live from washington, this is bbc news. maternal mortality in the us is making headlines across the globe. after the death of a 32—year—old olympic athlete, we'll discuss the impact of this ongoing health crisis, as america is named the most dangerous country among wealthy nations in which to give birth. and black women bear the brunt. 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 subsequently 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 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, with the maternal mortality rate for black women at 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, saying... i spoke to kat stafford, national investigative race reporter at the ap. thank you so much for joining us to speak about this important issue. and i know that your reporting has delved really deep on this issue. the numbers are shocking. just talk to us about some of the factors — and i know they're myriad — that you have found in terms of why we are seeing such alarming numbers of black mothers dying. well, thank you for having me first. but one of the things that i think is most important to note about the maternal mortality crisis is that 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 that i've talked to over the years about this issue say it's very important to note that this cannot be explained just 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 through the discrimination that black women report encountering when they enter hospital systems. 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 that i have talked to who, like serena, said that while they were in the middle of childbirth, theyjust felt that their concerns weren't 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, kat, that i found so particularly striking about your reporting.

often, we see public health officials talking about socioeconomic factors. but one of the first women that you cited in your fascinating piece was working at a university, and she was struggling to be taken seriously at the university where she worked. i mean, just tell us more about that. yes, so the ap, what we did was publish a five—part series investigating, essentially, how from birth to death, black americans are far more likely to experience a lot of health inequities that really has been generations in the making. and the first story was about this very issue. we went to the state 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 that she doesn't trust the medical system any more. she no longer even works in the health care field. so when we think about this, it's notjust about the number of women that are dying. it's about the ripple effects that this creates across generations. trust is such an important word that you just brought up there. i mean, your reporting talks about maternal health care deserts, particularly in the south, and it also speaks about mistrust in the system historically, going back to slavery. tell us more about that. yes, so the very foundation of gynaecology in the united states started in alabama on a slave farm. and it's just this odd circle that we've found ourselves centuries later in the same spot, the birthplace of gynaecology, that began on literally the testing, the torture of enslaved black women. so for a lot of advocates on the ground, it's frustrating, it's alarming and it's haunting to see that

centuries later, decades later, this still continues to be such an issue in america. there was a study that we cited in our reporting, as recent as 2016, that showed that there are health care providers that still believe false notions about black americans. there are folks that believe black americans have less pain that they feel, that their skin is thicker. and this is 2023. these are issues that we are still seeing across the board in america. across the board in america, and with huge ramifications as well notjust for mums but for children as well. in your report, you say black babies are more likely to die. they're also far more likely to be born prematurely, essentially setting them up for health issues that run all the way through their lives. yes, and these two issues are so intertwined. we have seen a lot of emphasis, a lot of reporting, on the black maternal mortality crisis. but we know, as you stated, that black infants are most likely to die, they are most

likely to be born prematurely. and what this does is it does set the stage for potential future health issues that one might encounter throughout the course of their lives. so we're talking about respiratory issues that can manifest later on as asthma and so on 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 have yet to be rectified. well, really important reporting there from kat stafford, national investigative race reporter at the associated press. we thank you for coming on. good to talk to you. thank you. i also 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.

welcome to you both. really great to have you on the programme. now, before we talk through the causes and what you think needs to be done, i really want to talk about how women you look after our feeling, and i am sure that they are aware of these alarming numbers. ijust alarming numbers. i just wonder, alarming numbers. ijust wonder, do you hear black women, women from minority backgrounds being buried essentially about what could happen to them during their pregnancies? first to you, dr doee? ~,,. , pregnancies? first to you, dr doee? ~ , ., ., doee? absolutely. i hear from women and — doee? absolutely. i hear from women and black— doee? absolutely. i hear from women and black women - women and black women especially that they are afraid, when you see statistic that black women are ten times more likely to die, it is very frightening and patients are expressing those fears to me. and to you, dr bayo, what do your patients tell you about their experiences, their fears,

