live from washington, this is bbc news. maternal mortality is making headlines after the death of a 32—year—old olympic athlete, we will discuss the impact of this ongoing health crisis. —— maternal. thank you forjoining me. 32—year—old us olympic star tori barry was eight months pregnant when she went into labour and died at a florida home. her death was confirmed by authorities in early may and in an autopsy, her cause of death is respiratory dispatched to distress and this eclampsia, a

condition which can cause seizures or coma, and is more prevalent in black women. is a wake—up call for blackman tournament —— black maternal mortality crisis. study showed that black women have a greater risk of eclampsia and with issues like the quality of care, underlying conditions, and implicit bias preventing many women from getting the healthcare that could save their lives are. black women are three times more likely to die from pregnancy —related causes than white women, and them at home — maternal mortality rate for black women was 69.9 deaths per 100,000 life both at 2121, higher than any other race. this issue touches every corner of the black community, with celebrities and olympians are speaking about their dangerous conditions of their pregnancies and how tough it was for them to speak out, with tennis legend serena williams in an editorial for elle magazine saying giving birth to my baby,

turned out, was a test for how loud and how often i would have to call out before i was finally heard. lets bring in our cat stafford, our national race reporterfor our cat stafford, our national race reporter for the associated press. i know your reporting has dealt really deeply on this issue, the numbers are shocking. just talk to us about some of the factors, and i know they are myriad, that you have found in terms of why we are seeing such alarming numbers of black mothers dying.— alarming numbers of black mothers dying. thank you for havin: me, but one of the things i think is most important to note about about the maternal mortality crisis is this really impacts all black women across the board, and what i mean by that is regardless of your wealth, regardless of your wealth, regardless of your social standing, it doesn't matter, if you are black, if you are a black woman in america, you are far more likely to die during

pregnancy, childbirth or postpartum, and a lot of the experts say it is very important to note that this cannot be explained by genetics alone. what we have seen is the role of structural racism which frankly is still deeply embedded in america, and that has shown up for the discrimination that black women report and encounter when they enter the hospital system. it is also the simple act of not listening, at the start of busy talked about serena williams, there are so many black women i have talked to who, like serena, say that while they were in the middle of childbirth, they felt like their concerns were not being heard, and that can literally be the difference between life or death when you are delivering a child. absolutely, and that was _ delivering a child. absolutely, and that was one _ delivering a child. absolutely, and that was one of _ delivering a child. absolutely, and that was one of the - delivering a child. absolutely, | and that was one of the things i found so striking about your reporting. obviate often we see public health officials talking about socio—economic factors, but one of the first women that

you cited in yourfascinating piece was working at a university, and she was struggling to be taken seriously, at the own university where she worked. tell us more about that. what we did was — tell us more about that. what we did was published - tell us more about that. what we did was published a - tell us more about that. what we did was published a 5-parti we did was published a 5—part series investigating essentially how births from doubts in black americans are much more likely and that has been generations in the making and the first story was about this very issue, we went to the seat of alabama where we met two sisters who both had very traumatic burning experiences at the same hospital and as you mentioned one of the sisters, she worked at that very hospital as a public health instructor, so for me, throughout the course of the reporting and talking to a lot of advocates, this just reaffirms the fact that again, regardless of your background, this is something that can happen to you, and for that woman that we interviewed, it has had such a disastrous

effect on her life to the point that she feels he does not trust the medical system any more, she no longer even works in the healthcare field so when we think about this, it's not just the number of women that are dying, it's the ripple effect that this creates across generations. effect that this creates across generations-_ generations. trust is such an important — generations. trust is such an important word _ generations. trust is such an important word you - generations. trust is such an important word you just - generations. trust is such an . important word you just brought up, and your reporting talks about maternal healthcare about maternal healthca re deserts, about maternal healthcare deserts, particularly in the south and it also speaks about mistrust in the system historically, going back to slavery, tells more that. the very foundation of gynaecology and the united states started in alabama on a slave bar, and we found ourselves centuries later in the same spot at the birthplace of gynaecology, they began the testing, the torture of enslaved black women, so for a lot of advocates on the ground, it's frustrating, alarming, and it's haunting to see that centuries later, decades later, still continues

