Season 2: Episode 1:Unmasking Maternal Mortality: Confronting Racial Disparities and Reproductive Injustices with LeJeune Johnson, LCSW

Episode Description

Why is it that despite advancements in technology and medicine, maternal mortality rates continue to rise, particularly among Native and Black women? That's the unsettling question we tackle today with our esteemed guest, LeJune Johnson. As a licensed clinical social worker with a rich history in mental health and a seasoned professional from the Mississippi State Department of Health and the Centers for Disease Control (Contractor Consultant), LeJeune unpacks this pressing issue with us. We leave no stone unturned in investigating the systemic factors contributing to this shocking trend.

Then, brace yourself as we navigate the somber corridors of history, revealing the haunting legacy of reproductive injustices against Black women. From the infamous surgeries performed by Dr. J Marion Sims on enslaved women, to Fannie Lou Hamer's coined term Mississippi appendectomy, we lay bare the harsh realities of the past. LeJeune then sheds light on how these injustices can be confronted and mitigated, guiding us on a path towards health equity. This episode challenges us to question and combat healthcare inequities in today's world. Tune in for an illuminating conversation that will leave you informed, provoked and ready to take action.

Powerful The Podcast Intro

Powerful the podcast  Outro Music

Transcript

Speaker 1: 0:30

Welcome to Powerful Podcast. My name is Shalonda Carlile, and we have also.

Speaker 2: 0:36

Dr Bianca Bulley Kawase Williams.

Speaker 1: 0:41

And today we will have a powerful conversation about maternity mortality. Our wonderful guest, lejune Johnson, has provided therapy-based services to children and families of Mississippi. She is a licensed clinical social worker with a professional and academic background heavily invested in the mental health field. In 2006, she received her bachelor's degree in social work from Mississippi State University. She later attended Jackson State University and acquired a master's of social work degree in 2008. Her passion for working with trauma survivors that has led her to pursue a trauma-based graduate program at Mississippi College. In 2017 of August, she earned a trauma-informed care certificate.

Speaker 1: 1:33

She has been practicing social work since 2008 and she has been a licensed clinical social worker since 2011. Her professional background is rooted in providing trauma-related therapeutic services to at-risk populations. She strives relentlessly to provide therapeutic, educational and life skills, enrichment services and resources to those populations that are underserved and considered to be at risk and vulnerable. Her services are aimed at enhancing and strengthening youth and families. Therapy presents the opportunity for growth and healing. I want to welcome Ms LeJune Johnson and also would love for her to tell us about her new role that she has taken on for the state of Mississippi. Hello.

Speaker 4: 2:30

Thank you so much. Thank you so much for the warm welcome And, of course, for the invitation. I certainly appreciate the opportunity to share this space with you all and this platform to talk about maternal mortality a little bit nationally, but also regionally here and what that looks like in Mississippi locally. So my background with maternal and infant health dates back about three years. Three years ago I joined the Mississippi State Department of Health as a clinical social work consultant with their Maternal and Infant Health Bureau And for the last three years I have served on their maternal mortality review committee And I think there'll be some opportunities for me to kind of delve in and talk a little bit more in depth about that maternal mortality review committee a little later on.

Speaker 4: 3:30

But I've been doing that for three years And most recently I have adopted a role with the Centers for Disease Control as a contractor, consultant and trainer for their race maternal mortality initiative And I'm really really excited about that and that that that new venture. I have the opportunity to train other MMRCs across the United States about the importance of informant interviews, and informant interviews is a qualitative data collection tool where we reach out to the surviving family members of maternal loss and we capture their story and we integrate that into the data that we collect about the woman's death and the circumstances leading up to their death, and so I'm very honored and humbled to be able to do that. I'm humbled to be immersed in this work for the last three years And again, i'm very excited to be here with you all today.

Speaker 2: 4:42

Yes, thank you, lejeune. I have been reviewing some of the National Center for Health Statistics E-Stats on maternal mortality rates and I did not know that maternal mortality was such a significant topic in the rates of maternal deaths in the United States. Can you explain or provide a general definition for the listeners on what maternal mortality is and why is it so important?

Speaker 4: 5:24

Absolutely, and that is a really great question. And before I deep dive in and get really talking about this important topic, i just want to throw a little disclaimer out there that, although I do work as a clinical consultant for the Mississippi State Department of Health and as a contractor consultant for the Center for Disease Control, the views that I express today are my own and may not necessarily reflect those of the CDC or the Mississippi State Department of Health. Have to throw that out there, although the data that I share with you all is very real, very concrete. These are numbers that I have resource from. Typically I resource numbers from the Center for Disease Control.

Speaker 4: 6:11

But, dr Bulley, maternal mortality is something that most recently, in recent years, has had started to come up on a lot of people's radar.

