a health scare or something traumatic, which makes you more aware. But I would love to see other mothers from experiencing what I have in the hospital, even though it may happen and may not have been traumatic as some people have experienced, going in front of policymakers, in front of legislators, they need to hear the voice of lived experience experts. I mean, it's fine to hear statistics, it's fine to hear numbers, it's fine to hear the report of the maternal mortality review committees, all of those things are very important. But I think what kind of can drive it home is just hearing the voice of someone who's actually been in that place, who has had those traumatic experiences. And I can tell you the ways or things that would have helped.
Shukriyyah
As we talk about the importance of having people with lived experience at the table, informing and driving initiatives. Let's look ahead, what are some of the new or forthcoming initiatives that you're working on that you're excited about? Saleemah?
Saleemah
We're in the thick of a capital fundraising campaign to acquire our first brick-and-mortar location in the Germantown area of Philadelphia. Where families can come and feel supported in their endeavors to survive that fourth trimester. We are curating our own maternal wellness village that will be standing center in Philadelphia. And the most important thing is that we are not replacing maternal health care. We are an enhancement to the standard of prenatal care. And we work in collaboration with our midwives, with our doulas, and our health care systems to provide those supplemental services. We understand that providers only have a limited time to do what they need to do. And we are dedicated to them focusing in on helping those families survive while we help them thrive. We are very much so a village and look forward to collaborating with so many birth workers across the city and institutions and not for our first brick-and-mortar location. So if you all want to help us out in those endeavors, please go to our website, read more about our journey, and help us raise this money to get this brick-and-mortar location.
Shukriyyah
Thank you for sharing. I'm so excited about our brick-and-mortar location. I can't wait until it comes into fruition. Imani, Is there anything that you'd like to share about the future in the work that you're doing?
Imani
I do work on a number of different committees and projects. Besides the community advisory board for Nurse-Family Partnership, I'm also on a steering committee for an upcoming project in the city. It's called the Philly Joy Bank. So I'm on that steering committee. And this is a pilot project where we are giving I want to say around 200 families a guaranteed income of $1,000 monthly and hopefully, this will help those families in the prenatal and postpartum period. And that is specifically for Black and Brown parents and families. So there's one project that I'm really excited about in the existence of it, how it actually helps families.
Shukriyyah
I think that’s the theme to this, right? Not just surviving but thriving. I just want to take that opportunity to thank you both Imani and Saleemah for having this conversation with me today. I look forward to continuing to read about you and to join in community with you around Black maternal health and wellness. Thank you again.
Imani
Thank you so much. I really appreciate this conversation and being able to speak with you ladies. It's always a pleasure when I see you virtually or in person, and I look forward to seeing you in person during Black Maternal Health Week. I will definitely be there and see you both hopefully very soon.
Saleemah
100% Black Maternal Health Week will be hands down lit this year. We have a good time every year, but we have some special things in store. We've got a lot of support from our sponsors for this year to put all the bells and whistles for every event that we have. So go to our website at bmhwphilly.org to register for events for Black Maternal Health Week. We will see you there.
Sarah
Many thanks to Imani, Saleemah, and Shukriyyah for taking the time to share their expertise and perspectives. You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at paactioncoalition.org. On social media you can stay up to date with us through our handle at @nurseledcare. This episode of At the Core of Care was produced by Emily Previti of Kouvenda Media and mixed by Brad Linder. I'm Sarah Hexam Hubbard with the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium. Thank you for joining us.
