Micaela Berry-Smith, the program manager of maternal and child health initiatives at the Foundation for Black Women’s Wellness, has deep family-tree roots in the area of medicine, roots that stretch back to at least the early 1800s in Antebellum Kentucky.

“The wealthier plantations would have your slave population midwife who would also serve as the doctor and the pediatrician to make sure that everyone stays healthy,” Berry-Smith said. “You aren’t going to make more money if your slaves are sick. You have to do something. And my great, great great grandmother was a midwife on the plantation that she was enslaved at. And she was kind of like the medicine doctor. She would deliver all the babies. She would make concoctions for colds and things like that. One of her grandsons, my great grandpa became a doctor and served in the African American community. I come from a generation of Black doctors who have made changes in the United States. And my dad is in the medical field.”

Also in her family tree is a cousin, the late Julian Bond who was one of the Greenville, South Carolina students who staged a sit-in at a segregated Woolworth’s lunch counter in 1960 and would later become chair of the National NAACP board of directors. And so it is no surprise that Berry-Smith is doing the work that she does.

“I come from this rich history of reproductive justice,” Berry-Smith said. “It’s in my blood to change things.”

Berry-Smith was drawn to the Madison area by the 2014’s Race to Equity Report published by Kids Forward and became a doula.

“I was always a partner with the Foundation, especially in 2016-2017 as Lisa Peyton-Caire was bringing more maternal and child health initiatives, more attention to it in a broader spectrum,” Berry-Smith said. “What I loved about Lisa was she was already in Black women’s health care. And she was noticing that her focus was really on heart care because we know that diabetes and heart health is the number one reason why Black women pass at an early age. What she wasn’t aware of earlier was the Black maternity mortality rate that was happening here in Wisconsin, the Black maternity and infant mortality rate here in Wisconsin. It was one of the highest in the United States. That’s what really got me into doula work. And so when you think about reproductive justice, Black maternity and infant mortality rate is under the umbrella of reproductive justice.”

And what is reproductive justice?

“It’s about liberation and empowerment,” Berry-Smith said. “It’s the freedom to autonomy. If you think about it, although African Americans have been free for over 250 years, we still operate a lot under those rules and regulations that were created when we were kidnapped and brought here. I was having a discussion with my dad about when he went through medical school in the early 1980s and how there were a bunch of young Black students who wanted to liberate the medical system because when you think of how some of these medicines and operations come about, it’s because they were operating on enslaved people without compassion. I really feel at the heart of reproductive justice is the desire for compassion. What we are saying is that our lives matter, being able to choose to have children or to choose not to have children as a Black-bodied feminine, whether you identify as a woman or not. If you are able to bring a child into this world, you are still under the umbrella of these disparities that are happening here in Wisconsin. It was really important to us to not just talk about health, but also talk about the justice within the birth system.”

As a program manager, Berry-Smith manages multiple programs that support families in the maternal and child health, which is perinatal to 5-years-old, with support and resources.

The health care system is a behemoth in the United States, as it accounts for approximately 17 percent of the country’s GNP. The health care system is one of the largest employers in Dane County. And so, more than likely, it will tgake a sustained effort over many years to change the tide reflected in the disparities of maternal and child morbidity for Black women and their families. And it is a system that doesn’t necessarily encompass all of the maternity help that Black women need.

“One of the ways that we provide reproductive justice at the Foundation is we have created a very consistent stream of income for our doulas,” Berry-Smith said. “It values their work and the way that they are able to be seen as part of the medical care team. They aren’t medical professionals like primary care providers or nurses. But they are part of that medical care team because they are trusted advocates who are able to support a pregnant person through the perinatal and postpartum journey.”

The Foundation has partnered with the Dane County Health Council — composed of community representatives and representatives from the major health organizations in Dane County — to create a pilot program called Connect RX.

“Connect RX, which is under our Saving Our Babies umbrella that we started in 2019,” Berry-Smith said. “And the community asked for this. With our Connect RX programming, all of the clients who come through that referral service from all clinics in Dane County are able to get a doula, a community health worker, have a connection to Anesis Therapy, and a lactation support specialist. What that does is support them in every aspect from perinatal to postpartum and through that first year of the baby’s life.”

