By Kylie Marsh for the Charlotte Post, with support from the Pulitzer Center on Crisis Reporting.
Broadcast version by Shanteya Hudson for North Carolina News Service reporting for the Charlotte Post-Public News Service Collaboration.

Tomeka Isaac was 35 weeks pregnant in 2018 when she suddenly fainted.

At the emergency room, Isaac and her husband were told that their son, Jace, died in utero. Without time to process, Isaac was also informed that she had HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet) with no further explanation and transferred to an emergency room to be induced.

Bereaved, Isaac investigated her medical records to determine how the baby died and whether it was preventable.

At 40, Isaac was at a heightened predisposition for preeclampsia, or high blood pressure during pregnancy. A 2021 report by the American Journal of Public Health found that Black women were five times more likely to die from heart and blood pressure-related conditions than white women, according to data between 2016-17. The report also found pregnant and postpartum Black women were two times more likely than white women to die of severe bleeding or vessel blockages.

“I checked all the boxes that they say is a cause of maternal death or stillbirth,” Isaac said. “I went to all my appointments, I had access to all other resources that I thought I needed, I had Blue Cross Blue Shield, I was going to a provider that I had been going to for years.” Isaac explained that she isn’t the typical victim of Black perinatal mortality. “When you check all those boxes, we still have a disparity.”

Never during Isaac’s pregnancy was a urine sample collected, and she has no idea why. If it were, doctors would have been able to detect preeclampsia much earlier.

Isaac’s experience is only one example of medical mistreatment or neglect women of color face at exponential rates in North Carolina.

Alexis Garrett knew she was considered a “high-risk” pregnancy because she was overweight and over 35 years old when her son Maui was born in 2020. She was referred to a “high-risk clinic,” Novant Maternal Fetal Medicine.

Garrett is acutely aware of the stigma placed against women like her in healthcare settings. She’d witnessed friends, cousins and acquaintances lose their lives or their babies due to birthing complications in hospitals.

“I try to limit my interactions with the healthcare system,” Garrett said. “I’ve always been kind of leery about it. As I grew older, you know, you hear the whispers and, oh somebody died here and somebody died there,” Garrett said. “[Providers] think we’re faking our pain, or have a higher pain tolerance,” she said. “For this reason alone, we are so unprotected and so unheard.”

One of Garrett’s friends, who also gave birth on the same day Maui was born, ended up losing her baby. Garrett delivered Maui vaginally at 26 weeks.

At a rate of 14%, Black infants are twice as likely to be born weighing less than 5.5 pounds than white infants (7%); the highest rate of any ethnicity. Similarly, the rate of premature births for Black infants, 14.6%, is the highest for premature birth rates, which can also contribute to low birthweight.

The U.S. Department of Health and Human Services Office of Minority Health reports that Black women have the highest rates of obesity compared to other groups in the United States, and that about 4 out of 5 Black women are overweight or obese. Last year, the Brookings Institute published research analyzing the distribution of grocery stores in several large U.S. cities. Grocery stores are less likely in Black-majority neighborhoods, regardless of the average household income of those communities. Feeding America reports that 1 in 5 Black people in America were food insecure in 2021, Black families’ poverty rate of 17.1% was higher than compared to the nationwide rate of 11.5%.

With a comprehensive view of the prevalence of these health conditions in the Black community, one can get a clearer picture of the source of the poor treatment, and poorer health outcomes, for Black mothers and their babies.

When having her daughter Hiro in 2021, Garrett was dealing with even more stress due to the murder of her partner, Horace McCorey. There are many stressors of daily life that have serious physiological health impacts on Black birthing people.

Author and doula Sabia Wade wrote about the effects of “weathering,” or the impact of stressors, in the 2023 book “Birthing Liberation: How Reproductive Justice Can Set Us Free.” For example, Wade reports the heightened frequency of Black people’s involvement with the criminal justice system, including deadly interactions, and high rates of unemployment especially following the COVID-19 pandemic in 2020.
A 2023 report from the United States Department of Justice states that an estimated 1 in 19 Black adult U.S. residents was under correctional supervision in 2021.

