Even in Washington state, a beacon for reproductive rights, officials struggle to close racial gaps in infant and maternal health

After the reversal of Roe vs. Wade in June 2022, I was determined to look at reproductive justice in Washington state. While we await the full picture of the impact of this Supreme Court decision, it’s important to remember that reproductive justice goes well beyond abortion. MaryJo Webster, a Center for Health Journalism senior fellow, suggested I explore the other end of the reproductive justice spectrum: perinatal health. 

So I set about investigating how Washington and Seattle — a beacon for reproductive rights — performs on health outcomes for mothers and infants of all communities. With training from the USC Center for Health Journalism Data Fellowship, I could critically assess data from the state and county health departments and confidently perform complex data analyses. 

Halfway through working on my project, Seattle — King County Public Health — and the state Department of Health put out new data on infant and maternal mortality, respectively. They also announced measures and recommendations to address disparities in the death rates of infants and mothers in their jurisdictions. In Washington state, Black and Indigenous mothers are three and seven times more likely to die than their white counterparts. In King County, babies born to Black parents and American Indian/Alaska Native parents are two and three times more likely to die than those born to white parents.  

The evolving response turned me to a new direction. From exposing and highlighting the problem, I pivoted to diving deeper into the root causes and solutions. 

For the infant mortality story, I dug into what the data showed on how closely infant death rates in King County correlated with majority-minority neighborhoods, single mother households and the level of access families have to prenatal care at the census-tract level. I carried out this spatial analysis with guidance from senior fellows Alvin Chang (who was also my advisor) and Andrew Tran. 

The intensive data training the data fellowship provided early on boosted my confidence and ability to do this data analysis and produce the first story quickly after the release of the data. 

The training also set me up to develop a well-rounded view of the subject as I learned about various databases I could tap and how to use community engagement to collect data where official sources offered none. In the subsequent story looking at maternal health in Washington, this groundwork helped me reach families most vulnerable to poor health outcomes. 

With Alvin’s help, I designed a survey to get a comprehensive understanding of the problems confronting maternal health in the state. Midwives, as frontline workers operating outside the hospital system, were a critical resource given the growing calls against unnecessary medicalization of birth across the U.S. and the systemic medical racism that has alienated many Black, Brown and Indigenous people.

Over 30 midwives responded to the survey, helping me draw out the range of problems pregnant people face in accessing healthcare. 

Interviewing this group and several experts focused on improving outcomes for mothers from vulnerable communities, I came to understand the special role doulas play in reaching underserved communities. Community-based doulas, a diverse workforce, are largely overlooked as a resource for addressing inequities in access to perinatal health care. I partnered with photojournalist Erika Schultz, my co-worker, to visually illustrate the impact of their work on the communities they serve. 

As we brainstormed how to tell this story, I knew we had to negotiate for better access to follow them on the job and document the experiences of the families they worked with. 

It took time to build connections and trust with families from historically marginalized communities. It required patiently waiting, responding to questions honestly with all the knowledge and experience I had accrued from my interviews and previous work, and offering reassurances wherever possible. Over time, these communities welcomed us into their lives wholeheartedly. 

This is how we were able to follow Trinity Landrum, a Black mother, through her high-risk pregnancy with her doula, LaShaye Stanton-Phillips. Erika also enlisted me to help her with the videography, which was a thrilling opportunity. I distinctly remember being on call in early April to drop everything and run to the hospital any moment.  We were, as my editor called it, on baby watch! 

In the end, an emergency C-section prevented us from being present in the hospital room despite Trinity’s best efforts. While it was disappointing to miss out on sharing this experience with a family we had gotten to know so closely, we immediately recognized the ethical concerns of the moment. Trinity and her baby’s health were first priority. We did not need to be in the delivery room under those tense circumstances to tell her story. So we visited the new mother and her baby the next day, and let her share her story on her own terms. 

Our focus on building connections and maintaining the agency of our interviewees also helped us tell the story of an incredible birth justice center led by Indigenous women on the Yakama Nation reservation. Working out of a farmhouse, these women have served families in the area for over a decade, with a goal to improve Native American maternal and child health outcomes. Earning their trust helped us go beyond the data to learn about their lives. This is an especially critical point to consider when covering marginalized communities of statistically small numbers. Our work in this community also helped update the paper’s stylesheet on how to refer to the Yakama Nation Reservation and its residents. 

The same reporting process allowed us to cover other birth centers in rural Washington and connect with mothers in remote areas who graciously welcomed us into their homes. These voices, perspectives and experiences helped us constructively argue why even one of the best states for maternal and child health needs to do better. 

Looking back, I am truly grateful for all the resources this fellowship offered to cover a topic that has grown so close to me. This project allowed us to expand on our inclusive coverage of critical issues impacting underserved communities with thoughtful depth. Needless to say, there’s so much more to discuss about maternal and infant health than space allowed. We’ve only scratched the surface.