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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A majority of South Dakotans have voted to maintain a strict abortion ban but other factors are shifting the landscape for reproductive care in the state.

Of the 10 states voting on abortion during the 2024 election, South Dakota was one of three to keep a ban in place.

Kim Floren, director of the Justice through Empowerment Network, which provides financial assistance to people seeking abortions, said the state's view on the issue is not new but concern is growing over how the federal government may affect reproductive rights.

"I'm feeling the panic from people who are in areas that maybe haven't experienced what we've experienced as far as barriers go," Floren noted. "The reality is that we as a community can figure out how to take care of one another."

The Justice through Empowerment Network provides assistance with travel and transportation, child care, lodging, interpreters, birth control and medical procedure funding. Floren pointed out the organization supports 30 to 40 people per month. The final tally for Amendment G, which would have established a right to abortion in the state's constitution, was 41% for and 59% against.

South Dakotans voted in 2006 and 2008 against near-total abortion bans but Floren stressed since then, President-elect Donald Trump's first term made people feel "emboldened to be more vocal." Still, she acknowledged his second term will begin in a different context than his first.

"Before Dobbs, we did not have all of these reliable, safe websites where you can order abortion pills from and have them sent to your house for extremely cheap," Floren observed. "In some ways, access here has gotten better."

Floren added Gov. Tim Walz of Minnesota will return to his post after running for vice president on the Democratic ticket. Walz in 2023 signed a bill protecting patients who travel to Minnesota for abortion care and their providers from legal penalties in other states.


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It is now up to Wisconsin Supreme Court justices to decide the fate of an abortion law from the mid-1800s.

A circuit court determined last year an 1849 law does not apply to "medically consented" abortions in Wisconsin. The high court heard arguments Monday about whether a 1985 state law overrides the older one, allowing abortions before the point at which a fetus could survive outside the womb.

Jenny Higgins, professor of obstetrics and gynecology at the University of Wisconsin-Madison, said while the impact of this case is critically important, even if the 1849 law is determined to be unenforceable, returning to the status quo would mean a dire landscape for abortion access.

"Even though abortion is technically available at clinics in Wisconsin right now, it's heavily restricted," Higgins explained. "Because of insurance and Medicaid prohibitions, people have to pay out-of-pocket for a service that should be covered by insurance."

The 1849 law, which was brought to light after Roe v. Wade was overturned by the U.S. Supreme Court, prompted a statewide freeze on abortion services for more than a year. Higgins noted if Wisconsin's high court rules the law still applies today, the state would be looking at another abortion freeze.

Abortion access disproportionately affects those who are already the most marginalized, Higgins pointed out. She noted while people from all walks of life may find themselves needing abortion care, factors like poverty and racism make it much harder for some to achieve reproductive autonomy, compared to those with more economic and social resources.

"Those effects make it much harder for folks to be able to access contraceptive care, be in relationships that are stable and healthy and communicative, to be able to see past the end of the day into one's future if you are, again, mostly focused on your own economic scarcity or figuring out how to feed your kids, or figuring out how not to get evicted," Higgins outlined.

The 1976 Hyde Amendment, established three years after Roe v. Wade, prohibits the use of federal funds for abortion. Higgins hopes federal lawmakers will focus more on this amendment when considering the barriers to abortion care.


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Strong reactions are pouring in from both sides as Missouri voters made history by adding abortion rights to the state constitution.

The decision to pass Amendment 3, the "Right to Reproductive Freedom Initiative," makes Missouri the first state to overturn a near-total statewide abortion ban. Advocates and opponents are now gearing up for future battles.

Jamie Morris, executive director and general counsel of the Missouri Catholic Conference in Jefferson City, said he is disappointed with the passage of the amendment but emphasized his organization's pride in the conference's efforts, despite limited resources, and vowed the fight is not over.

"From the church's perspective, win or lose, we were going to continue to advocate for policy to help address the needs of women to help them choose life to begin with," Morris explained. "So that not only you're dealing with, necessarily, the supply of abortion, but also the demand."

In addition to abortion rights, Amendment 3 protects access to contraception and reproductive health services.

Meanwhile, pro-choice advocates in Missouri including Planned Parenthood and the ACLU are celebrating the passage of the amendment, while filing a lawsuit to block some restrictions, including parental consent for minors and continued regulatory oversight of abortion services.

Maggie Olivia, senior policy manager for the advocacy group Abortion Action Missouri, applauded the vote.

"I could not be more proud of the first steps that we are taking together as Missourians to dismantle the decades of political infringements on our access to abortion and, frankly, all reproductive care," Olivia stressed.

Missouri was among nine states with abortion rights measures on the 2024 general election ballot. Amendment 3 takes effect Dec. 5.


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