The U.S. Bureau of Labor Statistics reported that unemployment amongst Black adults was 11.4%, despite the average rate (among all demographics) of 8.1% in 2020.

“We don’t know if these people have hoods on when they treat us,” Garrett said, alluding to traditional headwear of Ku Klux Klan members.

Garrett’s second pregnancy presented just as much difficulty. At a routine checkup for her daughter Hiro, Garrett was again pressured for a Cesarean section.

“At this point, I was getting an attitude,” she said. “There [weren’t] any measures being taken to try to get this baby from being born early.”

Garrett had been informed she had a “low cervix,” also sometimes called an insufficient cervix, which can also lead to premature birth. Her friend was given a cervical stitch, also known as a cerclage.

“I’m literally telling them ‘You will not make me have this baby. I will not be bullied into having this baby.’”

Eventually, Hiro’s heart rate dropped to dangerous levels, and Garrett started passing clots. The baby was delivered by emergency C-section at 23 weeks.

After delivering, Hiro was whisked away to the NICU. Garrett also noticed that little Hiro had a large scar on her back, and one around her arm. Garrett was told that the scar around her daughter’s arm was possibly from the umbilical cord being wrapped around it, and the scar on her back was from a bacterial infection from her placenta. Garrett is distrustful and feels completely dismissed.

“Every question I ask, I’m getting deflective answers,” she said. “The scar looks like a third-degree burn. Somebody screwed up.”

To make things worse, when Garrett complained about the scar, a doctor suggested plastic surgery.

Thirty-six hours after her c-section, the hospital’s wound team informed Garrett her skin was necrotizing: a fast-spreading bacterial infection that causes tissue death. However, the no one explain what necrotizing meant as she spent 38 days in the hospital recovering before leaving “half-dead” with a walker.

“I have to live with these scars,” Garrett said.

Earlier this year, the North Carolina Maternal Mortality Review Committee reported that bias and discrimination contribute to traumatic and near-death experiences. It can manifest in terms of race or ethnicity, weight, geography, substance use, history of incarceration and other factors.

For example, Black neighborhoods are targeted by the tobacco industry more than other ethnic groups, according to the American Lung Association. In 2017, Reuters reported that poor Black neighborhoods tend to have a higher proportion of smoke shops per capita than other neighborhoods. Smoking can increase the rate of premature births and low birthweight. Similarly, higher density of liquor stores has been found in Black neighborhoods.

The American Heart Association reports that approximately 60% of Black women aged 20 and older have a cardiovascular disease, and 60% have high blood pressure. Factors leading to these conditions include family history, being overweight, diabetes, smoking and high cholesterol.

In 2022, the incarceration rate for Black women was 64 per 100,000, 1.6 times the rate for white women, according to The Sentencing Project, a non-profit that advocates to minimize incarceration in the U.S. North Carolina has a “habitual felon” statute in which any person convicted three times can be given harsher sentencing.

Heightened stress and anxiety, poor mental health, chronic conditions, financial burden, and strained relationships among incarcerated people and impoverished communities can adversely affect birth outcomes.

A study by the University of Pennsylvania found states that implemented three-strike laws like North Carolina saw immediate worsening of birth outcomes among Black infants, especially those from poor backgrounds. Those effects didn’t impact white infants.


Kylie Marsh wrote this article for the Charlotte Post.


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There are growing concerns about the prevalence of Christian Nationalism, an ideology that seeks to establish a theocracy rooted in Christian principles. Research indicates that about one-in-three Pennsylvanians support Christian Nationalist views, which opponents argue challenge the American ideal of separation of church and state.

Rachel Tabachnick, an independent researcher and former political research associate fellow, said the rise of Christian Nationalism, seen during the 2024 elections, threatens reproductive healthcare access.

