In this wildly unsettled time, what does it take to decide to bring a child into the world? Love? Faith? Hope? Courage? Mere biology? Perhaps all of those, but sometimes it also takes help.
It almost has become trite to observe that it takes a village to raise a child. It is not noted often enough, however, that sometimes the village also is needed to successfully birth children.
In Cuyahoga County, the infant mortality rate among African American women is nearly four times that for white women. A remarkable organization—Birthing Beautiful Communities (BBC)—began working in 2014 to address this disparity by providing perinatal birth supports to Black women. BBC’s trained specialists—called doulas—provide physical and emotional support, education, advocacy and community engagement as they work to overcome the effects on birth of poverty, limited opportunity and proximity to violence—all of which contribute to the toxic stress that is central to the infant mortality crisis among Black women. Numerous scientific trials have demonstrated that doulas greatly improve physical and psychological outcomes for both mother and baby.
Deana Lawson, an acclaimed artist who has been widely exhibited, turned her camera lens on the work of BBC for the photographic essay featured this year on our website. Lawson portrays the mothers, children, fathers and doulas who BBC brings together to save lives through early intervention.
Birthing Beautiful Communities has grown rapidly in its short life, a testament to the quality of its work but also to the tragically great need for its services. Fortunately, it does not labor alone. BBC is part of a community-wide, coordinated plan of attack on high infant mortality rates called First Year Cleveland. Its key strategies focus on racial disparities, extreme prematurity and sleep-related infant death.
The work of First Year Cleveland has shown promising impact in its first few years, but the vexing racial difference remains alarmingly high. Although the infant mortality rate has declined for all groups, the disparity between white and Black infant deaths has grown.
The very fact that we must marshal the resources and commitment for Birthing Beautiful Communities and First Year Cleveland is just one aspect of the ongoing inequality in our society, which has been again starkly illuminated by the unequal impact of the COVID-19 pandemic and by the brutal on-camera killing of George Floyd.
The social isolation required by the pandemic is frequently punctuated by reminders that “We are all in this together.” And while that is certainly true, the limits of our togetherness are also quite evident. Multitudes have lost their jobs while others have not. Many of those still employed have the benefit of being able to work from home while others cannot. Among those who must report to work because they are essential are scores who are relatively underpaid, including health care aides, supermarket cashiers, delivery workers and others. Racial disparities coil through all of these circumstances, but perhaps the most prominent is the toll the virus is directly inflicting. African Americans are nearly a third of those hospitalized with COVID-19 in Ohio even though they are only 13% of the population. Nationally, Black people are five times as likely to need hospitalization as whites.
Although COVID-19’s impact has been uneven, a virus always has a reach that is potentially universal. The affluent may be able to more readily reduce the risk of exposure and access better testing and care. But no one can truly hide. The spread is insidious and it obviously can afflict people of every status. The very inequality of health conditions, the fact that a few bear a disproportionate burden, ironically is why everyone is at greater risk. It may be easier to ignore the society-wide costs of unequal schools and unequal opportunities. But the costs to everyone do exist; many people just look away. In the case of a viral pandemic, without a far better public health system and universal heath care, those who cannot avoid exposure are more likely to become carriers and transmitters of the disease. That puts everyone at risk. Looking away is no escape. One way or the other we all pay.
No crisis should go unused, and this can be an incredibly valuable opportunity for reassessment and reckoning. For pragmatic reasons alone, the pandemic should force us to take a fresh look at virtually every system and way of doing things.
But in the nation-defining period ahead there must be a call to conscience as well as self-interest. Racial inequities arising from countless societal decisions continue to afflict Black and Brown Americans. People of goodwill must seize this moment to force the scrutiny of disparities in education, incomes and employment, health care, housing and other fields. All of these inequities stem from choices that we have made as a society or that have been made for us. They are not inevitable.
These choices tragically include actions throughout our history that created the criminal justice system we have today, a system which, among many other failures, gave a Minneapolis policeman a belief that he had license to take George Floyd’s life in an appallingly heartless way. It was, of course, far from the first time something like that has happened to a Black American. But the repeated broadcasts of the video to an audience enlarged by quarantine sparked rage, anguish and multiracial cries—and marches—for justice. Perhaps Mr. Floyd’s legacy will be that his death generates enough empathy, understanding and enlightened self-interest to make lasting change.
Perhaps. But that is up to all of us, and especially to white people. We are still the largest and most powerful population group. We must emerge from both the social isolation of the pandemic and the far more complicated isolation of our privileged societal position to embrace not just the slogan, but the truth that Black Lives Matter. The consternation of some over the potential loss of historic monuments is nothing compared to what is really at stake: the loss of our core national beliefs, our animating national spirit, our ideals. For nearly our entire history we have celebrated those ideals even as we allowed the whitewashing of racism’s reality and its mockery of our lauded principles. We cannot lay honest claim to our ideals when we continue to so evidently deny them to Black Americans, a truth finally brought home for many by a video of a policeman—essentially a representative of our collective will—calmly murdering a Black man. If we do not change, those ideals are no longer ours.
But what ideals they are: All are created equal. Freedom. Equal justice under law. Democracy. They are worth fighting for and building toward.
In America, one of the primary ways that we wrestle with such issues is through civic engagement, politics and elections. Distressing and alienating as politics can sometimes be, if informed citizens fail to engage and take action, including voting, there can be no assurance that the policies enacted on our behalf will reflect the broad will of the people. That is the choice before us. Will we step out of our isolation, and add reasoned and compassionate voices to the inevitable clamor? Will we act?
Nature and George Floyd are telling us something both profound and elementary: In the final analysis, we are, in fact, all in this together. If we do not come out of these twin crises working to build a better, more just future, then the next contagion—perhaps a lethal virus or perhaps a violent uprising—will be the one that truly levels us. Yet, we need not be motivated by anxiety; signs of hope abound. They can be seen in the refreshingly multiracial marches for justice. In the encouraging poll numbers showing majority white support for Black Lives Matter. In the expectant and newborn faces in Deana Lawson’s photographs.
The road ahead may be hard, but only on it will we find the awakening that America needs and a new birth for our beautiful communities.