live from washington, this is bbc news. maternal mortality in the us is making headlines across the globe. america is now the most dangerous place among wealthy nations in which to give birth, and baring the brunt on this crisis are black women. after the death of a 32—year—old olympic athlete, we'll discuss the impact of this ongoing health crisis. hello i'm helena humphrey, thanks forjoining me. we start our programme tonight talking about us olympic star tori bowie. she was 32—years—old and eight months pregnant when she went into labour and subsequnetly died at her home in florida.

her death was confirmed by authorities in early may. an autopsy released this week lists bowie�*s cause of death as respiratory distress and eclampsia, a rare and severe pregnancy—related condition which can cause seizures or coma and is more prevalent in black women. many are calling tori bowie�*s death a �*wake—up call�* for the black maternal mortality crisis. not only has america become the most dangerous wealthy nation for all women to give birth in, studies are now showing that for black women the risks are even higher, with an increased risk of pre—eclampsia and are at a greater risk for maternal mortality. with issues like the quality of health care, underlying conditions, racism and implicit bias preventing many women from getting the health care that could save their lives. according to the cdc, black women are three times more likely to die from pregnancy—related causes than white women. and the maternal mortality rate for black women was 69.9 deaths per 100,000 live births in 2021, higher than any other race. this issue touches every

corner of the black community, with celebrities from beyonce and bowie�*s fellow 0lympian allyson felix speaking out about their dangerous conditions of their pregnancies and how tough it was for them to speak up, with tennis legend serena williams writing in an editorial for elle magazine last year after her first pregnancy, "giving birth to my baby, it turned out, was a test for how loud and how often i would have to call out before i was finally heard." earlier i spoke to kat stafford, national investigative race reporter at the ap. thank you so much forjoining us to speak about this important issue. 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. thank you for having me. 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 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 this you 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 one of the things i found so striking about your reporting. 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 published a five—part series investigating essentially how from births to deaths 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 birthing 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 notjust the number of women that are dying, it's the ripple effect that this creates across generations. trust is such an important word you just brought up, and your reporting talks 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. to slavery, tell us more on 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, that this still continues to be such an issue in america. there was a study we cited in our reporting as recent as 2016 that there are healthcare providers still believe false notions about black americans and believe black americans have less pain that they feel, 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 and with huge ramifications as well, notjust from mums but for children, in your report, you say black

babies 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. yes, these 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 likely to die, and be born prematurely, and it sets the stage for potential future health issues that one might encounter throughout the course of our lives, so we're talking about respiratory issues that can manifest later on as asthma, and so on, so it's notjust about this one particular health issue, it's about all of these health inequities that have long existed in america that yet to be rectified. really important reporting there from kate stafford, the national investigative race reporter for the associated press, we thank you for coming, good to talk to you. earlier, i spoke to dr doee kitessa, she's an 0b/gyn at the university of maryland medical center and also on the faculty

at the university of maryland school of medicine, and dr bayo curry—winchell, who is a medical director, physician and public health communicator based in reno, nevada. before we talk to the causes and what you think needs to be done, i want to talk about how how the women you look after are feeling, and i'm sure they're aware of these are alarming numbers. do you hear black women, women from minority backgrounds being worried about what could happen to them during their pregnancies? yes, thank you for having me, and absolutely, i hear from 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.

what are your patients telling you about their experiences, their fears in a country where they are cognizant of the fact that they are three times more likely to die from pregnancy related courses? when you think about the historical fear that has been a part of the medical system, and when you talk about giving birth, which is such an important piece of healthcare, and in such a vulnerable time in your life, and my patients continue to say even before getting pregnant, thinking about getting pregnant, there is a fear of should i even do 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. yet, you are hearing these kinds of comments, i just 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. yeah, so where this is really important to take into account, when you look at the statistics and you break down by socio—economic status, black women, of high 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 but those statistics highlight that poverty is not only a play at 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 just talking now about the generational impact. have you also seen kind of generational mistrust filtering down as well? i have. when we think about how we are disproportionately black people from diseases that we hear about, we need to take a step back and think about why they may be happening and when you look at this fact that there is this mistrust which leads to the inability or not wanting to go in and access care or seek out