"This is supposed to be a bottom-up theocracy based on biblical law being enforced at the family,
church and local civil government level. So, in order for this to work, women must stay in their God given roles, which is to have children and raise her family," she said.

On a recent episode of the "(In)Accessible" podcast, Tabachnick spoke about the history of Christian Nationalism, and how Theocratic Libertarianism advocates for laws based on biblical principles.

Tabachnick said that movement seeks minimal federal government and governance based on biblical law, aiming to dismantle institutions like the IRS and Department of Education.

Rebecca Susman, communications and development director with Keystone Progress, added that Project 2025, a 900-page guide by the Heritage Foundation, is intended as a blueprint for another Trump administration. The guide covers numerous issues, which Susman argues pose threats to basic rights and freedoms, particularly reproductive rights. She added that aspects of the plan were proposed last year.

"Conservatives have already begun implementing it, with one example being the addition of an anti-trans health care rider in a military spending act that was right out of the Project 2025 playbook, and it passed out of committee," Susman explained.

Tabachnick pointed out that in the 1970s and 1980s, the founders of Christian Reconstructionism wrote thousands of pages detailing how to reshape society and government under Old Testament law. Decades later, these blueprints remain relevant, as they were designed for a long-term transformation. Like Project 2025, most Americans reject these ideas, but they still need greater exposure and scrutiny.

Evanston Regional Hospital is discontinuing its labor and delivery services next week, citing a "steady decline of demand."

It is the fourth Wyoming facility to end services since 2016. The change will add to the state's list of "maternity care deserts," which included five counties last year, according to the March of Dimes.

Gov. Mark Gordon requested about $2.4 million in supplemental budget funding to better reimburse hospitals for Medicaid births, which make up about one-third of all births in the state.

Rebekah Hazelton, director of the Wyoming Women's Foundation, called it a "really positive thing."

"Labor and delivery services in Wyoming are not paying for themselves, even at the market rates," Hazelton pointed out. "That's part of the problem why they're closing, is because there are relatively few births in Wyoming and the birth rate has gone down."

Declining birth rates also mean providers are getting less practice in birthing rooms, which Hazelton noted could affect the quality of care. With ongoing abortion litigation and an expected slew of legislation, Hazelton added physicians are leaving the state because the laws are "vague enough," some fear providing care could bring legal consequences.

Maternal health access has been a priority for Gordon, whose Health Task Force includes an OB Subcommittee. The topic was also high on the Labor, Health and Social Services Interim Committee's agenda but Hazelton noted many seats turned over on Election Day.

"A lot of the legislators that are new won't have benefited from that interim study," Hazelton acknowledged. "We'll be kind of starting over to educate them about the problem, in terms of advocates for moms and babies in Wyoming."

She added both groups are working on various solutions. So far, no 2025 bills have been drafted on the subject.


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Birth doulas across Arkansas have formed a new organization to improve maternal health care across the state and help pass legislation they hope will make doula services accessible to more families.

Doulas are members of a birthing team providing emotional, physical and educational support to expectant mothers.

Cora Crain, cofounder and board vice president of the Doula Alliance of Arkansas, said research shows doula services can reduce cesarean sections, premature deliveries and length of labor.

"We have people reaching out to us. This is their first time they don't know what they don't know," Crain explained. "It's all very overwhelming. There's definitely a certain amount of fear that a lot of people are bringing to the birth experience and then of course if you had a doula in your previous birth then you usually continue."

Doulas provide services during pregnancy, childbirth and postpartum.

Members of the alliance are supporting a bill before state legislators next year mandating insurance companies and Medicaid to cover doula costs. Crain noted if passed, the legislation will make services available to more expectant mothers.

"Doula services can be so important in getting healthier outcomes and also just more positive experiences that lead to more positive postpartum times," Crain emphasized. "But it's just not as accessible to so many women that can't afford that out-of-pocket expense. "

Arkansas has one of the highest maternal mortality rates in the nation.


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