Tambra Morrison.

On a sunny Saturday morning in July, Tambra Morrison’s kids played in the living room. Morrison’s wiggly one-and-a-half-year-old, Kalani, motored around, picking up toys as her two older siblings played video games and scrolled on their phones.

There was an obvious sense of joy that day, one Morrison’s perpetually grateful for. Her pregnancy with Kalani was tough. It was 2020, during the height of the pandemic, and she didn’t have any family in Dallas. She felt like she was doing everything for the first time again.

She also saw stark statistics about the mortality rate of Black people giving birth.

“When I got pregnant, it was the first pregnancy that I was actually scared to go through,” Morrison said. “It was so emotional because so much had transpired.”

She started looking for support, and had heard about doulas, but “didn’t really fully understand what a doula was.” She asked D’Andra Willis to be her doula in June of 2020. Willis had done her hair for a few years and had become a doula with The Afiya Center, a Dallas-based reproductive justice organization that provides HIV programming, abortion access, and pregnancy support.

Tambra Morrison said doula support made her feel less alone. “She supported me all the way through it, even if it was just over the phone,” Morrison said. “She would [also] come write affirmations and put them all over my room in the hospital.” (Azul Sordo / KERA)

Doula care through The Afiya Center

Willis and Qiana Lewis Arnold are full-spectrum doulas with Southern Roots Doula Services, which The Afiya Center launched in 2019.

Doulas are “a proven key strategy to improve maternal and infant health,” according to a 2016 article from the National Institutes of Health (NIH) and the Journal of Perinatal Education. But doula care is rarely covered by Medicaid, and out-of-pocket costs can range anywhere from $1,000 to $2,500 and beyond in Dallas.

The center’s aim is to make doula care more affordable and accessible to Black pregnant people.

“Our job is to support them, to teach them how to advocate for themselves and to advocate for them if necessary, and to literally be there to hold their hand through the process,” Arnold said.

Part of that work is talking about the health risks, like high blood pressure, bleeding, and gestational diabetes.

“We know that the infant and maternal mortality rate is astronomically high, not just in the nation, but in the state of Texas,” Arnold said. “A lot of folks who come to us and they’re really concerned, scared, emotional. We help them work through that, and we also help them understand their options.”

Willis was with Morrison through her whole pregnancy and the birth; when Morrison was feeling lonely, trying to figure out what to pack for the hospital, and grieving a change to her birth plan.

“I’d be texting her late at night,” Morrison said. “Like, am I supposed to feel like this? Is this supposed to happen? As far as pregnancy, she kind of helped me through what to say to my doctor, giving me the confidence that I don’t just have to go with my doctor’s plan, because it’s about me.”

“There’s this growing momentum around really relying on community driven solutions, those folks who are on the ground, working with mamas and families,” Kyrah K. Brown said of doula support for Black parents. “At the root of it is these models that are based on respectful, safe care, and dignified care.” (Azul Sordo / KERA)

Pregnancy support past delivery and birth

Willis still helped after Kalani arrived: making sure she had financial support to cover her bills, delivering groceries, and answering questions. Willis said her work as a full-spectrum doula extends about a year past the due date. She works with people after terminated pregnancies, too.

“Be it with post-abortion, postpartum, post-miscarriage, you still have us an additional 13 months,” Willis said. “We’re there to hold space during that time. We do understand that those 13 months is a difficult, interesting transition, whatever reproductive choices that you make.”

Morrison was grateful to have Willis, because she said compassion was missing from the experiences she had in the hospital, especially with complications during Kalani’s birth.

“I remember [my doctor’s colleague] was helping her, and it was a white man,” Morrison said. “He was talking about going golfing. Meanwhile, I’m on a drip, so I won’t have a stroke, because my blood pressure is super-high. My baby is being delivered five weeks early. I want to live! I would like to live, to see her go to college.”

Protesters raise their signs atop a hill as a pro-choice march comes to an end in Downtown Dallas, Texas on June 24. The march took place only hours after the Supreme Court’s landmark decision to overturn Roe v. Wade. (Azul Sordo / KERA)

Doula work has changed in response to Texas abortion laws

Full-spectrum doula work has been changing since Texas passed SB-8 in September 2021, and Roe v. Wade was overturned by the Supreme Court this past June.

Doulas with The Afiya Center have been in overdrive since June, spending hours on the phone late at night with lawyers to understand what they can and cannot do for their clients.

“We now have to protect them from being criminalized and protect ourselves from being criminalized,” Lewis said.

Willis fears what the future holds for Black people giving birth in Texas.

“I think about how so many of them are going to fall through the cracks, and how so many are going to have unwanted pregnancies,” she said. “Maternal mortality and morbidity, postpartum depression, and all of that, I think about how those numbers are gonna skyrocket.”

This is something Kyrah K. Brown has been researching for years. She’s an assistant professor of public health and runs the Maternal and Child Health Equity Research Lab at the University of Texas at Arlington.

“My philosophy is if we can improve the birth outcomes of Black [people], we can improve everybody’s birth outcomes,” Brown said.

Morrison is concerned about Black maternal mortality, especially if abortion isn’t an option in Texas now that Roe v. Wade is overturned. “How’s that gonna look when you’re forcing me to birth?” she asked. “How is that going to look for hospitals, doctors, mothers, families, because a death of a mother affects the entire family.” (Azul Sordo / KERA)

Improving maternal mortality and morbidity for Black Texans

Nationally, Black people were almost three times as likely to die from a pregnancy-related cause than their white counterparts in 2020, according to a Centers for Disease Control and Prevention (CDC) report. The report also showed that mortality rates rose for everybody giving birth during the pandemic. Many of these causes were and are preventable; bleeding, infection, pre-eclampsia and eclampsia can all be addressed with improved access to care, according to the World Health Organization.

“There’s so much more beyond the individual and beyond the health care system,” Brown said. “Structural, gendered racism has to do with the conditions before they even get to the hospital.”

Brown said it’s important for people to know that disparities in pregnancy outcomes are systemic; contributing factors include a lack of culturally competent providersdelays in care, and health care coverage.

“What tends to happen is this victim blaming, like, well, if they’re healthier, then they would have better birth outcomes,” she said. “I think the more we can focus on the systems level, the more we can move forward.”

Texas is one of the worst states in the nation when it comes to the rate of uninsured reproductive-aged people, said Brown, and health insurance is a strong predictor of health outcomes.

“We’ve seen a lot of research around states that have expanded Medicaid, and seen reductions in maternal mortality and reductions in Black maternal mortality,” she said. “We refused to accept those federal dollars to expand Medicaid, [and] that creates a barrier for every [person], but especially for Black [people].”

Medicaid covers more than half of the births in Texas, but currently insurance only extends for two months after people give birth. Texas lawmakers are petitioning for six months of postpartum coverage instead, but Brown, Willis and mother Tambra Morrison think it should extend for at least a year.

“Birth is a wild ride,” Morrison said. “Whatever it starts out in the beginning, it might not be that in the end.”

She wants Black people giving birth in Texas to have all the support they deserve, before, during and after their pregnancies. Having a doula made her tough pregnancy a little easier.

“I truly don’t know mentally, physically, where I would be if I didn’t have her,” Morrison said. “I didn’t have anybody here. So for her to show up…it meant a lot.”