Dr. Jasmine Johnson On Her Black Maternal Health ECHO Initiative

MadameNoire interviewed Dr. Jasmine Johnson, an OB-GYN clinician and maternal healthcare advocate, who is actively working on the frontlines to empower Black women in the face of the ongoing maternal mortality health crisis affecting the community.

 

Dr. Johnson co-founded The Black Maternal Health ECHO (BMH) at the Indiana University Indianapolis ECHO Center to create a program that shares best practices and brings together a diverse group of practitioners dedicated to supporting new and expectant Black mothers. This collaborative network includes physicians, nurses, doulas, midwives, and others committed to improving maternal health outcomes.

The disparities in maternal healthcare for Black mothers across the U.S. are striking. Black women are three times more likely to die from pregnancy-related causes than white women. They also face higher rates of complications like hypertension, preeclampsia, and hemorrhage, and are more likely to undergo cesarean sections, with rates reaching 36% even among low-risk pregnancies, March of Dimes notes. These inequities arise from systemic barriers and medical coercion within the healthcare system. With the imposition of abortion bans and other harmful legislation undermining their rights, the struggle for reproductive justice becomes even more complex for Black women.

Love Education? Get more! Join the MadameNoire Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Subscribe

We care about your data. See our privacy policy.

Dr. Johnson and her team are doing everything in their power to change this. During their weekly virtual ECHO sessions, program participants and community providers collaborate with a multidisciplinary team of specialists to tackle critical issues related to the disparities faced by Black women. Participants present their patient cases to receive feedback and insights from both their peers and experts. The primary goal is to leverage collective knowledge, share recent patient outcomes, and develop actionable strategies to enhance Black maternal health on both local and national scales. 

Johnson offered her perspective on the current landscape of maternal health, highlighting essential information Black women need to know about their rights as they approach delivery, especially in today’s challenging political environment. She also outlined her ongoing work with the ECHO initiative to help ensure that more Black women have safe and healthy childbirth experiences.

 

MadameNoire: Dr. Johnson, it’s a pleasure to speak with you today, and we’re honored to hear more about your work in the maternal healthcare space. To begin, could you share a bit about your background? What ignited your passion for this field?

I’m a mother of two, and I navigated my two pregnancies in very different life circumstances. I think that was kind of the first time that it really highlighted to me how your pregnancy outcomes can be dictated, not so much by just having insurance or not, but also where you give birth, your race — your pregnancy experiences can be very different. It has nothing to do with biological things or genetics, but just kind of the structures in our country. And so I ultimately went to medical school. I went to Indiana University and decided to practice obstetrics, and did my training at the University of North Carolina in Chapel Hill. Then, I stayed on for a maternal-fetal medicine fellowship, which was three years after the residency.

In my current position, I take care of those who have high-risk pregnancies, so that can be something that the patient comes into their pregnancy having a condition like high blood pressure or diabetes, or during their pregnancy, they have a diagnosis that makes their pregnancy high risk, so that can be maternal factors or something going on with the baby.

During this recent election cycle, reproductive rights have been a prime talking point, but it really does touch my career, because there are many times I have to give a diagnosis that is quite devastating for families, and being able to support people through those pregnancies is one of the things I’m most proud of in my job. 

 

MadameNoire: What are some key insights you’ve gained about maternal health, especially regarding Black women, through your work?

During my fellowship, I started doing research, taking my lived experience and looking at it through a lens of, how does this look for Black birthing people around the country? And so I did a few different studies, and one of them was looking at preterm birth [premature birth] rates. We talk a lot about maternal mortality, but preterm birth is an outcome, that maybe there’s not a maternal death, but it’s actually one of the biggest drivers for infant mortality in our country. Black babies have a higher infant mortality rate. 

One of the arguments for disparities is, well, Black women are more likely to be uninsured or they’re not getting prenatal care. So, we created a study population where they had insurance, they were college educated and above and they had gotten prenatal care. We still saw that Black women had a significantly worse preterm birth rate compared to white women. When we control for factors that can create a bad outcome, like not having insurance or not going to prenatal care, the last thing we’re left with –  if there’s still a difference by race and ethnicity –  is that there’s racism. That’s the racism that we’re talking about. The experiences that people have during their pregnancies, and even before, that set them up for these bad outcomes.