In times past when there was a greater sense of community among neighbors, pregnant women were surrounded by the support they needed during their pregnancies. But now in an era when people don’t know their neighbors, other means of support need to be created to ensure healthy outcomes from perinatal to postpartum periods in a Black mother’s life.

“There are community hardships that you go through during parenting in Madison,” Berry-Smith said. “It can kind of get lonely, especially if you birthed during COVID-19. It can be a very lonely journey. And we’ve seen that depression and suicide ideations have gone up unfortunately during the COVID-19 pandemic. What we see here as birth justice here at the Foundation is birthing people and Black women being able to have access to humane life-sustaining care. That comes with partnering with insurances and having that as a service. That is something that we are advocating for and trying to partner with these insurance companies here in the state of Wisconsin who impact Dane County to say, ‘You should be paying our doulas because it is improving your rates. It’s improving the outcomes for you in the long run. Let’s uplift this as well.’”

Reproductive justice is about diversity, equity and inclusion permeating the medical system at all levels to ensure equal resources and support for all during the perinatal and postpartum periods in a woman’s life. Nothing less will ensure the elimination of Black maternal and child morbidity rates in the state of Wisconsin.

 What I am learning from the clients who come through the Foundation is they get all of this attention and all of this care during pregnancy and then they are forgotten about in postpartum. Or they are remembered again once the baby goes through Head Start or a day care setting. But they are forgotten about and they don’t know how to navigate schooling and where their child should go to school and what community is the best to raise a child in. We really want to fill in those gaps. But we want everyone to come together to fill in those gaps that it truly feels like a village that is surrounding these families. 

Micaela Berry-Smith –  And so as a transit to Madison, I learned of the disparities here through the Race to Equity report in 2014. I quickly partnered with a lot of organizations who were doing work here in Dane County.  

I am now the program manager of maternal and child health initiatives. We have 

We have resources and support during that time period. 

And so 

As someone who has given birth twice in Dane County and has transportation stability and housing stability, has my parents here and my husband’s parents here, I still dealt with depression and stress. 

We also want to uplift the fact that not only is birth justice life-sustaining care and support, but also having anti-racism and racism-free care in community in arrangements where Black families are empowered and feel like they are valued. 

I am married. I have housing. I have stable transportation and food. I have family around me. And I was so stressed out that I was diagnosed with preeclampsia in my second pregnancy. And that came as a surprise. I didn’t have hypertension or high blood pressure issues beforehand. But the stress of my work — not because I am not happy, but because I want things to be better for other Black women — weighed upon me. And I was affected by that. I know that Serena Williams and Beyoncé also were diagnosed with preeclampsia during their pregnancies. It’s just these women who are viewed as leaders who are trying to make change for everyone else. And we just carry that burden on our shoulders. A lot of times, hospitals and some providers deem preeclampsia or other health issues that affect Black women as the ‘Black Body Problem’ or a ‘Poverty Problem’ or a ‘Low-Income Problem.’ But it’s really not just the stress. It’s also just racism. I’ve had some doctors say some off-the-wall racist things to me. And I am educated in knowing what they are talking about. 

I remember my very first doctors appointment for my first pregnancy. And the doctor asked where my husband was. This is in the midst and height of COVID-19. You couldn’t have anyone come into the room with you. I said, ‘He’s out in the waiting room waiting for me to be done because we know only one person can be in here.’ And she said, ‘No, does he live with you?’ I know that’s not on My Chart. I asked her why she wanted to know that. She replied, ‘I just want to know what type of support you have in the home.’ I said, ‘Then that is the question you should ask.’

What’s not killing us is these huge policy issues. Now those are a problem. But what is killing each individual Black woman are these small, nuanced biases like that nurse asking me if my husband lives in the home or assuming that I smoke or assuming that I need to take multiple STI tests throughout my pregnancy because you just assume that all Black women are promiscuous. Those are the biases that are harming us during pregnancy. It’s not the, ‘Okay, you are showing these things, so you need a c-section or you are showing these things, so you need an induction.’ It’s just the individual, personalized racism and biases from providers. 