to be such an issue in america. there was a study recited in our reporting as recent as 2016 and so there are healthcare providers that still believe false notions about black americans and believe black americans and believe black americans have less payment, that their skin is thicker and this is 2023, issues that we are still seeing across the board in america. across the board in america. across the board in america and with huge ramifications as well, notjust from mums but for children, in your report, use a black babies are more likely to die. they are more likely to die. they are also far more likely to be born premature, essentially setting them up for health issues that run all the way through their lives.- issues that run all the way through their lives. yes, these two issues _ through their lives. yes, these two issues are _ through their lives. yes, these two issues are so _ through their lives. yes, these two issues are so intertwined, | two issues are so intertwined, we have seen a lot of emphasis, a lot of reporting on the black mortality crisis but as you stated, black people are more like — more likely to die, and

be born prematurely, and it sets the stage for potential future health issues that one might encountered throughout the course of our lives, so we're talking about respiratory issues that can manifest later on as asthma, so it's notjust about this one particular health issue, it's about all of these health and inequities that have long existed in america that have yet to be rectified. america that have yet to be rectified-— rectified. really important reporting _ rectified. really important reporting now _ rectified. really important reporting now from - rectified. really important reporting now from kate l reporting now from kate stafford, the national investigative race reporter for the associated press, we thank you for coming, good to talk to you. to talk more about this issue including from a medical perspective, i'mjoined including from a medical perspective, i'm joined by an obstetrician, gynaecologist at the university of maryland medical centre, also on the faculty of the university of maryland school of medicine and i am joined by a medical director of physician and public health communicator based in reno, nevada. welcome to you both, great to have you

on the programme. before we talk to the courses and what you think needs to be done, i want to talk about how how the women you look after our feeling, and i'm sure they're aware these are alarming numbers. do you hear black women, women from minority backgrounds and be worried about what could happen to them during their pregnancies? yes. during their pregnancies? yes, thank you _ during their pregnancies? yes, thank you for— during their pregnancies? yes, thank you for having _ during their pregnancies? yes, thank you for having me, - during their pregnancies? 1a: thank you for having me, and absolutely, i hearfrom my patients regularly, black women, and especially that they are scared and afraid, and you see the statistics that black women and three times more likely to die, it's very frightening and patients are expressing those fears as well. do you, what are your patients tell you about their experiences? theirfears in a country where they are cognizant of the fact that they

are three times more likely to die from pregnancy related courses?— die from pregnancy related courses? ~ , ., ~ ., courses? when you think about the historical— courses? when you think about the historical fear— courses? when you think about the historical fear that - courses? when you think about the historical fear that has - the historical fear that has been — the historical fear that has been a _ the historical fear that has been a part of the medical system, _ been a part of the medical system, and when you talk about giving _ system, and when you talk about giving birth, which is such an important _ giving birth, which is such an important piece of healthcare, and in — important piece of healthcare, and in such a vulnerable time in your— and in such a vulnerable time in your life, and my patients continue _ in your life, and my patients continue to say even before getting _ continue to say even before getting pregnant, thinking about— getting pregnant, thinking about getting pregnant, there is a fear— about getting pregnant, there is a fear of should i even do this, — is a fear of should i even do this, so— is a fear of should i even do this, so when you look at that, that— this, so when you look at that, that should not even be part of the thought process when you are deciding to create a family _ are deciding to create a famil . , ., ., ., family. yet, you are hearing these kinds _ family. yet, you are hearing these kinds of _ family. yet, you are hearing these kinds of comments, l family. yet, you are hearing these kinds of comments, i | family. yet, you are hearing - these kinds of comments, ijust wonder, whether you are hearing those kind of concerns that women are actually coming to you saying you know, i am concerned about starting a family, for example, due to these adverse health effects. i think the combination of adverse health effects and high