There was another study where we looked at people who had a low-risk cesarean delivery [c-section] in our hospital. So, they just came for the delivery of their baby, they had to have surgery, but no complications. We found that Black women having the same surgery as everyone else, reported higher pain scores, but they were checked on less frequently by the nursing team, and they were given less pain medication.

My work today is a mix of taking care of people and making sure that they have the best pregnancy experience they can, even when they have challenging experiences, but also using the research to advocate and call out racism in these outcomes that we’re all talking about. 

MadameNoire: It’s noteworthy that you bring up the election cycle, as we seem to be hearing more heartbreaking stories about Black women who the healthcare system has failed. Many enter the delivery room expecting a healthy pregnancy, only to face tragic outcomes. One case that stands out is that of Amber Thurman, who lost her life to maternal sepsis after being denied a D&C procedure to remove fetal tissue due to Georgia’s Living Infants and Fairness Equality Act, or “LIFE Act,” which classifies such procedures as potentially felonious. Are these distressing stories gaining attention now because of the nationwide abortion bans, or have these issues been present long before those laws were enacted?

The maternal mortality crisis has been going on long before I came to medicine – long before I was born. You know, we have these disparities where Black women were having worse outcomes in pregnancy – more likely to die. I think the abortion ban just only amplifies the disparities because we know that when we are in a situation where our healthcare teams don’t feel comfortable providing evidence-based care or giving the standard recommendations they would give in an unrestricted situation, communities of color are more likely to bear the burden of that because we know that communities of color disproportionately have less access to healthcare resources. You can only get the care that you need if you’re able to travel across state lines and if you’re able to reach a specialist like me. However, there are these maternity deserts in communities that are under-resourced. I think that this talking point that we have now, it’s not so much that this is new. The abortion bans are just exacerbating a problem that was already there.

 

MadameNoire: Medical experts believe that Thurman’s death could have been prevented if hospital staff had intervened sooner. How can we prevent such tragic outcomes in the future? What strategies can Black women use to advocate for themselves in these situations to help ensure their safety and well-being?

It’s a great question, and it’s so difficult. It makes me emotional to think about it because it’s such a hopeless place to be in. You’re going to people who are supposed to be protecting you and saving your life, but on the other side of that, there are people with families and a livelihood, and there’s a threat to their livelihood. There’s a threat for them to go to jail, or, to be made an example of. One of my colleagues here in Indianapolis, the Attorney General just totally went for her because she was providing care to someone.

The other thing is, how do you tell someone they need to better advocate for themselves if they’re already in a system that is, no matter what they do, almost predestined to not give them what they need because of the law? This is what we as clinicians have been saying and why people with medical expertise must be in these conversations when the laws are being made because it is evidence-based care to save someone’s life, and if that includes ending a pregnancy to save the life of the Mother, why do we have to wait till she’s on death’s doorstep? You know? Why do we have to have a committee decide how close to dying she is to tell us that it’s okay?

For us as clinicians, it’s a really hard place to be in, because we are not going to stop telling our patients the truth and making sure that they know what all of the risks in their pregnancy are — especially when we’re practicing in restricted states. We are trying to continue to support our patients to get to places that are safe for them, to make those decisions. And unfortunately for lower-income patients, it may not be an option, because they have to take off work, they have to travel and all of that stuff sometimes costs time, money, and resources that they don’t have.

I don’t really have a good answer for you. Right now, everything is discouraging. Never in a million years would I think that I would be in a profession where to provide the care that I was trained to provide, or give the advice and expertise that I spent the majority of my life training to do, I could be criminalized for it.

 

MadameNoire: I can imagine, but you’re doing an incredible job of empowering and educating mothers and healthcare professionals about this issue, especially with the Black Maternal Health ECHO initiative that you co-founded with Dr. Velvet G. Miller. Could you share more about it and what key topics you’re teaching participants as part of this initiative?

