Podcast Summary: Title: Something Was Wrong
Episode: S23 E14: Black Maternal Health and Reproductive Justice with Dr. Ndidiamaka Amutah-Onukagha, PhD, Founder CBMHRJ
Host/Author: Broken Cycle Media | Wondery
Release Date: May 22, 2025

Introduction

In the fourteenth episode of the 23rd season of Something Was Wrong, host Tiffany Reese engages in a profound conversation with Dr. Ndidiya Maka Amuta Onukagha, the Founder and Director of the Center for Black Maternal Health and Reproductive Justice (CBMHRJ). This episode delves deep into the critical issues surrounding Black maternal health in America, exploring systemic racism, historical injustices, and the urgent need for equitable healthcare reforms.

Dr. Onukagha’s Background and Motivation

Dr. Onukagha introduces herself as a passionate advocate for Black maternal health, sharing personal tragedies that fueled her dedication to this cause. She recounts the loss of friends due to preventable childbirth complications, stating:

"A lot of my professional journey was shaped by personal tragedies... These types of events solidified my professional expertise and passion in Black maternal health." [03:35]

With a doctorate in maternal and child health and firsthand experience as a mother, Dr. Onukagha emphasizes the failures of the healthcare system to prioritize and listen to Black women during pregnancy and childbirth.

State of Black Maternal Health in America

Dr. Onukaga paints a stark picture of the current maternal health crisis in the United States. She highlights alarming statistics:

"The United States is in the middle of a maternal health crisis. It is one of the most dangerous high-income countries in the world in which to give birth." [05:32]

She details that as of the pandemic, the maternal mortality rate was 32.9 per 100,000 live births, with Black women experiencing rates more than double, reaching 69.9 per 100,000 live births in 2021. Moreover, 84% of maternal deaths are preventable, underscoring systemic failures [05:32].

Factors Contributing to High Maternal Mortality in Texas

Focusing on Texas, Dr. Onukaga discusses specific factors exacerbating maternal mortality among Black women:

"Racism is the root cause of a lot of the disparities that we see... Policy decisions, racism, healthcare access, proximity to providers, lack of highly trained skilled providers in rural parts of the state." [11:56]

She explains that structural racism manifests in hospital closures, increased travel distances for care, and inadequate access to prenatal services, all contributing to higher mortality rates in Texas.

History and Racism in Obstetrics and Gynecology

Dr. Onukaga delves into the historical roots of racism within obstetrics and gynecology:

"The person that was considered the godfather of obstetrics and gynecology was an inhumane, racist criminal who essentially perfected his surgical techniques on the bodies of black enslaved women without anesthesia, without consent." [13:13]

She critiques contemporary practices still influenced by these racist ideologies, such as the VBAC algorithm that inaccurately factors race into medical decisions, leading to unnecessary C-sections for Black women.

Midwifery and Its Historical Context

Exploring midwifery, Dr. Onukaga highlights its origins as a response to the exclusion of Black women from hospital birthing services:

"The field of midwifery started because Black women were not able to deliver in hospitals that were considered to be white-led... The field of midwifery also became very whitewashed and very white-led." [16:00]

She underscores the need to reintegrate Black midwives into the healthcare system to provide culturally competent and respectful care, improving outcomes for Black birthing people.

Solutions: Universal Healthcare and Workforce Diversification

Dr. Onukaga advocates for universal healthcare as a foundational solution, ensuring equitable access to care for all birthing individuals:

"Universal healthcare is a card to play in this conversation and also, diversifying the healthcare workforce is huge to me." [19:22]

She emphasizes that alongside universal healthcare, increasing the diversity of healthcare providers—such as doulas, midwives, and obstetricians from marginalized communities—is crucial for reducing disparities.

Medicaid and Insurance Policies Impact

The role of Medicaid and insurance policies is pivotal in shaping maternal health outcomes. Dr. Onukaga explains:

"Medicaid has a huge role to play because they cover so many births and there is a current model on the street... Transforming Maternal Health is a 10-year project funding 15 states to reimagine, redevelop, revamp their maternal health, clinical care, and Medicaid policies." [20:32]

She expresses hope that this initiative will bring meaningful changes over its intended duration.