rates of maternal mortality as well as morbidity, so the complications that many women experience, particularly black women, there is a tremendous fear about that as well, and so patients are expressing that they are concerned about starting a family, about potentially expanding their family, particularly about the statistics, and also based on their experiences that they have had within the healthcare system in the united states, the discrimination that they have experienced, the lack of trust that they feel in healthcare providers in the united states, and these are all impacting their decisions about planning for the family. and you will have just heard from the investigative reporter just speaking there at the associated press, and she said often these outcomes are being put down to physical differences which may play one part, but one thing i know you have touched on in the past is

weathering, essentially how long—term discrepancies in the health system can result in poor birth outcomes. tell us more about that.— poor birth outcomes. tell us more about that. yeah, so where this is really _ more about that. yeah, so where this is really important _ more about that. yeah, so where this is really important to - this is really important to take into account, when you look at the statistics and you break down by socio—economic status, black women, hi socio—economic status have a higher mortality rate than white women with less than high school education, and we should be appalled by any woman dying with those statistics highlight that poverty is not only a play here, and chronic stress from discrimination, for years and generations is having an impact on the health of black people and in this case black women in this country, increasing the risk of hypertension, diabetes, actually affecting the dna that causes premature ageing in black people, because of

discrimination, so it's having tremendous effects. we were 'ust tremendous effects. we were just talking — tremendous effects. we were just talking now _ tremendous effects. we were just talking now about - tremendous effects. we were just talking now about the - just talking now about the generational impact. have you also seem kind of generational mistrust filtering down as well? i mistrust filtering down as well? . ~ ~ well? i have. when we think about how — well? i have. when we think about how we _ well? i have. when we think about how we are _ about how we are disproportionately —— this proportioning black people from diseases— proportioning black people from diseases that we hear about, we need _ diseases that we hear about, we need to— diseases that we hear about, we need to take a step back and think— need to take a step back and think about why they may be happening and when you look at this fact — happening and when you look at this fact that there is mistrust which leads to the inability— mistrust which leads to the inability or not wanting to go inability or not wanting to go in and — inability or not wanting to go in and access care or seek out care, — in and access care or seek out care, ail— in and access care or seek out care, all of— in and access care or seek out care, all of those pieces are really— care, all of those pieces are really important in another piece — really important in another piece i_ really important in another piece i want to talk about as we talked about how social economics do not play a role, as a _ economics do not play a role, as a physician, i had this happened to me, and so it really— happened to me, and so it really highlights that even someone who has the education

and is _ someone who has the education and is stating something is wrong _ and is stating something is wrong and understand that something is wrong was dismissed.— dismissed. that's really interesting _ dismissed. that's really interesting that - dismissed. that's really interesting that you - dismissed. that's really. interesting that you were dismissed. that's really - interesting that you were able to tell us about your own personal experience, someone with your education, with your medical professionals knowledge, just tell us more about how for example, it's not necessarily about physiological difference, it's about pain and people being listened to and pain being taken seriously. absolutely. when you look at first — absolutely. when you look at first of— absolutely. when you look at first of all race, you have to think— first of all race, you have to think about that it's a social construct, it is not biological, so when you have a group — biological, so when you have a group of— biological, so when you have a group of people, black people who are — group of people, black people who are dying at a higher rate, its structural racism, unconscious bias, and for me, i knew_ unconscious bias, and for me, i knew after— unconscious bias, and for me, i knew after i_ unconscious bias, and for me, i knew after i had come out of my c-section — knew after i had come out of my c—section that something was not right _ c—section that something was not right. i didn't feel the same _ not right. i didn't feel the same way i did after my first one, — same way i did after my first one. and _ same way i did after my first one. and i_ same way i did after my first one, and i shared that with my nurse. — one, and i shared that with my nurse. and _

