Nam Kiwanuka: You're listening to Mistreated. I'm Nam Kiwanuka. Way back in 1992, public health researcher and professor Arline Geronimus had a theory that the chronic stress of racism had an impact on black maternal outcomes. In 2006, Geronimus and her team tested her theory. Could the chronic daily tension of {quote} racism, microaggressions, and socioeconomic disadvantages impact someone's physical health and aging and contribute to poor health outcomes? The answer was yes. Geronimus had coined this weathering. {quote} The effects of weathering include a rise in health risks at younger ages for conditions that impact pregnancy and the likelihood of experiencing complications such as hypertension, type 2 diabetes, and high blood pressure. This weathering from the chronic stress of racism on black women's bodies may also be a part of the puzzle as to why the black maternal mortality rate is higher.

Nam Kiwanuka: In America, black women are more than three times likely to die during childbirth than white women. According to the National Library of Medicine at the National Institutes of Health, black American Indian, Alaskan Native, and Latina women in the United States are more likely to experience preterm birth compared to white women. And black women are significantly more likely to die in childbirth.

Nam Kiwanuka: In the UK, black women are more than twice as likely to die in childbirth compared with their white counterparts. Babies born to black mothers in the UK are at an increased risk of stillbirth, too.

Nam Kiwanuka: While there are provinces in Canada that collect race-based data, historically this country hasn't tracked health outcomes by race, which means the picture for what black maternal health looks like across the country is unclear. However, an Ontario-based study from 2022 found that {quote} black pregnant patients are at an increased risk for having stillbirths, gestational diabetes, preeclampsia, emergency cesarean sections, and placental abruptions when compared to white pregnant patients.

Nam Kiwanuka: The increased likelihood of experiencing a birth loss or complication has been identified as a black maternal health crisis. It's evident that no matter where they live or what their socioeconomic background is, birthing and pregnancy present more dangers to black mothers. According to reporting from the New York Times in 2023, the babies born to the richest black women, the top 10% of earners, tended to have more risk factors, including being born premature or underweight, than those born to the richest white mothers. Notably, the richest black women had more risk factors than those born to the poorest white mothers.

Nam Kiwanuka: And the Times said that is {quote} evidence that the harm to black mothers and their babies, regardless of socioeconomic status, begins before childbirth. Beyoncé and Serena Williams, two of the most famous celebrities in the world, both shared similar stories of birth trauma and having to have emergency C-sections. Beyoncé shared the birth story of her twins and how she developed high blood pressure and preeclampsia. And Serena Williams wrote an essay about getting an emergency C-section and how she {quote} almost died after giving birth. She also experienced postpartum complications.

Nam Kiwanuka: Considering all this, it's hard for me not to think about how historically black women have been treated in medicine. Both the fathers of modern gynecology and the cesarean section experimented on enslaved African women without the use of anesthetics. How does that legacy impact how black women seek out maternal health care now? On today's episode, we speak with Jennifer Dockery and Janelle Ambrose Dash about Toronto's Black Maternal Health Week taking place April 11th to the 17th and what their organization, the Black Maternal Health Collective Canada, does to stand up against weathering today. We talk about accountability, the concerns of collecting race-based data in Canada, and what action looks like. Please listen with care. Jennifer and Janelle join me now. Jennifer and Janelle, thank you so much for joining us on the podcast. Before we start, could you please introduce yourselves? Jennifer, could you start?

Jennifer Dockery: Sure, hi. My name is Jennifer Dockery and I am the vice chair for the Black Maternal Health Collective. Thanks for having us today. And Janelle?

Janelle Ambrose Dash: Uh my name is Janelle Ambrose Dash. I'm the chair of the Black Maternal Health Collective Canada.

Nam Kiwanuka: So what is the Black Maternal Health Collective?

Janelle Ambrose Dash: So the Black Maternal Health Collective Canada is a group that was started in 2024. It brought together a group of health professionals, lawyers, just policy makers as well, who all saw the need for there to be more action within our larger community around Black Maternal Health. The fact that there there isn't necessarily a group that existed like that before was part of the reason why we felt the need to to come together. And so over the course of a week, you have events to talk about the Black Maternal Health Crisis.