‘If I don’t trust my provider, I may not go to my doctor’s appointment. I’m not going to show up at the hospital until I need to have this baby.’ That is harmful because you get there and you might need an emergency c-section and there are some things that could have been taken care of where you could have had the vaginal birth that you desired.

Part of reproductive justice is changing systematic racism in the hospitals. But also part of reproductive justice is saying, ‘Why does birthing have to be in a hospital where illness is treated?’ Pregnancy isn’t an illness. It’s life giving. So why are we not respecting it and why isn’t separated from the hospital? I love free-standing birth centers. I believe in them. But I also believe in the health system. 

 So I would be remiss to not uplift the medical system. But I also know that if you are a healthy woman and you are having a healthy baby, how beautiful it is to have control over your environment in terms of where you bring that baby into the world. And so reproductive justice is part of that, bringing birth back into the community. Historically in Africa, Black women have their babies surrounded by the elder women in the community. They are supported by women and their family. They have a whole ceremony and it is beautiful. But here when we have a baby, we have to go to the hospital. Sometimes it is necessary. And the beauty is you are able to have you doula and a midwife. But nonetheless, you are going into a system where you feel like this is a problem because it is where they treat illnesses.

This was in Kentucky and Illinois.

Especially with the opioid epidemic, even though that is a predominantly white issue, Black people, because of systemic racism, the consequence lies with us. I’ve had clients who have said, ‘Hey, I’m in a lot of pain. Can I have a narcotic or this kind of pain medication?’ And they are asked millions of questions because they are automatically assumed to be an addict. Their pain is not heard. And a lot of times, it’s thought in the medical field that Black women don’t feel pain unfortunately, because of the history of obstetrics and the violence in that. Black enslaved women were the guinea pigs for understanding how to have a safe c-section or how to use forecepts. Pain medication wasn’t given to them because we weren’t viewed as human. And so a lot of those practices sometimes still happen today.

The freedom to not have children is a part of reproductive justice. The freedom to contraception. The freedom to be able to say, ‘I would like my tubes tied.’ Or ‘I would like to have an elective hysterectomy because I don’t desire to ever have children.’ Unfortunately there are rules and regulations to that too. In certain states, you have to already have had a child in order to have a hysterectomy. Or you have to have a medical reason to have your tunes tied. But also the cultural competency of contraception is part of reproductive justice because some women are forced or coerced to have a hysterectomy or even untold that they have had a hysterectomy after a baby. In fact, I had a conversation with three of my doulas yesterday because we are seeing a pattern at a hospital where if you have over five children, they are strongly encouraging you to get a tubal ligation. One of these women who was strongly encouraged — she was having her seventh child — is an immigrant. But she identifies as Black. And it is in her culture to continue to have children until her body says, ‘You’re done.’ She doesn’t believe in contraception. And so reproductive justice is saying, ‘She doesn’t have to get her tubes tied. He doesn’t have to take contraceptives. As long as she is safe and the children are safe and she is healthy, why are you regulating how many children she can have?’ It is all that encompassing. Reproductive justice is having the autonomy of your body and having the support behind you in order to do that. If you do want a tubal ligation, you’re going to be down for a couple of weeks. You’re going to need the community to come around you and help you heal. But if you also don’t want to have contraceptives, then you need to be able to freely talk to your doctor about family planning if that is something that you need to know or even better education about your menstrual cycle and when you are fertile and when you are not fertile. That can also be out there. A lot of women, grown women, don’t even understand that. And that is part of reproductive justice, education. And that is part of the Foundation, empowering, energizing and educating the next generation of well Black women.

It means the freedom to choose, the freedom to be able to share that without fear, whether you want to continue to have children or you don’t want to continue to have children. I think one of the biggest fears for any Black woman or any Black person in the medical field or system is feeling that your doctor is a mandated reporter. If you are struggling with addiction, but still have pain during childbirth, how can you navigate that healthwise with your provider without having CPS called or without being thrown in jail. It’s the freedom to be a human within limits, of course. When I say limits, if you do need support, if you do need to go to rehab, it’s to have the ability to go with passionate care and not with a bias of racial judgment. 

Access to abortion services is also a part of it although that has come back to Wisconsin, so that’s not as much of an issue. Planned Parenthood has been able to come back to providing abortions for the moment.