in a country where they are cognizant of the fact they are three times more likely to die from pregnancy —related causes? when you think about the historical fear, that has been a part— historical fear, that has been a part of— historical fear, that has been a part of the medical system, and then_ a part of the medical system, and then when you talk about giving — and then when you talk about giving birth, which is such an important _ giving birth, which is such an important piece of health care, and such— important piece of health care, and such a _ important piece of health care, and such a vulnerable time in your— and such a vulnerable time in your life. _ and such a vulnerable time in your life, and my patients continue _ your life, and my patients continue to say, even before being — continue to say, even before being pregnant, thinking about being _ being pregnant, thinking about being pregnant, thinking about being pregnant, there's a fear of, should i even do this? when you took— of, should i even do this? when you took at— of, should i even do this? when you look at that, that china not — you look at that, that china not even _ you look at that, that china not even be a part of the thought— not even be a part of the thought process when you're deciding _ thought process when you're deciding to create a family —— should — deciding to create a family —— should not— deciding to create a family —— should not even be a part. and et should not even be a part. and yet you're _ should not even be a part. and yet you're hearing _ should not even be a part. fific yet you're hearing these kind of comments. ijust yet you're hearing these kind of comments. i just wonder, yet you're hearing these kind of comments. ijust wonder, dr kitessa, if you are also hearing those concerns, that women are not wanting to start families for example because of these adverse health effects? i

example because of these adverse health effects? i think it is a combination _ adverse health effects? i think it is a combination of - adverse health effects? i think it is a combination of the - it is a combination of the adverse house effects and high levels of mortality but also mobility. there is a lot of fear of that as well. —— morbidity. they are concerned about signing a family, about potentially expanding their family, particularabout potentially expanding their family, particular about the statistics and also i think based on their experiences that have had within the health care system, in the united states, the discrimination they've experienced, the lack of trust that they feel in the health care providers in the united states and these are all impacting their decisions about planning for their family. find planning for their family. and ou will planning for their family. and you will have _ planning for their family. and you will have just _ planning for their family. and you will have just heard from the investigative reporter who we were just speaking to, kat stafford at the associated press, and she was saying often these are put down to physical differences that may play one

part, but one thing i know you've touched on in the past, dr kitessa, is how long—term is governed is any health care system can result in poor birth outcomes. just tell us more about that.— about that. yeah, and so i think where _ about that. yeah, and so i think where this _ about that. yeah, and so i think where this is - about that. yeah, and so i think where this is really l about that. yeah, and so i. think where this is really poor to take into account, when you look at the statistics, and you break down by socioeconomic status, black women of heights -- hi —— hi socioeconomic status have poorer white women with less than a high school sit down next education, —— title education for tub it is not just poverty at play here. one thing thought to be a factor in this work chronic stress from discrimination for a years and generations is having an impact on the health of black people in this case, black women, in this country, increasing the risk of hypertension, diabetes actually affecting the dna that premature ageing in black