Speaker 4: 6:20

And I don't want to get too technical about the definition of maternal mortality because depending on who you, what organization, public organization you ask, the definition may slightly vary. But essentially, maternal mortality is the death of a woman during pregnancy or during labor and delivery or in the postpartum period. And maternal mortality is an important issue everywhere, but particularly here in the United States, because data and research tells us that maternal mortality rates in the United States are more than three times the rate than other high-income countries or countries that we consider to be developed countries. I mean it's really hard to believe that it is more dangerous to give birth today than it was 30 years ago. And I mean I tell people you know when I say that, really let that sink in that you know, in the past 30 years we've had advancements in technology and medicine and equipment, but all of that has done very little to curb maternal mortality rates And that decade after decade these numbers continue to climb. And nationally and regionally we see that Native and Black women are disproportionately impacted by maternal death.

Speaker 2: 7:46

That is mind-blowing because many years ago, our grandparents were having seven, if not 10, children with no problems at all, and you would think, with today's technology and advancements, that the numbers would significantly be going down. But yet, when I was reviewing, the data every year is going up and up and up. Why do you? I know some of the other undeveloped countries, as you say. Our numbers are not as up as ours, so why do you think that that is? Why are we steady, going up instead of going down?

Speaker 4: 8:32

Well, great question, Great question And a lot of maternal health care advocates that we get together and we discuss these things to try to figure this out And, to be honest with you, when we look at who is impacted and where they are impacted regionally, we see that Southern states typically tend to have higher maternal mortality rates.

Speaker 4: 8:58

We also see that areas that are identified as maternity care deserts And I think we're going to get into a conversation a little in depth about what maternity care deserts are But essentially, maternity care deserts are regions where there is a significant lack of access to obstetric care or an OBGYN. That is impacting numbers. And when we talk about specifically these numbers that impact Native and Black women, from a national perspective, Native and Black women are two to three times more likely to die from pregnancy-related complications than than white women. That's from a national perspective. And so you know, when we talk about race and health equity, health inequity, racial disparity in maternal and infant health, we have to also have a conversation about discrimination and bias and how that impacts the numbers that we're seeing as well.

Speaker 2: 10:04

Absolutely. In this day and age you would think discrimination with health care would be a topic that is not being discussed, but in this day and age is still a very relevant and a very known, which, to me, is just. It just puts disgust in my, in my, in my, in my, in my very being. Knowing that the very field that I work in, that we still have such discrimination when people enter the ER or come seeking for health care, instead of treating each person in the visual and not based on their race, and providing the same equal care whether their white, black, hispanic or Chinese, is very just. This heartening to say the least I don't have words for because I thought we would be past that by now and the numbers are so alarming.

Speaker 4: 11:15

Absolutely It's. It's definitely sobering to know that. You know the Latin. Very little has changed over the last few, few decades. I mean earlier you mentioned that.

Speaker 4: 11:28

You know back in the day. You know our mothers, our grandmothers, you know we're we're having more optimal births than we are having now. And when we talk about previous generations, specifically black women, you know there was a time in the south or black women couldn't give birth in the hospital because of segregation. So you have to have your baby. Who was giving, who was helping you give birth to your baby typically was a well respected midwife in the region and she would come around and and give birth and this was a very well respected individual in the community.

Speaker 4: 12:13

You were talking about women having, you know, more births. You know my grandmother had 11 births and 10 of those births were at home and the last birth was actually in a hospital because segregation. You know they had lifted segregation and integrated the hospital so she could have that baby at home. But you know, today research also shows us that black women have better health birthing experiences when they have access to midwifery and doula services. So you know that's definitely a tactic that we can adopt. You know, increasing access to doula services and midwifery services to women and birthing women having children, to kind of help combat this.

Speaker 3: 13:02

So I was reading some data and I found something. I don't know whether or not it's true or not. I just let me just ask the question do you feel that in the state of Mississippi we are as far as number one when it comes to infant mortality rates here?

Speaker 4: 13:22

Well, you know, the sad reality is that, yes, you know, the CDC released new numbers last year identifying Mississippi as number one in infant mortality or infant death, and that is the number one ranking that we don't want to be on top of. you know, i think in previous years it was Louisiana. so again, do you see the trend of southern states kind of being at the top of these adverse incomes when it comes to maternal and infant health care? But basically what that means is babies born in Mississippi are more likely to die before their first birthday than any other state in the United States.

Speaker 3: 14:09

Do you think we have the resources to actually prevent some of these deaths?

Speaker 4: 14:15

Absolutely. I think so. I think we have resources. I think we also can open ourselves up to more resources. This is a very calm. It's getting heavy off. It's a very complex, multi-layered situation.

