This was the fundamental question attendees explored during the May 12 Death by Delivery screening and panel discussion in North Little Rock, Arkansas. Reproaction’s maternal and infant mortality campaign is highlighting the reality that Black women are four times more likely to die from pregnancy-related causes than their white counterparts. The documentary screening was hosted at First Presbyterian Argenta and was followed by a panel that included physician and anti-poverty organizer Dr. Anika Whitfield, public health professional Shakia Jackson who works in maternal health disparities, and Nicolle Fletcher, an award-winning doula whose business serves Arkansans during and after pregnancy.

I moderated the conversation, asking questions about the panelists’ professional and personal experiences in the maternal healthcare landscape. The film brought up a lot of emotions–anger, shock, and for some attendees, a validation of their previous experiences.

Nicolle Fletcher, a doula and founding owner of Birth by Design, spoke about the stark differences she has witnessed firsthand in Arkansas hospitals. She described years of working with primarily white clients with few issues, building rapport with medical staff. When her business began growing in popularity in the past several years with Black clients, she noticed an immediate change in the demeanor of the same staff at the same hospitals.

“Before working with more Black clients, I didn’t understand the difference. But now I do. Because I’ve seen it.”

Fletcher recounted Black patients being sent home under the same circumstances in which white clients were admitted to inpatient care. She shared one patient’s experience waiting in triage for five hours and being denied an epidural even until her contractions shortened to three to five minutes apart. “I watched my client suffer. Pain and suffering are two different things, and pregnancy should not be about suffering.” She continued, sharing how white patients she would bring in with the same symptoms would be processed quickly and offered an epidural.

Dr. Whitfield shared insight about the need to actively confront these issues and acknowledge the roots of racial health disparities. Many rural areas of Arkansas do not have birthing centers or hospitals equipped to handle high-risk pregnancies. She emphasized the connection between race and poverty as forces harming pregnant women of color in Arkansas.

Panelists shared personal accounts of issues during their pregnancies. Fletcher recounted not being believed during her third pregnancy, where she presented at a hospital with active labor and was doubted by the staff. Within 10 minutes, she gave birth in triage, a room for sorting patients in emergency departments to decide the urgency of their needs. Jackson spoke about how her debilitating migraines caused by the baby’s position on a nerve was neglected by her physician. She expressed frustration for the lack of support from her doctors, and pointed to the distrust felt by communities of color towards the medical field. “The Black community needs doulas. Had I known I could have had someone looking out for me, things might have been different,” Jackson concluded.

The panel discussion highlighted two vital areas that need to change to stop women from suffering and dying during pregnancy: anti-bias medical training, and increasing the number of doulas and midwives throughout Arkansas. These, combined with a more robust health system that meets the needs of pregnant women in rural Arkansas, are necessary to changing the landscape of maternal and infant health in Arkansas.

Reproaction has begun work in Arkansas to highlight and address maternal and infant health, seeking to learn stories from women across the state. These problems are massive, complicated, and require us to work together at every level – from policymakers to community organizations – to create change. “When the elephant has been in the room for so long, it becomes normal,” concluded Fletcher. The sentiment of the panel was perfectly clear: Arkansas women deserve better.

If you have a story about your experience with pregnancy/childbirth in Arkansas or had a loved one who experienced problems during pregnancy, we want to hear from you!

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