people, because of the discrimination, so it is having tremendous effects. dr discrimination, so it is having tremendous effects. dr bayo, we were 'ust tremendous effects. dr bayo, we were just talking _ tremendous effects. dr bayo, we were just talking about _ tremendous effects. dr bayo, we were just talking about the - were just talking about the generational impact. have you also seen generational mistrust filtering down as well? i also seen generational mistrust filtering down as well?- filtering down as well? i have. when we _ filtering down as well? i have. when we think— filtering down as well? i have. when we think about - filtering down as well? i have. when we think about how- filtering down as well? i have. when we think about how we | filtering down as well? i have. i when we think about how we are to personally, black people, for affected by certain diseases that we hear about, we have _ diseases that we hear about, we have to — diseases that we hear about, we have to take a step back and think— have to take a step back and think about why that may be happening —— disproportionately. and when you took— disproportionately. and when you look at the fact that there is this— you look at the fact that there is this mistrust, which leads to the — is this mistrust, which leads to the inability or not wanting to the inability or not wanting to go— to the inability or not wanting to go in— to the inability or not wanting to go in and access care, seek out care, _ to go in and access care, seek out care, all_ to go in and access care, seek out care, all of those pieces are reatiy— out care, all of those pieces are really important, and another— are really important, and another piece i want to talk about, _ another piece i want to talk about, as _ another piece i want to talk about, as we talked about how sociai— about, as we talked about how social economics do not play a role, — social economics do not play a role, as— social economics do not play a role, as a _ social economics do not play a role, as a physician, i had this— role, as a physician, i had this happen to me, and so it really— this happen 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 understands something is wrong _ wrong and understands something is wrong was dismissed.— is wrong was dismissed. that's really interesting, _ is wrong was dismissed. that's really interesting, that - is wrong was dismissed. that's really interesting, that you - really interesting, that you are able to tell us more about your own personal experience, someone with your education. with your medical professional knowledge. just tell us more about how, for example, it is not necessarily about or it is not necessarily about or it is not about physiological difference, it is about pain and people being listened to, and people being listened to, and pain being taken seriously. absolutely. when you look at first — absolutely. when you look at first about risk, you have to think— first about risk, you have to think about, it is a social construct, it is not biological, and so when you have — biological, and so when you have a _ biological, and so when you have a group of people, of black— have a group of people, of black people, who are dying at a higher— black people, who are dying at a higher rate, it is structural racism, _ a higher rate, it is structural racism, it— a higher rate, it is structural racism, it is unconscious bias, and _ racism, it is unconscious bias, and for— racism, it is unconscious bias, and for me. _ racism, it is unconscious bias, and for me, i knew after i finished. _ and for me, i knew after i finished, came out of my c—section, that something was not right _ c—section, that something was not right i_ c—section, that something was not right. i did not feel the same — not right. i did not feel the 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 are fine, — nurse, and she said, you are fine, your— nurse, and she said, you are 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 that i normally was able to do after the first c—section. shortly afterthat, c—section. shortly after that, my c—section. shortly afterthat, my husband ended up calling mike — my husband ended up calling mike colleague, my 0b, and said that something is wrong with bayo. — that something is wrong with bayo, come back and check on her, _ bayo, come back and check on her. so — bayo, come back and check on her. so i — bayo, come back and check on her, so i was taken back to the or her, so i was taken back to the 0r because he recognised 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 doctor, a physician, but in — medical doctor, a physician, but in the _ medical doctor, a physician, but in the end, i was a black wornan— but in the end, i was a black womanjust like everyone else that is— womanjust like everyone else that is impacted by these statistics.— statistics. that is a horrifying - statistics. that is a i horrifying experience, statistics. that is a - horrifying experience, and statistics. that is a _ horrifying experience, and we are grateful for you sharing it. dr kitessa, something i want to ask you about is,

often, women are told to advocate for themselves, but is this just about women advocating for themselves? is this also not about medical professionals listening? yes, and i professionals listening? yes, and i was _ professionals listening? yes, and i was a — professionals listening? yes, and i was a more _ professionals listening? yes, and i was a more so - professionals listening? yes, and i was a more so it - professionals listening? yes, and i was a more so it is - and i was a more so it is done... the burden should be on healthy professionals, the healthy professionals, the health care community, to change —— health care professionals. this should not be borne by black women and patients, ourjob is to care for people, so really there needs to more conversations, more policy changes, more education, and to really change and affect the bias that is affecting black women in health care, and so the burdens of the is on us as health care providers and physicians and the health care system to change, to change these statistics and decrease this disparity and decrease maternal mortality in the united states.

dr kitessa, dr curry—winchell, do stay with us, because i want to take a little look at a case study. one state focused on the mortality rate is newjersey, which previously had one of the highest maternal mortality rates in the united states, and earlier i spoke with the first lady of newjersey, who has been working to dismantle those disparities within her state. thank you so much forjoining us here on bbc news to talk about a topic which i know you're very focused on, and recent tragic news of the death of sprinter terry -- tori —— tori bowie has really brought attention to the learning state of maternal mortality in the united states right now, critically black women, american albina most dangerous place to be pregnant or to give birth in high income countries. —— now being the most. why are doctors not more focused on this?— focused on this? first of all, thank you — focused on this? first of all, thank you for _ focused on this? first of all, thank you for your _ focused on this? first of all, thank you for your interest l focused on this? first of all, | thank you for your interest in this, and i think that with tori, it is 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 by 100 m, 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 this? this is a systemic problem across the country and it comes down, i hate to say it, but it is systemic racism. there are circumstances where women are 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. 0n the other hand, they are not taken seriously —— taken seriously and there sometimes dismissed, and when you have people like serena williams or beyonce, who have also nearly died delivering babies, who have incredible platforms, you have incredible platforms, you have to accept the fact that something is really wrong and

