When compared to nations of similar wealth, the United States is the most dangerous place for birthing people to have their babies. The United States has the highest maternal mortality rate in the developing world, and according to the Commonwealth Fund, this crisis is only worsening. Working towards a better future for birthing people seems daunting, as our realizations regarding the inefficacy of current systems seem to call for a collaborative effort to uproot them. Dr. Zahirah McNatt’s work unveils a comforting reality about the nature of our fight. The potential solutions we are imagining are being realized beyond our borders. At the third Doula Expo by Mama Glow, McNatt took the stage to highlight the capacity for global solutions to inform our approach to improving local realities.
Titled, Global to Local: Expanding the Lens on Maternal Health, McNatt’s fireside chat urged the “bridging of boundaries and borders” in the context of maternal health to improve the conditions of labor, delivery, and parenting for birthing people in New York City. Her guiding question encapsulates the theme of the Doula Expo—what do we want a future for birthing people to look like? Her background and various roles enabled her to explore different environments in her quest for answers. What she learned is that everywhere, there are people just like the collective present at the doula expo—people united by the principles of social justice and the desire to create positive change. Additionally, she learned that within the sphere of maternal health, there exist examples of the change many desire to see. All it takes is one look beyond our borders.
The Doula Expo is not just a time to acknowledge the harrowing realities of birth in the United States. It is also a time for celebration and joy, especially as we consider advances in maternal health. Dr. Zahirah McNatt believes it is humility that will enable us to celebrate these advances and ultimately improve outcomes, as our efforts require a closer look at regions the United States often disregards. “A lot of the conversations we have in the Department of Health and Mental Hygiene are unfortunately about the bad outcomes. For a moment, I want to center, that everywhere I’ve ever learned, birth is a spiritual, ancestral, beautiful experience, as is parenthood.”
Dr. McNatt drew on the dismal maternal health statistics of 2020, the peak of the COVID-19 pandemic. About 300,000 birthing people died as a result of pregnancy and birth-related complications across the globe. What’s worse, about 95% of maternal deaths occurred in low and middle income countries, and most of them—around 75%—were preventable. While these statistics on their own call for collective action, McNatt’s fireside chat was an attempt at painting a more complete picture and thinking about ways that this can prime us in our efforts to improve maternal mortality in the United States. “While this is heavy to hear and to carry, these are also the places where the most dramatic improvements have been made, and where there is opportunity for us to learn as well.”
Dr. McNatt centers her insights on the two places where she has spent the most amount of time—Rwanda and India. Rwanda had a maternal mortality rate of over 1,000, which she agrees is a reality many people cannot conceptualize in the Western world. And yet, the shift they’ve experienced over the course of 15 years—1020 losses, to 290 losses per 100,000 live births—tells a promising story. To distance ourselves from the unpleasant realities of the less-developed world is to distance ourselves from a source of great vision, wisdom, and innovation—their solutions. In 2005, Rwanda executed its Community Health Worker (CHW) Program. The CHWs, says Dr. Zahirah McNatt, sound a lot like an indispensable force on which the United States leans in the fight against maternal mortality; community-based doulas.
“Their doulas, or their CHWs, were the first point of contact for anyone in the neighborhood who is pregnant. They are a trusted figure—they’re actually nominated by their neighborhood to represent their neighborhood. They help with education, support during the birth, and administer misoprostol to help with hemorrhaging within the home setting.
In 2000, India’s maternal mortality rate stood at 398 losses per 100,000 live births. Today, this number is below 99. To Dr. McNatt, the example of India is a testament to the power of data and naming in the context of maternal health. “We make these generic statements about harm in public health, and so their data let them know that the vast majority of their losses were happening on the day of birth, within that 24 hour period.” Local governments designed their solutions with the significance of this time period in mind, enabling them to reduce maternal mortality rates with time.
India’s maternal health landscape also underscores the unique position of abortion within the sphere of reproductive justice. The only other circumstance in which losses are commensurate with those of the first 24 hours is during an unsafe abortion. Reducing maternal mortality is just as much about honoring birthing people’s right to have empowering birthing experiences as it is about protecting their right to have safe, dignified abortions.
For many birth workers and changemakers such as Dr. Zahirah McNatt, the Mama Glow’s Doula Expo is a source of hope. “There is so much joy in this room, and so many solutions, and so much power. We have a lot of work to do, but the Doula Expo is about uplifting some of the most amazing solutions that are in New York and across the globe.”
Learn more about the Doula Expo.