one, and i shared that with my nurse, and she said you're fine, — nurse, and she said you're fine, your— nurse, and she said you're fine, your vital signs look fine, _ fine, your vital signs look fine, and _ fine, your vital signs look fine, and i knewl fine, your vital signs look fine, and i knew i was in pain and— fine, and i knew i was in pain and something was amiss, and i was not — and something was amiss, and i was not able to speak and do all the — was not able to speak and do all the things normally was able — all the things normally was able to— all the things normally was able to do after the first c—section, well, shortly after that— c—section, well, shortly after that my— c—section, well, shortly after that my husband ended up calling _ that my husband ended up calling my colleague and saying that something is wrong, come back— that something is wrong, come back and — that something is wrong, come back and check on her. sol that something is wrong, come back and check on her. so i was taken _ back and check on her. so i was taken back— back and check on her. so i was taken back to the or because he recognised that i was not myself _ recognised that i was not myself. i was bleeding internally, and i had to be transfused and i was hospitalised for two weeks, so when — hospitalised for two weeks, so when you _ hospitalised for two weeks, so when you take note of that happening from someone who is a medical— happening from someone who is a medical doctor, a physician but in the — medical doctor, a physician but in the end _ medical doctor, a physician but in the end i was a black woman, 'ust in the end i was a black woman, just like — in the end i was a black woman, just like everyone else that is impacted by the statistics. that— impacted by the statistics. that is— impacted by the statistics. that is a _ impacted by the statistics. that is a horrifying experience and we are grateful for you sharing it. something i want to just ask you about is often women are told to advocate for

themselves. is thisjust women are told to advocate for themselves. is this just about women advocating for themselves? is there is also not about medical professionals listening? not about medical professionals listenin: ? , not about medical professionals listeninr? , ., ., listening? yes, and i would say more so. _ listening? yes, and i would say more so. and _ listening? yes, and i would say more so, and the _ listening? yes, and i would say more so, and the burden - listening? yes, and i would say| more so, and the burden should not be on healthcare professionals, the medical community, to change, it should not be borne by black women, by patients, ourjob is to care for people, and so really there needs to be more conversations, more policy changes, more education, and to really change and the fact the bias that is affecting black women in healthcare, so the burden really is on askers healthcare providers and physicians in healthcare providers and physicians in healthca re system to providers and physicians in healthcare system to change the statistics and decrease this disparity and decrease mortality in the united states. dr bayo curry—winchell and dr

doee kitessa, i now want to focus on newjersey which had one of the highest mortality rates in the united states, earlier i spoke with tammy murphy, the first lady of new jersey who is working to dismantle those disparities within her state.— dismantle those disparities within her state. given “oining us to mi within her state. given “oining us to talk about t within her state. given “oining us to talk about a h within her state. given “oining us to talk about a topic]- within her state. givenjoining us to talk about a topic which | us to talk about a topic which you are very focused on and the recent tragic news of the death of the sprinter tori bowie while eight months pregnant has drawn attention to the alarming state of maternal mortality in the united states particularly for black women, american now the most dangerous place to be pregnant or to give birth in high income countries. why aren't doctors more focused on this? ~ , , . ~ aren't doctors more focused on this? ~ , , ., ~ this? well, firstly thank you for our this? well, firstly thank you for your interest _ this? well, firstly thank you for your interest in - this? well, firstly thank you for your interest in this - this? well, firstly thank you for your interest in this and | this? well, firstly thank you | for your interest in this and i think that with tori bowie, enough is enough, we have seen this and she is one of four who

were competing and won the gold in the 2016 olympics in the four x 100 metres, and three of those four have had life—threatening maternal problems, if not death now. so we have to focus on this. why are doctors not focused on it? this is a systemic problem across the country, and it comes down, i hate to say, to systemic racism. there are instances where women are either too nervous, too scared to complain or to raise their voices on the one hand because they don't want to come across as being difficult. on the other hand, they are not taken seriously, and they are sometimes dismissed. and when you have people like serena williams or beyonce who have also nearly died delivering babies, who have incredible platforms, we have two accept the fact that something is really wrong and it needs to be addressed. $5 really wrong and it needs to be addressed-— addressed. as you 'ust mentioned *