it needs to be addressed. this it needs to be addressed. as ou 'ust it needs to be addressed. as you just mentioned there, we had 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 start. what needs to be done to tackle this, to address this? so it has to be transformational change. and when i say that, it is everything from workforce development to access to care the 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 back in 2019, and that was really to raise awareness and to also correct

the scourge that we have here in newjersey. you just talked about 2.6 in terms of differential. in newjersey, according to data from 20162018, 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 for my husband came to office, we are 45th in the country in mortality risk most subs to a7. as of yesterday, it has been said that we are now 29th. so we're definitely moving the needle. are policy changes that we can make. we have a nurture newjersey plan, we invalidate in 2021, that has 70 different action steps, of which we have tackled about half of them, and a dishonestly shown we are moving the needle here, and i would say that the highlight, three that are really important and we know they have really made and

impactful to one is we are in the third state to provide dedicated reimbursement for care, but we are the only to reimburse and grow our community workforce —— medicare l it has been proven to move the needle in the space. second we expanded medicaid coverage to 365 days postpartum but we also have increased our medicaid rates for our entire perinatal workforce to 100% of medicare rates. this means that not only do mothers, all mothers, have equity in terms of their health care, it means more providers will take medicaid coverage, and that means less waiting times for the patient. {line times for the patient. one thin i times for the patient. one thing i do _ times for the patient. one thing i do want _ times for the patient. one thing i do want to - times for the patient. one thing i do want to ask - times forthe patient. one thing i do want to ask about, alongside those measures, is the fact that the united states is a country where there is no

enshrined, in law, mandatory, paid maternity leave, and his wonder if you got is also damaging to women's health? yes. i guess the short answer is yes, and the reason i would say that is the death... most of the debts happen after delivery. most people think this happens at delivery. it is not, it is after delivery, and so women go home, you don't know what they're going home to, and you don't know if they are going to go right back to work, if they are going to 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 of birth and we are addressing that in newjersey as well with the most robust universal nurse home visitation programme. yes, is the answer.— is the answer. and so, first lad , is the answer. and so, first lady. you — is the answer. and so, first lady. you have _ is the answer. and so, first lady, you have outlined - is the answer. and so, first i lady, you have outlined some is the answer. and so, first - lady, you have outlined some of the steps that newjersey 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? just 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 having all sorts of

benchmarks. we are now 29th in the rankings. the march of dimes also came out they report that showed the improvement across the country in terms of reducing preterm births. they looked at 53 states and territories, and director new jersey is one of the four that improved. we definitely have a secret sauce and we'll continue working on this.— working on this. first lady of newjersey. _ working on this. first lady of newjersey, tammy - working on this. first lady of newjersey, tammy murphy, there. also an advocate for women's health. thank you for joining me here on bbc news. thank you, helena. back to our panel now, dr doee kitessa, _ helena. back to our panel now, dr doee kitessa, and _ helena. back to our panel now, dr doee kitessa, and dr - helena. back to our panel now, dr doee kitessa, and dr bayo . dr doee kitessa, and dr bayo curry—winchell, talking about how this whole issue should be tackled. we were just hearing there from the first lady of newjersey on the issue. are

those some solutions that you think could be implanted more broadly, to you, dr curry—winchell? broadly, to you, dr curry-winchell? broadly, to you, dr cur -winchell? , ~ curry-winchell? yes, i think this is a great _ curry-winchell? yes, i think this is a great step, - curry-winchell? yes, i think this is a great step, and - this is a great step, and finding— this is a great step, and finding ways to increase access, _ finding ways to increase access, but we also cannot forget, _ access, but we also cannot forget, without access, as we talked — forget, without access, as we talked about, it is all social economics, so we have to lean into, _ economics, so we have to lean into, what— economics, so we have to lean into, what are we doing to invest— into, what are we doing to invest in— into, what are we doing to invest in unconscious bias, meaning _ invest in unconscious bias, meaning these kind of thought processes that black people do not feel— processes that black people do not feel as much pain as we mentioned? a recent study in 26 in highlighted that. we half of course — in highlighted that. we half of course look at expansion for certain— course look at expansion for certain insurance, as far as medicaid, _ certain insurance, as far as medicaid, but we also know that commercial insurance of all social— commercial insurance of all social economics are impacted try social economics are impacted by this, — social economics are impacted by this, so _ social economics are impacted by this, so more work to be done, — by this, so more work to be done, but _ by this, so more work to be done, but this is a great step. 0n done, but this is a great step. on that— done, but this is a great step. on that issue, dr kitessa, to you, ijust wonder, are you seeing younger medical

