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“It is impossible to fix a system with an unwillingness to bend. It means working together to accomplish a goal.

Living in the gray requires a commitment to growth and discomfort. In the gray, it is possible to hold on to deeply held convictions while bending just enough, leading toward personal and collective liberation. That will save lives in a way that causes no harm.”

Cessilye R. Smith is a writer, speaker, and activist.

She shares her story and discusses her KevinMD article, “Protecting Black women’s maternal health is urgent.”

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Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Cessilye Smith. She’s a writer, speaker, and activist, and her KevinMD article is titled “Protecting Black women’s maternal health is urgent.” Cessilye, welcome to the show.

Cessilye R. Smith: Thank you so much for having me.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Cessilye R. Smith: My journey into maternal health started off with my own birth journey. I had great midwives and an amazing birth experience with my first child, and then I decided to become a doula and a childbirth educator. I entered into this work with rose-colored lenses and with the desire to assist others in having birth experiences similar to mine.

It wasn’t until 2013, while holding my two-week-old daughter at a birthing conference, that my world was cracked wide open. I had learned about the devastating infant and maternal mortality rates among Black women and babies, listening to renowned midwife Jennie Joseph speak on this topic. It catapulted me into something different, a different way of advocating for Black women and babies in a more profound way. So in 2017, I founded a maternal justice organization that centers the lives of Black women, with the purpose of reducing infant and maternal mortality.

Kevin Pho: All right, so take us into that conference room, or that hall, where you heard the speech. You said that your world was turned upside down. So talk about some of the highlights during the speech that really made that impact on you.

Cessilye R. Smith: Yeah, absolutely. Going to this birthing conference, you’re surrounded by a bunch of people who are passionate and excited about birth. At this point, I had my second child, and all of my birthing experiences had been wonderful. But in that moment, listening to Jennie Joseph, who is the founder of Commonsense Childbirth and has been practicing midwifery here for over 35 years, she’s a Black, British-trained midwife, I learned that Black women die at three to four times the rate of white women from childbirth-related causes. And I learned that Black babies die at two to three times the rate of white babies before they reach their first birthday. It gutted me, and in that moment I really was shocked.

Around that time, I was a very green doula and childbirth educator having my own babies, but I didn’t get into birth work because of some kind of traumatic experience of my own. For years, I had been advocating for just women and babies. And so just hearing those statistics caused me to question what in the world is going on, and so I began to dig deeper into the world of maternal health, specifically surrounding Black women.

Kevin Pho: And you talk more about that in your KevinMD article titled “Protecting Black women’s maternal health is urgent.” Now, as you started to dig deeper into those numbers, what were some of the things that you found that perhaps may have explained those numbers?

Cessilye R. Smith: That two-thirds of these numbers are preventable. I think that is the thing that really hit me: that Black women dying, it’s not Black women’s fault, you know, that these are preventable issues. And a lot of it boils down to biases that we all carry. I tell everyone that if you’re human, you have biases, and so it’s something that we all must address and confront.

And it’s interesting when I did a lot of digging. You would think that the biases are really blatant, or they’re really laced with very explicit racial biases, but a lot of them are implicit. A lot of them are biases that we are unaware of that we carry, and the judgments that we carry within us, all people across racial lines, that influence the standard of care that we give to others. And so it’s been a journey to confront those biases myself, and then also encourage others and challenge others to confront theirs, to check their own biases.

Kevin Pho: So can you give us an example, say, in your world of midwifery and through your journey as an activist? What would be a scenario or a story of these implicit biases that you would encounter, specifically?

Cessilye R. Smith: Oh, absolutely. So some people are judged just based upon how they may sound and their name. The biases can begin from the first phone call a client makes to a clinical office, if they have a specific dialect, or if their name is Shaniqua as opposed to Kelly, you know. And so the person on the receiving end, just depending upon their cultural background and what has influenced how they see the world, the lens in which they see the world, can make assumptions about someone’s intellect, their socioeconomic standing, their health care coverage, just based on the sound of the person’s name, the dialect, how that conversation is going.

And then also there are judgments based on age. Teen mothers can be judged as ignorant and careless, and that can influence their standard of care in the hospital or whatever clinical setting they’re in.

Another thing that I would like to share is, say, if someone comes into a hospital in labor, a Black woman comes in in labor and she hasn’t received any prenatal care, there are biases there. Oftentimes a woman can be just judged and, like I said before, thought of as careless. Is that really the case? Does she have health insurance? Does she have a job that she can take off from? Does she have other children that she’s caring for? What are the underlying issues that an individual is facing that may cause them not to receive health care throughout the duration of their pregnancy? Are there gaps in education? Those are all questions that we have to ask ourselves before we jump into judgment. And unfortunately, it’s Black women whose lives are at stake because of those biases that we carry.

Kevin Pho: So talk more about that impact. You wrote about it in your KevinMD article, so go in more depth. What else did you talk about in your article?

Cessilye R. Smith: Yeah, I wrote the article because of all of the polarizing conversations that I’ve had, that I’ve witnessed, around the subject of abortion. And because I have navigated the world of pro-life activism and reproductive justice, I believe I have a clear understanding of how unproductive it is to see things in black and white. I believe swimming around in the gray is where the real work happens, and it helps us to really unpack history, systems that cause harm, and policies that are unhelpful. And living in the gray can also help us to humanize those with varying perspectives and strongly held views.