care, all of those pieces are really important, and another piece i want to talk about as we talked about how social economics do not play a role, as a physician, i had this happened to me, and so it really highlights that even someone who has the education and is stating something is wrong and understands that something is wrong was dismissed. that's really interesting that you were able to tell us about your own personal experience, someone with your education, with your medical professional 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 of all race, you have to think about that it's a social construct, it is not biological, so when you have a group of people, black people who are dying at a higher rate, its structural racism,

unconscious bias, and for me, i knew after i had come out of my c—section that something was not right. i didn't feel the same way i did after my first one, and i shared that with my nurse, and she said you're fine, your vital signs look fine, and i knew i was in pain and something was amiss, and i was not able to speak and do all the things i normally was able to do after the first c—section. well, shortly after that my husband ended up calling my colleague, my 0b, and saying that something is wrong, — come back and check on her. so i was taken back to the 0r because he 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 you take note of that happening from someone who is a medical director, a physician, but in the end

i was a black woman, just like everyone else that is 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 this just about women advocating for themselves? is and is also about medical professionals speaking? yes, and i would say more so, it's 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 in effect the bias that is affecting black women in healthcare.

so the burden really is on us as healthcare providers and physicians in the healthcare system to change the statistics and decrease this disparity and decrease mortality in the united states. dr curry—winchell and dr kitessa, stay with us, because i now want to focus on newjersey which had one of the highest mortality rates in the united states, and earlier i spoke with tammy murphy, the first lady of newjersey, who has been working to dismantle those disparities within her state. thank you forjoining us on bbc news 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 brought attention to the alarming state of maternal mortality in the united states right now, particularly among 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? well, first of all, thank you for your interest in this and i think that with tori, it's 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 4 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 it, but 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 to accept the fact that something is really wrong and it needs to be addressed. as you just mentioned there, we have a situation in this country when black women are 2.6 times more likely to die in childbirth, during pregnancy or thereafter, than white women — the disparity is incredibly stark. what needs to be done to tackle this, to address this? so there has to 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 cost a lot of money and some are absolutely common sense.

we in newjersey started something called nurture nj are back in 2019, and that was to raise awareness and also correct the scourge that we currently have in new jersey. you just talked about 2.6 in terms of differential — in newjersey, according to data from 2016 to 2018, black women were nearly seven times more likely than white women to die and black babies were three times more likely than white babies to die before their first birthday. when my husband came into office we were 45th in the country in terms of maternal mortality rates, we then slipped to 47th. 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 could 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 doula care, but we are the only state to both reimburse and grow our community doula work force and this provides culturally competent care and it it has been proven to move the needle in this space. secondly, we expanded medicaid coverage to 365 days postpartum, but we also have increased our medicaid rates for reimbursing our entire perinatal workforce to 100% of medicare rates. this means that 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 the patients. one thing i do want to ask about as well, 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, i guess the short answer is yes. and the reason i would say that is that most of the deaths happen after delivery. most people think this happens at delivery, it's not — it's after delivery. so when 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, with the most robust universal nurse home visitation programme. so yes is the answer. and so first lady, you have outlined some of the steps

newjersey has been taking to tackle this. what more does the administration need to do? just so you know, i have been working on this for six years in newjersey. we have made tremendous strides over the past six years and we are having all sorts of benchmarks. i already talked about america's health rankings where we are now 29th. 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, 47 declined, one remained the same and four improved, and newjersey is one of those four. so we definitely have a secret sauce and we will continue working on this. the first lady of newjersey, tammy snyder murphy there, also an advocate for women's health, thank you forjoining us on bbc news. thank you, helena. back to our panel now, dr doee kitessa is a 0b/gyn

and also on the faculty at the school of medicine, 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 newjersey on the issue. are those some solutions that you think could be implemented more broadly, to you, dr curry—winchell. yes, i think this is a great step and finding ways to increase access — but we also cannot forget with that access, as we talked about, it is all social economics. so we have to lean into, what are we doing to address unconscious bias, meaning these kind of thought processes that black people don't feel as much pain as we mentioned, 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, i wonder, are you seeing younger medical professionals learning, 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? i think 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 panel discussions 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 practice right now.

that is some of the work that i do as director of our diversity and inclusion programme in my department, is educating, 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 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. ladies, thank you both so much for being with us, dr kitessa, dr curry—winchell, this is a really important conversation to have and i want to thank

you for having it here on bbc news. you're watching bbc news. i'm helena humphrey in washington dc. thanks for your company. 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. 0ur 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, we're generally 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 spots. 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.