Addressing Maternal Healthcare Deserts

Maternal healthcare deserts—areas with limited or no access to maternity services—pose significant challenges. Dr. Onukaga discusses the rise of alternative care models:

"We're seeing the increased use of telehealth services... mobile maternity clinics... the opening of birth centers." [22:15]

She highlights how these innovations help bridge gaps in access, particularly in rural and underserved communities, ensuring that families receive necessary prenatal and postpartum care.

Collaboration between Birth Centers and Hospitals

Effective collaboration between birth centers and hospitals is essential for ensuring safe transitions during emergencies. Dr. Onukaga compares this relationship to a safety mechanism:

"We have a transfer agreement. It's like a fire extinguisher... You only use it if you need it." [26:04]

This ensures that low-risk births can occur in supportive environments while having protocols in place for emergencies.

Actions for Healthcare Providers to Improve Equity

Healthcare providers play a critical role in enhancing maternal health equity. Dr. Onukaga advises:

"The best thing clinicians can do is to be present and attentive to the needs of their patients... Listen to them, listen to their family members." [28:43]

She emphasizes the importance of building strong patient-provider relationships, being vigilant for signs of complications, and creating an atmosphere of safety and respect.

Policy Recommendations

For policymakers, Dr. Onukaga stresses the importance of listening to constituents and prioritizing maternal health:

"I think the best thing for policymakers is to listen to their base... Advocacy is a skill and it's an art, but anyone can do it." [31:39]

She encourages active engagement with elected officials to push for necessary reforms and support initiatives that address maternal health disparities.

The Work of the Center for Black Maternal Health and Reproductive Justice

Dr. Onukaga elaborates on the multifaceted efforts of CBMHRJ:

"We're an academic-based but community-facing research center... focusing on racial bias, cultural competency, and patient-centered care." [32:54]

The center operates through six units, including the MOTHER Lab, data analysis, policy advocacy, education and training, and community-engaged research. Initiatives like "Nurture Kids" provide postpartum support to vulnerable populations.

How Listeners Can Support

Listeners are encouraged to support CBMHRJ through financial contributions, partnerships, and participation in events like the annual conference:

"We rely on financial support to fund our research, to stipend our students, to provide trainings, to support our advocacy efforts... All of our information is on our website, blackmaternalhealth.tufts.edu." [36:22]

Dr. Onukaga highlights the importance of community involvement in sustaining and expanding the center's impactful work.

Conclusion

The episode culminates with heartfelt acknowledgments and a call to action for listeners to engage with and support the ongoing efforts to dismantle systemic barriers in maternal healthcare. Dr. Onukaga's insights underscore the urgent need for structural changes, diversified healthcare workforce, and robust policy reforms to ensure equitable and safe birthing experiences for Black women and marginalized communities.

Notable Quotes:

• Dr. Onukaga [05:32]: "The United States is in the middle of a maternal health crisis. It is one of the most dangerous high-income countries in the world in which to give birth."

• Dr. Onukaga [11:56]: "Racism is the root cause of a lot of the disparities that we see."

• Dr. Onukaga [13:13]: "The person that was considered the godfather of obstetrics and gynecology was an inhumane, racist criminal who essentially perfected his surgical techniques on the bodies of black enslaved women without anesthesia, without consent."

• Dr. Onukaga [19:22]: "Universal healthcare is a card to play in this conversation and also, diversifying the healthcare workforce is huge to me."

• Dr. Onukaga [28:43]: "The best thing clinicians can do is to be present and attentive to the needs of their patients."

• Dr. Onukaga [31:39]: "I think the best thing for policymakers is to listen to their base."

This comprehensive summary encapsulates the critical discussions and insights shared by Dr. Ndidiya Maka Amuta Onukagha, highlighting the multifaceted approach needed to address and rectify the systemic inequities in Black maternal health.