TULSA, Okla. — In the place of a racial murder that reduced neighborhoods reduced to ashes a century ago, where murals once flourished “ Black Wall Street“An African American mother tries to prevent others from dying while trying to bring new life into the world.
Black women are more than three times as likely to dying from pregnancy or childbirth such as white women in Oklahoma, a state that consistently ranks among the highest maternal mortality rates in the United States.
“Tulsa is hurting,” said Corrina Jackson, who directs a local version of the federal Healthy Start program, coordinating needed care and helping women through their pregnancies. “We’re talking about lives here.”
Across the country, programs at all levels of government — federal, state, and local — share the same goals of reducing maternal mortality and closing the racial divide. No one has all the answers, but many are making progress in their communities and paving the way for other places.
Jackson’s project is one of more than 100 funded through Healthy Start, which has distributed $105 million in grants nationwide this year. Officials call Healthy Start a critical part of the Biden administration plan to address maternal health.
Other approaches to the crisis include cutting California’s maternal mortality rate in half through an organization that shares best practices for treating common causes of maternal death, and New York City expanding access to midwives and doulas two years ago. Several states have passed laws this year aimed at improving maternal health, including a drastic measure in Massachusetts. And last week, the U.S. Department of Health and Human Services announced more than $568 million in funding to improve maternal health through efforts such as home visits and better identifying and preventing pregnancy-related deaths.
At the local and national level, “we really need to identify the people who are giving birth who are potentially at greatest risk,” said Dr. Ashwin Vasan, New York City’s health commissioner, “and then embrace them throughout their pregnancies.”
In addition to coordinating prenatal and postnatal care — which experts say is crucial to keeping mothers alive — local Healthy Start projects offer pregnancy and parenting education and referrals to services for issues such as depression and domestic violence. The local efforts also involve women’s partners and children up to 18 months. And they focus on issues that impact health, such as transportation to appointments.
“We try to get them into their first trimester and then work with them all the way up to delivery day, and then we work with the babies to make sure they’re hitting their milestones,” Jackson said.
As a single mother, Jackson received help from her local Urban League and felt called to give back to her community. She has been with Healthy Start for more than 25 years, first through the Tulsa Health Department and more recently through a nonprofit she founded that received about $1 million in federal funding this fiscal year.
“I’m like a mother to this program,” Jackson said.
Overall, Oklahoma has a maternal mortality rate of about 30 per 100,000 live births, significantly higher than the national average of about 23. But in Jackson’s 25-year tenure, she said, there have been no maternal deaths among clients.
Critical to Healthy Start’s success are care coordinators like Krystal Keener, a social worker at Oklahoma State University’s obstetrics and gynecology clinic, where clients receive prenatal care. One of her responsibilities is to educate clients about health issues, such as how to recognize the signs of preeclampsia or how much bleeding is too much after delivery.
She also helps with practical matters: many clients do not have a car, so they call Keener when they need transportation to a prenatal visit, and she helps schedule a visit.
Keener serves as a patient advocate with physicians. On a recent afternoon, Keener sat in on a prenatal appointment for Areana Coles. Coles, a single mother, was accompanied by her 5-year-old daughter, who was born prematurely and spent time in the intensive care unit.
Coles, 25, said Healthy Start was “probably the best thing that’s happened to me this pregnancy.” She called Keener “an angel.”
Together they tackled a number of recent medical issues, including dehydration and low potassium levels, which landed Coles in hospital.
As Coles’ due date approaches, Keener spoke about what to watch out for around the time of delivery and shortly afterward, including blood clots and postpartum depression. She advised Coles to take care of herself and “give yourself credit for the little things you do.”
During an ultrasound a few minutes later, Coles watched Dr. Jacob Lenz point to her unborn baby’s eyes, mouth, hand and heart. He printed out an image of the scan, which Coles immediately showed to her daughter.
Keener said she was glad Coles wouldn’t be giving birth prematurely this time.
“You did it – hooray!” she said to her client.
Coles smiled. “My body can do it!”
While programs like Healthy Start focus on the individual needs of the patient, there are other initiatives that manage the overall quality of medical care.