Speaker 4: 14:34

Back in March, we just adopted postpartum Medicaid expansion. We just got that done. Maternal health care advocates, maternal and infant health care providers in the field have been advocating this for years as a tactic to combat maternal mortality infant mortality as well. You know, adopting postpartum Medicaid expansion can improve outcomes in the state of Mississippi and we finally got that done. However, I want to say that that was specifically for postpartum care. What we really need to start thinking about is taking advantage of Medicaid expansion as well. That is also a tactic that we can embrace.

Speaker 4: 15:30

Unfortunately, in Mississippi, we have been holding out on accepting Medicaid expansion, which would improve a lot in the state of Mississippi. I think that a report came out last year that Mississippi adopting Medicaid expansion would lead to 11,000 jobs each year, then pre-expansion levels, and that we would see a reduction in uncompensated health care costs. That's a really big deal in Mississippi, because what we're seeing is that a lot of our rural hospitals are closing and that's impacting our health care outcomes too in Mississippi. If you have to travel over an hour away to get medical attention for your baby or for yourself, that impacts your ability to access care and that will adversely impact your health care outcomes. Specifically, the Mississippi Delta has been significantly hit with hospital closures and Medicaid expansion has been identified as a way to help improve that, to reimburse hospitals at a higher rate so they won't face these closures.

Speaker 4: 17:00

I know that since Mississippi has been in a lot of negative national attention about our maternal mortality numbers and infant mortality numbers, the Mississippi State Department of Health has actually initiated a Healthy Moms, Healthy Babies program. This program is actually going to launch in all 82 Mississippi counties and these services will be targeted to women and families who have identified health risks. The services would include case management where a nurse will come into your home to visit you, to check in on you. They will help you find medical services for you and the baby to come. They will also provide some wraparound services for your family and community supports. I think they're also going to link you to, if needed, to Medicaid services, food stamps, WIC, providing nutritional information. This is a new program, I believe, that just recently launched and is really targeted for all 82 counties. I think that is also going to help us. Time will tell for sure. I do think that there are tactics that we can adopt in support of better healthcare outcomes for mom and for baby.

Speaker 3: 18:34

Great information, and those particular services are most definitely needed.

Speaker 4: 18:39

Yes, absolutely We have to. I mean, you know, i think you know, we were in a, i think last year, with the CDC listing us as number one in infant death And then also recently, we learned that maternal mortality rates in Mississippi recently, january of this year we learned that maternal mortality in Mississippi is increasing. So you know, i'm glad that the health department has taken on a very proactive stance about community engagement and getting programs up and running to support our moms and babies.

Speaker 1: 19:19

And the June. I just want to thank you for being a part of this movement I was. I had the extreme pleasure of coming to your conference in March where we had a heavy discussion, a very informative discussion, on maternal mortality rates. We I found a lot of different good resources, like six dimensions, And I found something that was, is still is very hard for me to even look at when I go back and look at the videos. But I wanted you to kind of brief our viewers on the history of reproductive injustice for black women and specifically speak on Dr J Marion Sims. He was supposed to be the father of OBGYN, So I would love for you to kind of briefly speak on those experiments and information regarding that.

Speaker 4: 20:15

Sure, sure. And thank you, shalonda, for the sweet compliments about the conference. I enjoyed it thoroughly, we got a lot of great feedback about it And I was happy to have you to serve as a guest speaker on self-care, which is definitely just very important when you are most immersed in this work that is often considered to be traumatic. I mean, it can definitely be very sad work. But to circle back around to your question, you know the history of reproductive injustice towards black women is really deeply rooted in our US history And to fully understand where we are with the status of black women and maternal health healthcare or I would say the status of black women receiving poor maternal health care outcomes we really have to take into consideration the mistreatment of black women's bodies that have occurred in this country for generations. I'm glad you mentioned Dr Marion J Sims.

Speaker 4: 21:22

He is noted to be in medical textbooks as the father of gynecology And you know he was an American physician that practiced during slavery times in the 1800s. He's accredited with mastering a corrective procedure that was needed after a woman gave birth. So back then you know this injury was very catastrophic after childbirth, where a woman had maybe developed a hole between her bladder and her vagina, and this just led to very constant, uncontrollable urinary and bowel incontinence. And so this condition would often leave these women as outcasts in their community, black and white women as outcasts in their community. And for enslaved women, you know, slave masters could no longer profit from them because they had this condition. It was just very inconvenient. And so Dr J Marion Sims sought out to fix this right, and so initially, what people don't know is that he would initially practice the corrective surgery on white women. But white women found it intolerable and his, i believe, his physician, his colleagues, you know, they just you know they didn't go for it. So what he then resorted to was purchasing and leasing enslaved black women And he would practice this corrective surgery on them without anesthesia, and he was during a time when anesthesia was available And so. But he did not adopt the practice of using the anesthesia, and so you know and this is documented, documented events that occurred, and so even his colleagues they were, just so you know the procedure was so barbaric that even his colleagues disassociated themselves with him And would not assist him anymore. And so Dr Sims then taught his other enslaved women to act as nurses to assist him with holding women down as he would perform these corrective surgeries. And Dr Sims has become very controversial in recent years because basically he made a name for himself off the suffering of enslaved black women. They actually had a statue of him in New York City And I think a couple of years ago, you know, people really became an uproar about it And so they took that statue down.

