“We can’t continue trying to solve this problem from the grave. Figuring out what went wrong after somebody dies can’t be our best approach.”
– Kimberly Seals Allers
Interview with Kimberly Seals Allers
Kimberly Seals Allers is a leading health strategist, author, journalist, and thought leader on maternal and infant health and breastfeeding. She is heralded for her groundbreaking work on improving birth equity for Black and brown birthing people. Allers has coupled her long-standing work in education and advocacy with designing tech solutions that shift the narrative around maternal-infant health, create transparency related to pregnancy and birth experiences, and work to make health systems more accountable to their communities.
What are the challenges Black birthing people face related to childbirth and how can these challenges be addressed?
On the challenges relating to childbirth, I don’t think that we’ll get anywhere without accountability and transparency. People are doing anti-bias trainings, but they become a tick-the-box exercise because there’s no accountability for whether they improve the lived experience of care or not. The other way they are trying to address what’s happening with high rates of maternal mortality are review boards and committees. It’s very important work and a lot of emotional labor, but we can’t continue trying to solve this problem from the grave. Figuring out what went wrong after somebody dies can’t be our best approach.
With health systems right now there’s a very low bar. We regularly meet with hospitals and they’ll say, “Well, we haven’t had a maternal death in 2 years, 3 years, 5 years,” whatever it is, as if not killing us is the goal. They think that’s a win because they haven’t killed us or have very low rates of nearly killing us. That is deeply troubling. We are pushing for a much higher standard. We’re pushing to learn what is a 5-star experience is for Black and brown people. Black people often feel lucky to be alive regardless of the trauma that they’re carrying, regardless of what happened to them, they are made to feel that they should feel lucky to be alive if they survive childbirth. It’s crazy. These are the things that are harming people because it leaves us in a fear-based space and being afraid is no way to bring life into the world.
Can you shed light on the obstacles that Black birthing people experience with breastfeeding?
If we look at breastfeeding, we look at the ways that Black women, because of systemic racism when we were enslaved, were being used to breastfeed the children of our oppressors, and not breastfeeding our own children. There are many amazing slave narratives where we see that our own children died because of this. And this became a narrative thread: that breastfeeding was something that we did for others and not for ourselves.
When we look at how this plays out today, we see still older generations who may not feel that breastfeeding or chestfeeding is something that new parents should be doing; it reminds them of a time they would like to forget. That has an impact on breastfeeding duration rates. While initiation is still decent in this country, our ability to continue breastfeeding without this multi-generational support is challenging. Many Black and brown women have high participation rates in the labor force, but without Federal paid leave policies, one quarter of women are forced to return to work 14 days after a birth. They try to turn to parents and older relatives for childcare but these older generations either don’t know anything about breastfeeding or they have negative ideas about it.
As systemic racism still exists, it continues to impede our ability to access fair, respectful, and equitable care. In some of my earlier work (funded by the Kellogg Foundation) we found that Black mothers in the Southeast were disproportionately reporting that they had not been educated about breastfeeding. This raises the question of who is receiving that education? Who is viewed as “good enough” to feed their baby with their body and who is not trusted?
What kinds of solutions could better support mothers who are breastfeeding?
We pay a lot of lip service to families in this country, but we just don’t have actual family-friendly policies. I already mentioned Federal paid leave, a core policy that we still can’t seem to pass despite the desire among Americans to do so. But even when some policies are on the books, it’s in the implementation where things fall apart. There is lots of great breastfeeding legislation; people are free to feed their babies wherever and whenever. But because there’s no enforcement mothers are still being shamed, they’re still being kicked out of cafés and airports and malls and this creates a very dangerous narrative that breastfeeding is actually risky behavior. If you’ve read a media story that someone in your neighborhood got kicked out of the mall because of breastfeeding, why would you want to attempt that? Especially among Black people where there’s historical precedent that any kind of authority-involved incident could go left and become incredibly dangerous. There are disparities in our country. Who is the person who’s going to stand up to that security guard and say, “Actually, this right exists in this state and I’m free to breastfeed anywhere,” without repercussions? And who’s going to have police called on them, be wrestled to the ground or be threatened to have their children taken away because of it? It is not just about policies; it’s about making sure that folks are aware of those policies and uphold them. There’s a lot of education that’s missing, but the burden should not be on the birthing person to provide that education.
What is Narrative Nation and why did you develop it?
Through Narrative Nation, we have 2 key projects, one is a grant-funded podcast called Birthright, where I tell joyful Black birthing stories and the other is Irth (as in “birth” but without the “b” for bias) which is a digital platform that lifts up our stories and turns them into data for change. I started Narrative Nation because I wanted to democratize how the story of health disparities was told; the goal is to shift the narrative in maternal-infant health by shifting the narrator because we know that who is telling the story matters. I met Black women across the country who had positive birth stories, but they were afraid to tell them because they knew what so many of their sisters had encountered and had something like survivor’s remorse. With the Birthright podcast I wanted to center joy as a tool for birth equity and share uplifting stories because there are things we can learn from those too. People listen and think, “Oh, she had a positive experience. Let see what she did. Who was present at her birth? What can I do to get that right?” We also have restoration episodes about people who have experienced birth trauma where they sit down with a perinatal mental health therapist who takes them on a healing journey. It serves both the individual involved and is a demonstration for others of what healing can look like.
Irth is a platform where on the front end, we share community crowdsourced peer reviews of OBGYNs, birthing hospitals and pediatricians. We currently have reviews from about 47 states. To get the reviews, we do a deep-dive collection campaign that requires community engagement work including activating birth workers as IRTH ambassadors and working with local agencies. We know that ratings and reviews have been used to move other industries, particularly those that have been slow to self-regulate or improve, and by making our reviews public, we’re here to drive transparency and accountability. Irth exists to leverage our consumer power in service of birth equity.
We have been asking health care systems to do better for a long time, we have been training them, and it’s not getting any better. So through Irth’s back-end, what we offer to health systems is the opportunity to learn and to improve their care. We turn reviews into data that shows what’s working, what’s not working, what a particular hospital needs to improve upon, and what the community itself is saying about what matters to them. We work directly with health care institutions so they can improve their care of Black and Brown birthing people, because we know if we get it right for those who are being most harmed, we’ll get it right for everybody.