California has the lowest maternal mortality rate in the country — 10.5 per 100,000 live births, less than half the national rate. But that wasn’t the case before it created a “maternal quality care collaborative” in 2006.
Founded by Stanford University School of Medicine in partnership with the state, it brings together people from all hospitals with maternity units to share best practices for dealing with problems that can lead to maternal injury or death, such as high blood pressure, cardiovascular disease and sepsis.
“If you look at the maternal mortality rate in the United States compared to California, they were basically neck and neck until it was identified,” said Dr. Amanda Williams, clinical innovation advisor for the collaboration. “At that point, they completely split up and California started to go down. The rest of the country started to go up.”
Under the partnership, hospitals will receive toolkits filled with materials such as care guidelines in multiple formats, best practices articles and slides that explain what to do in a medical emergency, how to set up medical teams and what supplies to have on hand in the unit. The partnership will also address issues such as improving obstetric care by integrating midwives and doulas, whose services are covered by the state’s Medicaid program.
Williams says some doctors initially resisted the effort, thinking they knew best, but now that the collaboration has proven its worth, there is much less resistance.
MemorialCare Miller Children & Women’s Hospital Long Beach began participating around 2010. The collaboration helps “scour all the research that’s out there,” said Shari Kelly, director of perinatal services. “It’s just so important to really understand how we as providers can make a difference.”
For example, if a woman is losing a certain amount of blood after vaginal delivery, “we know to activate what we call here a ‘code crimson,’ which brings blood to the bedside,” Kelly said. “We can act quickly and stop any potential bleeding.”
She said the collaboration has also helped reduce racial disparities, for example by reducing the rate of C-sections among black mothers.
In July, the US Centers for Medicare & Medicaid Services proposed a similar initiative to California’s, aimed at improving the quality of maternity care across the country: the first basic health and safety requirements for emergency and maternity care for hospitalized women.
Experts say that to control maternal mortality at the national level, it is necessary to tailor solutions to individual communities, which is easier if programs are implemented locally.
New York City has a goal of reducing maternal mortality overall, and specifically achieving a 10 percent reduction in Black maternal mortality by 2030. Across the state, Black residents are about four times more likely to die from pregnancy or childbirth than white residents.
The city is starting with low-income residents and those living in public housing, among others. The New Family Home Visits Initiative brings pregnant and postpartum people with visits from professionals such as nurses, midwives, doulas and lactation consultants. Vasan said more than 12,000 families have received visits since 2022.
Nurse Shinda Cover-Bowen works for the Nurse Family Partnership initiative, where she visits some families for 2 1/2 years, long after pregnancy and birth. She said, “That consistency of having someone there, listening to you, and guiding you through your motherhood journey is priceless.”
Being rooted in the local community — and its history — is also crucial to Healthy Start projects. The lingering effects of racism are evident in Tulsa, where an estimated 100-300 Black people were murdered by white residents in 1921 and destroyed houseschurches, schools and businesses in the Greenwood section, where Jackson now lives, and where health disparities persist.
Being relatable is valuable for Black women, who may distrust the health care system, Jackson said. Additionally, knowing the community makes it possible to work closely with other local agencies to meet people’s needs.
Denise Jones, who enrolled in Healthy Start in February, struggled with anxiety, depression and drug addiction, but has been sober since April.
In mid-July, her room filled with baby gear — a crib, a bassinet, tiny clothes neatly hung in a closet — in anticipation of her child’s arrival. Jones, 32, leafed through a baby book and pointed to an ultrasound of her son, Levi, due in a few weeks.
She said she feels healthy and blessed by the help she has received from Healthy Start and Madonna House, a transitional program of Catholic Charities of Eastern Oklahoma.
“I have professionals working with me and supporting me. I didn’t have that with my other pregnancies,” she said. “I’m one with my baby and I can focus.”
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Nicky Forster, a data journalist with the Associated Press in New York, contributed to this report.
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This is the second story in a two-part series examining how the United States can reduce the number of deaths from pregnancy and childbirth.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.