Speaker 4: 24:19

But I mean, that is not the only instance of just reproductive injustices. We also know that during enslaved times black women were often left unable to nourish their own babies with breastfeeding because they function as a wet nurse for their slave masters. And I you know data or you know some maternal health care advocates will argue that that is still relevant today because black women typically have lower breastfeeding rates than other other races. I want to talk a little bit about Fannie Lou Hamer, and she was a very notable civil rights activist. She coined the term Mississippi epentectomy And this was a procedure that was done routinely in the South by healthcare providers and doctors where they would remove the womb of black women who they considered to be unfit to reproduce. So no consent, no inquiry. I think Fannie Lou Hamer went in for an appendix being taken out but also had her womb removed. But this was something that was routinely happening in southern states against black women.

Speaker 4: 25:49

And I think I think you know Henrietta Lacks is someone else who comes to mind. You know her blood sales have made so many wonderful advancements in the field of medicine, even today. I think her blood sales were used to help make the COVID vaccination. But her blood sales were taken without her consent And you know, if you read the story about Miss Henrietta Lacks, then you know that she actually died of her condition on the color ward of a hospital and was buried in a nameless grave. So when we talk about the history of reproductive injustices against black women, these are just things that we know about. There are many instances and cases that we will probably never hear about. That happened as well. But when we talk about the reproductive injustices against black women, this is what we're talking about.

Speaker 1: 26:45

Wow, this just has been a very great, informative and powerful conversation, lejune, and you know I want to give you the opportunity, if you have anything to say in closing, to our viewers that you feel like will be instrumental in, if they wanted to know more information or you know what are their next steps, if they feel like they're experiencing, or know somebody that is experiencing, some of this.

Speaker 4: 27:19

Yes, you know, i know that a lot of things that we discussed today is heavy, like it just feels it makes you. I try to end on a positive note because it's like, oh my gosh, you start to feel hopeless when you think about what's happening, what's continuing to happen in today's society. But I want you to know that having a platform such as this, where we can talk about awareness, where we can talk about what's happening because we can't change what we don't acknowledge right. So just taking a moment to acknowledge this is where we are, this is what's happening is a part of strategies for solutions. This is a part. What we're doing right now in this space is a part of prevention. So I'm very, very thankful for that. And, just in general, things that we all can do to the agents or agents of change or is embrace policies and practices that promote health equity, support efforts to increase access for care for all women or birthing persons. This includes embracing things like Medicaid expansion right here in Mississippi. And also, you know, understanding that our implicit biases are real. Everyone has them, i have them, you have them, but it's important for us to recognize what they are and confront them head on, because we know that research has shown that implicit bias can pose as a barrier to obtaining equitable health care from providers, and so we can confront this by increasing training for implicit biases and literacy about equity.

Speaker 4: 29:09

And also, you mentioned, you know what can you, what can you say to a person who's expecting, or an imposed part of them is basically speak up for yourself. If you think something is wrong, if you suspect something is wrong in your, your pregnancy, speak up. You know educating our family members and loved ones about the importance of speaking up for our loved ones, because they may, you know, after giving birth to a baby, you're tired, you may not feel like getting speaking up, but you know educating our loved ones and our friends and family to about the challenges that women are facing right here in Mississippi. To give birth is very, very important too, because then it helps them to become advocates for our mothers as well. So that's definitely something we can do. We can definitely turn this around. It's going to take, you know, community action. It's going to take engagement, it's going to take partnership, but we can definitely do it.

Speaker 1: 30:14

I want to thank you, LeJune, for being on the show. And if you can quickly give us your contact information if any of our listeners would like to reach out to you to render services for speaking engagements or any additional services that you offer with your agency.

Speaker 4: 30:34

Yes, well, you can find me on Facebook, of course, under therapy plus LLC. Give us a like And you can also. We have a website, wwwtherapy plus LLCcom, and I'm also on LinkedIn under LeJune Johnson.

Speaker 1: 30:57

Thank you, thank you, thank you. I hope everybody got something from this powerful conversation And I hope everybody has a great day And thank you for tuning in to this episode. Thank you.

Speaker 4: 31:15

Thank you, thank you.

Speaker 3: 31:18

You're welcome.