profession is being trained to understand implicit bias? and how can they reach people who have been perhaps in the medical profession for much longer time? medical profession for much longertime? j medical profession for much longer time?— longer time? i think this is one of the _ longer time? i think this is one of the things - longer time? i think this is one of the things that - longer time? i think this is one of the things that has| one of the things that has changed a lot since i was in medical school. we did not talk about health disparities very much or unconscious bias, and now most medical schools, including where i am, that is part of lectures and discussions from first year in 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. as you said, we cannotjust that has occurred. as you said, we cannot just focus that has occurred. as you said, we cannotjust focus on our learners, because we need to focus on physicians who are in practice right now, and so that is the work that i do as director of our diversity inclusion programme in my department, is educating, is having conversations, is working with people to get all of us to confront our own biases for stub we are human,

we have biases, and it is important that we learn to understand them, to a knowledge 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 in 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. ladies, thank you _ diversity as well. ladies, thank you both _ diversity as well. ladies, thank you both so - diversity as well. ladies, thank you both so much | diversity as well. ladies, i 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. iam i am helena iam helena humphrey i am helena humphrey on bbc news. you can always find more news on a mac website. thanks so much for your company. more coming up at the top of the hour. i will see you then.

hello there. we saw a lot more cloud around on saturday, and it signals a change in the type of weather. we did manage some sunshine, mind you, and temperatures, 27 celsius in the south—east of england, where it is much better weather for a fly—past this time. but things are really going to kick off on sunday, especially later on in the afternoon, through the evening, a lot of rain developing, could be some large damaging hail. torrential rain likely to bring some flooding, and a lot of thunder and lightning, as well. we start the day with some sunshine, but may well be some sharp showers from overnight in the south—east of england and east anglia. and as temperatures rise, so the cloud builds up, and we'll see more of those downpours developing, particularly across england and wales and into northern ireland. probably not so many showers in scotland. more in the way of sunshine here, and temperatures around 22—2a celsius — and again, it'll be quite muggy. now, we may well have

some thunderstorms across northern ireland, but the worst of those will be developing across parts of england and wales. and through the latter part of the afternoon, into the evening, really wet weather will push its way northwards up into northern england, away from southern england and the midlands, and wales, and eventually that wetter weather arrives overnight into scotland. some torrential rain likely to bring some flooding, a lot of thunder and lightning in there, as well. that wet weather still across northern scotland on monday — it does tend to ease off. following on from that, there'll be some sunny spells, a scattering of showers, 1—2 of them on the heavy side perhaps. many places may well be dry. still quite warm, temperatures again around about in the mid—20s, more likely across the midlands and eastern parts of england. now instead of high pressure that's brought dry weather for some areas of the country for so long, it'll be low pressure that's sitting close by over the week ahead, which will bring the threat of some more heavy and thundery downpours. there'll be some sunshine around as well on tuesday, and it should be quite warm. many eastern areas likely to be

dry — it's out towards the west that we've got most of those thunderstorms developing, and again, there could be some localised flooding. so temperatures around about 22—23 celslius on tuesday. and we'll keep temperatures over the weekend around the mid—20s or so. there will be some further heavy, perhaps thundery showers over the weekend. maybe turning a little less humid, a little fresher, and perhaps some southeastern parts of the uk later in the week will be a bit drier.

this is bbc news. this is bbc news. we'll have the headlines we'll have the headlines and all main news stories for you at the top of the hour straight after this programme. and all main news stories a look at what's hello, everybody. hello, everybody. a very warm welcome a very warm welcome to talking business weekly to talking business weekly with me, aaron heslehurst. with me, aaron heslehurst.

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