addressed. as you 'ust mentioned we i addressed. as you 'ust mentioned we had h addressed. as you just mentioned we had a i addressed. as you just - mentioned we had a situation in this country when back women are 2.6 times more likely to die in childbirth during pregnancy or thereafter than white women, and the disparity is incredibly stark. what needs to be done to tackle this, to address this? 50 to be done to tackle this, to address this?— to be done to tackle this, to address this? so there has to be transformational - address this? so there has to be transformational change. | address this? so there has to i be transformational change. and when i say that, it is everything from workforce development to access to care, to transportation, to education — it is literally going to touch on every aspect of life. and i would say that in this instance there are many things we can do. some costs a lot of money and some are absolutely common sense. we're newjersey started something called nurture and jay are back in 2019 and this was to raise awareness and correct the scourge that we currently have

in newjersey. —— nurture nj. you talked about the differential in newjersey, black women were nearly seven times more likely than white women did i am black babies were three times more likely than white babies to die before theirfirst than white babies to die before their first birthday. when than white babies to die before theirfirst birthday. when my husband came into office we were 45th in the country for maternal mortality rates, we then slipped to a7. as of yesterday it has been said that we are now 29th. so we are definitely moving the needle. there are policy changes that one can make. we have a nurture nj plan that we unveiled in 2021 that has 70 different action steps of which we have already tackled over half of them, and it is obviously showing we are moving the needle here. and i would say, i would highlight three that are really important and we know they have really made an impact. one is we are the third state to provide medicaid

reimbursement for direct care, but without the only state to reimburse and grow our community do all the work force and this provides culturally competent care and it it has been proved to move the needle in this space. —— one workforce. we extended medicaid coverage to 365 dates postpartum but also we increased our medicaid race for reimbursing our entire perinatal workforce to 100% of medicare rates. this means not only do mothers, all mothers have equity in terms of their healthcare, it means more providers will take medicaid coverage and that means less waiting times for patients. fine waiting times for patients. one thin is i waiting times for patients. one thing is i want _ waiting times for patients. one thing is i want to _ waiting times for patients. one thing is i want to ask _ waiting times for patients. one thing is i want to ask about alongside those measures is the fact that the us is a country where there is no enshrined in law mandatory paid maternity leave. and ijust wonder whether you think that is also

damaging to women's health. yes, the short answer is yes. and the reason i would say that is most of the deaths happen after delivery. most people think that happened that delivery, it's not, it's after delivery. so women go home, you don't know what they are going home to and you don't know if they are going to go right back to work, if they will follow up on their appointments. babies are seen multiple times in the first six weeks of birth, and mothers are not seen until six weeks after birth. and we are addressing that in newjersey as well the most robust universal nursing visitation programme. so yes is the answer. programme. so yes is the answer-— answer. and so you have outlined _ answer. and so you have outlined some _ answer. and so you have outlined some of- answer. and so you have outlined some of the - answer. and so you have l outlined some of the steps answer. and so you have - outlined some of the steps new jersey has been taking to tackle this. what more does the administration need to do? just so ou administration need to do? just so you know — administration need to do? just so you know i — administration need to do? inst so you know i have been working on this for six years in new jersey. we have made tremendous strides over the past six years and we are heading all sorts of

benchmarks. march of dimes also recently came out with a report that showed the improvement across the country in terms of reducing preterm births. they looked at 53 states and territories and of those 53, a7 declined. one remained the same and four improved and new jersey is one of those four. so we had a secret sauce and we will continue working on this. the first lady of newjersey, tammy snyder murphy, also an advocate for women's health, thank you forjoining us on bbc news. back to our panel now, dr doee kitessa is a ob/gyn at the university of maryland, and dr bayo curry—winchell is a medical director, physician and public health communicator based in reno nevada. talking about how this issue should be tackled, we were hearing there from the first lady of new jersey on the issue. i those some solutions that you think could be implemented more

broadly, to you, bayo curry—winchell. broadly, to you, bayo curry-winchell.- broadly, to you, bayo curry-winchell. yes, ithink this is a _ curry-winchell. yes, ithink this is a great _ curry-winchell. yes, ithink this is a great step - curry-winchell. yes, ithink this is a great step and - this is a great step and finding ways to increase access, but we also cannot forget access, as we talk about, it is all social economics. so we have two lean into, what are we doing to invest in unconscious bias, meaning these kind of thought processes that black people don't feel as much pain as we mention, a recent study in 2016 highlighted that. so we have to of course look at expansion for certain insurance as far as medicaid, but we also know that commercial insurance, all social economics are impacted by this. so more work to be done but this is a great step. on that issue, dr kitessa, to you, are you seeing younger medical professionals learning and being trained to understand implicit bias and how can they