The Black Maternal Health Echo is so cool, and I’ve never been a part of anything like this. Indiana has one of the worst maternal mortality rates in the country. And then those disparities with respect to Black maternal mortality, are in our state as well. Indiana is very different, depending on where you are in the state as far as access to care, having good labor support, and having the resources for pregnancy care and reproductive care. So, the Echo takes this concept of essentially echoing out. We have this main team in Indianapolis, and we put on these seminars twice a month where we cover topics related to pregnancy and reproductive health care with a focus on health equity and the Black maternal health experience. The goal of these webinars is to educate the state so people know what’s accessible to them. We have plenty of work to do here, but we want to make sure that we’re reaching all of the communities across the state. Echo allows us to connect with community partners across the state and educate and hopefully amplify the call to action so that people can be committed to ending health disparities and addressing the needs of the Black community in their areas.

 

MadameNoire: Earlier, you mentioned how entering the delivery room can be financially burdensome for mothers who may not be in a strong financial position. Is the Black Maternal Health ECHO doing anything to support these mothers financially, such as assisting with delivery costs or offering resources to financial tools?

That is a great question. So the Echo itself does not have funding resources for moms, but the beautiful thing about the Echo is that we have a lot of people signing in to watch and to be a part of the conversation who do have resources. We have some of the healthcare payers on the call, so some of the state-funded health plans. We have a number of hospital leadership people on the calls, and we even have some policymakers. So, a lot of times when things come up related to access or financial barriers, there’s always someone in the chat who’s like, 

‘Hey, make sure that your people know about this service that they can access through Medicaid. Make sure they know about this service that’s free to the community. Make sure they know about these advocates.’ So, I do feel like the power of the Echo is that we do have so many people from different fields on the call who are able to make those connections with community workers. 

MadameNoire: What rights should women be aware of before entering the delivery room for childbirth? Are there specific measures they can take to address potential complications that might help prevent some of the critical outcomes we’ve been witnessing?

I always like to say Black women, there is nothing wrong with you. There is nothing genetic or biological that sets us up for these outcomes. But we definitely can equip ourselves with the resources and strategies to have the best outcome possible.

I think the first thing, as a high-risk pregnancy doctor, I want to make sure that my patients are as healthy as they can be coming into pregnancy. So, think about meeting with your reproductive health provider before you’re even getting pregnant, to talk through your history and make sure there’s nothing that needs to be done to kind of optimize your health beforehand. Then once you are pregnant, I think it is awesome to make sure you do your own research and come to your appointments with questions. If there is something that is said in the room that just doesn’t make sense or you may not agree with it, please speak up about it. You know, ask those questions. Don’t just go along with it. You know, in our country, we spend so much money on health care, but for some reason, people feel that they don’t have the agency to find a doctor that they like and or trust. And so it is okay to switch physicians or providers or whoever you’re seeing if you feel like they just aren’t listening to you, even before you get to the delivery time.

Then, I always think it’s always great to have someone with you. So, if you can have a family member or a support person in your appointments, you can even call them on FaceTime, that way, if there’s something that’s disclosed in the appointment that’s a little bit concerning or high risk,  you have someone else there to just support you and make sure that your questions are answered.

In the delivery room, the same thing goes for your prenatal care. Make sure you feel comfortable with the plan. It’s okay to ask questions. It’s okay to voice what your desires are for your delivery, and if you feel like things aren’t being done appropriately, there are patient advocates in the hospital. You can request to speak with one to make sure that your concerns are escalated.

 

MadameNoire: Having family or a support person present during childbirth is essential. I’ve noticed that more Black women are opting to hire a doula to help ensure a safe and smooth delivery. Are doulas expensive, and is this service readily accessible for expecting Black women?

I’m so glad you brought that up! So with the Echo, we actually partnered with the Indiana Minority Health Coalition, and they have a statewide doula collaborative, so they actually help us support the doulas within the state and make sure that we’re addressing the needs of the community. There are some private doulas – they can be expensive – but there are some hospital doula groups, like one of the hospitals I work at. You can get a doula during your labor for free.

Some people like to have a doula throughout their whole care experience, which can be kind of costly. There is some legislation going through to help get doulas covered under Medicaid, so hopefully there’ll be more access to doulas. But similar to our maternity deserts, we have so many people who want doulas, and not necessarily enough doulas to take on all the caseload. So, I think there’s still going to be a need for more support and growth within that but having a doula in your pregnancy and labor experiences is great. It has been shown to lower the risk of C-sections.

 

RELATED CONTENT: Why Supporting Black Midwives And Doulas Matters