Because of what’s going on in our country regarding reproductive freedom and rights and justice, it’s just very polarizing. And so over the years, I’ve had the privilege, I believe it’s a privilege, and it’s a beautiful, messy opportunity, to sit in that gray area and listen to people’s perspectives, so that I can gain a clearer understanding of just why they believe what they believe and why they advocate in the ways in which they do. And I have found that there are actually more people in that gray area than there are in these polarizing spaces, and it’s the polarization that gets most of the attention.

Sitting in the gray is where we can find common ground, where we can look at policies that actually are life-affirming for the unborn and for those that are carrying the fetus, or the child, or however people want to label a child in the womb: addressing maternity leave, parental leave, addressing universal health care and the expansion of Medicaid. I read an article, and I believe it’s actually in the article, that talks about how New York expanded Medicaid coverage from 60 days to one year. That’s such a simple thing, when you think about it, that can benefit people that are advocating on both sides. How do we enter into that gray area? How do we peel away these layers of toxicity in order to really address these issues? Because at the end of the day, Black women are suffering because of a lot of the policies that we are creating or refusing to address.

Kevin Pho: I think a lot of what you say certainly resonates. You’re certainly right. We do live in a polar society where we only see things in binary terms: right or wrong, yes or no. You talk about living in the gray. Sometimes that means you may have to listen to perspectives that you don’t necessarily agree with, and understand someone from across the political aisle and their perspectives as well. So in this society, where everything is so polarized, how difficult is that for you?

Cessilye R. Smith: It was difficult at first, but I think the catch is actually addressing my own biases. Oftentimes I think that’s the most difficult thing, addressing the lens in which we see the world, and understanding that hearing another person doesn’t mean that you have to shed your ideals, and you’re not compromising your values and your ideals just by listening to someone else. In fact, I believe that hearing from someone else, you’re rehumanizing. You live in a very dehumanizing culture, and I believe a culture of death, honestly. A lot of the decisions that we make and the policies that we create do not support life, and I’m talking about for everyone, for everybody.

And I think that’s, you know, veering off, but I think that’s one of the things that excites me even about reproductive justice: It’s about addressing when that child is here. We want an environment that is conducive or safe for them.

So going back to your question, what’s difficult? Addressing our own biases is the hardest part. And once we can admit that we don’t have all the answers, and admit that sometimes the lens that we operate in can cause harm, then we’re able to see others and start rehumanizing and start coming together.

Kevin Pho: So let’s talk about some of your solutions in terms of addressing the issues with Black women’s maternal health. What are some of the ideas that you have?

Cessilye R. Smith: Like I mentioned before, I’ve been on both sides of the aisle. I actually don’t hold to strongly held beliefs in black or white, navigating this gray area. And one thing that I’ve learned, sitting in that common gray area, is that those that are on both extremes really value life. For both extremes, the commonality is valuing life, whether that be having choice or whether that be valuing the life of the unborn.

And so what I believe is the solution is coming together for life, addressing, like I mentioned before, parental leave and the expansion of Medicaid, and making sure that we have culturally relevant care, that we’re approaching health care from the spirit of cultural humility. I don’t like using the term “cultural competency,” because you can never be competent in someone else’s culture, but you can approach things with cultural humility and being other-oriented. Right there, I believe, for all health care providers, that should be number one at the top of our list of things to address, and that will drastically impact the standard of care that we provide to our clients and to our patients.

And having constructive conversations with people from opposing views, and listening from a position of understanding as opposed to trying to express your view. This is what has helped me to humanize so many people on this subject, the subject of abortion, the subject of Black infant and maternal health, and these devastating outcomes. There are human beings, living and breathing, who are impacted by the standards of care that we’re providing, and so it’s really in our hands.

And I would say, with the organization that I lead, we’re an accredited Easy Access clinic, and it’s all about access, connections, knowledge, and empowerment. It’s utilizing a commonsense approach to health care, recognizing our biases, and providing a safe environment for Black, Indigenous, and people of color. We have to do that. And I believe, if all of us band together, we can provide these safe environments regardless of what our political affiliations are and what views we have on the subject. We can save lives.

I don’t know if you’re familiar with Jennie Joseph and the work that she does with Commonsense Childbirth and the Easy Access clinics, but studies show, with the work that she’s doing in Winter Garden, Florida, that the JJ Way model reduces the rate of infant mortality. It does, and it is a commonsense approach to health care. And it doesn’t have to be led by midwives; it can be led by OB/GYNs and nurse practitioners. And so we’ve instilled the JJ Way model into the way that we work at the organization that I lead, and we’re seeing positive birth outcomes. And we have people who work at our clinic who are pro-life, pro-choice, all across the spectrum, because we’re coming together for a common cause, and that’s what we need to see more of.

Kevin Pho: And my final question: What are your take-home messages for the KevinMD audience?

Cessilye R. Smith: My take-home message: into the gray. Into the gray is where the real work is. Sit down, let’s humanize each other, and let’s have impactful conversations that lead to positive, legacy-building change.

Kevin Pho: Thank you so much for sharing your time and insight. Thanks again for being on the show.

Cessilye R. Smith: Thank you.