reach people who have been in the medical profession perhaps for a much longer time? the medical profession perhaps fora much longertime? i the medical profession perhaps for a much longer time?- for a much longer time? i think this is one _ for a much longer time? i think this is one of _ for a much longer time? i think this is one of the _ for a much longer time? i think this is one of the things - for a much longer time? i think this is one of the things that i this is one of the things that has changed a lot since i was in medical school. we didn't talk about health disparities very much or unconscious bias, and now at most medical schools including where i am, that is part of lectures and discussions from first year of medical school. and i have participated in a panel discussion as part of the curriculum for our medical students. so that is a change that has occurred. but as you said, we can'tjust focus on our learners, because we need to focus on physicians who are in crack this right now. and so thatis in crack this right now. and so that is some of the work —— in practice. that is some of the work that i do in my department, is educated, is having conversations, is working with people to get all of us to confront our own biases. we are human, we have biases, and it is important

that we learn to understand them, to acknowledge them and thatis them, to acknowledge them and that is how we can work to overcome them. and i think one of the other things that needs to happen is increased diversity in the physician workforce. 12% of the population of the united states is black, but only about 5% of physicians are black. and so it is important to have greater diversity as well.— diversity as well. thank you both so much _ diversity as well. thank you both so much for— diversity as well. thank you both so much for being - diversity as well. thank you j both so much for being with diversity as well. thank you - both so much for being with us, dr kitessa, dr curry—winchell, this is an important conversation to have and i want to thank you for being here on bbc news. there is more coming up bbc news. there is more coming up at the top of the hour, thanks for your company, i will see you soon. goodbye for now.

hello there. it's looking pretty different weather—wise this weekend — we're not going to have wall—to—wall sunshine like we've had the previous weekend. we have low pressure working its way and that's going to bring showers and some thundery downpours for many places. and there will be some sunshine around, but you'll notice it's going to feel increasingly humid. our air source still coming in from the south, so it's going to be fairly warm. but here it is, this area of low pressure continuing to edge in towards western areas. that's where we'll see most of the showers, even longer spells of rain across northern ireland for saturday morning. best of the sunshine towards eastern areas — could see a little bit of cloud here and there, and there could be the odd shower popping up into central areas into the afternoon. some low cloud, mist and murk affecting northeast scotland and the northern isles, so temperatures here only around 13 or 1a degrees, but for most, it's the low to mid 20s.

so, not quite as warm as of late, but still well above the seasonal norm. now, as we head through saturday night, we continue with showers through central and western areas, again, some of them will be heavy and thundery, tending to stay dry the further east that you are. and it's going to be slightly milder, i think, saturday night — a warmer, muggierfeel to things out west. now, into sunday, this is the day where i think we could see most of the showers and thunderstorms. they will become widespread across england and wales during the day and there could be some torrential downpours in places. now, there will be more cloud around, too, so it's not going to be quite as warm than of late, which then we're looking at the high teens, low 20s for many of us, and still some low cloud, mist and murk for northeast scotland, the northern isles. through sunday night, it looks like we could see an area of thundery rain spreading northwards across england and wales, pushing across scotland into monday, so a very wet start for monday morning across scotland. that heavy rain becomes confined to the north highlands into the northern isles, but elsewhere, it brightens up, sunshine and showers — again, some of the

showers could be heavy and thundery in places. but with more sunshine around, it'll be a little bit warmer, i think, with temperatures again reaching the mid 20s in the warmest spot. and then, as we move beyond monday, low pressure always nearby to the north and the west of the uk. however, towards the end of the new week, it could be the high pressure wants to build back in again, so that should kill off the showers across southern areas, and we could see temperatures rising again across southern britain with the increasing amounts of sunshine. but most of the showers will tend to be across the north and the west of the country. see you later.