Nam Kiwanuka: In the United States, black women are three times more likely to die from a pregnancy-related cause than white women. And in the United Kingdom, black women are twice more likely to die in childbirth. Do we know what the data shows in Canada?

Jennifer Dockery: So the data in Canada is very much similar to what is coming out of the US and the UK. The issue for us on this side is that we actually don't have race-based data. It's not actually collected in Canada. And so we're not able to fully quantify, even though we've got lots of anecdotal stories and we've got some research to actually support the fact that the issue is actually very much similar here in Canada. I think when you hear those stats, like three times more likely, twice more likely, we have to keep in mind that these are families, women.

Nam Kiwanuka: In what ways are black maternal outcomes different from other groups?

Jennifer Dockery: So in in all of the areas, whether it's the postpartum depression, black women are experiencing that at higher rates, but they're also less likely to actually get support with that. They're having poorer outcomes for issues that actually should be able to be managed when it it it comes to comparing them to their to their white counterparts. And so they have higher rates of preterm delivery, higher rates of preeclampsia, higher rates of both maternal and fetal mortality. So yeah, that's the that's kind of the the encompassing piece. And those stats don't change when you bring in things like a woman's socioeconomic status. So whether it's somebody who is well off or whether somebody living in poverty, the black women are having the same having same and similar experience and outcomes.

Nam Kiwanuka: Janelle, I wanted you to talk a bit more about that. So it's not just about the socioeconomics or race. Can you expand a bit more on that, please?

Janelle Ambrose Dash: Yeah, I think it's important to layer onto this that these are all preventable harms. So I think that's an important piece to identify. What Jennifer is expressing is essentially something that I think we talk about within the black community quite often, the idea that regardless of where you fall on the on the demographic socioeconomically, these are the same outcomes that are people are experiencing across the board, black women experiencing. And in particular, I I have I'm I'm speaking from a place of my own trauma-informed experience with accessing health care. And I will say that it's important to recognize that these outcomes for for women of different socioeconomic backgrounds, people aren't necessarily addressing that. And what I mean by that, it appears to me that the services seem to be centered around particular types of women and not necessarily be a reflection of the the different types of women that might be encountering. So it could mean that you have English as a second language. It could mean that you have intellectual disabilities. It could mean that you have you know, other types of existing factors that are not necessarily being taken into account. One of them also being your socioeconomic status. So it it's it's wide-ranging in terms of the types of intersectionalities that are leading to some of these outcomes.

Janelle Ambrose Dash: But I think the one thing that my experience taught me is that even if you had access to particular types of providers because you could economically afford that, it didn't really change the outcomes. I think too, a lot of people are some people may be familiar with Beyoncé's story when she had her twins. She experienced birth trauma. So did Serena. And you think that these women have access to the best care in the world, but then they're experiencing similar outcomes as you know, someone who doesn't have access to that wealth.

Nam Kiwanuka: In short, that's what you're saying. It doesn't matter what background, it's going to happen.

Janelle Ambrose Dash: Yeah, you know, and I think that's scary because I think for a lot of us they we think that we will be insulated from those types of experience experiences because we have access to the best in health care. And and and most for the most part I think we do. I think the issue is that the the types of care are somewhat color blind. Um and what I mean by that it's just that the the it's sort of the one-size-fits-all approach to health care is not necessarily serving um this particular group and the question is why is that the case and why is it not being um at least in within Canada um looked into in in a more deliberate way.

Janelle Ambrose Dash: Uh and the why I think centers around data because if you don't know if you can't show something is happening then you can't really address it. Um in October of 2025 the Black Women's Health and Institute for Health released Voices Unheard. It was Canada's first national health health survey of Black Women and Girls. Um and one of the findings in this report was that 42.4% almost half of the Black Women surveyed had avoided seeking health care because of fears of racism. Right. That's an astonishing number to me almost half did not seek health care because of fears of racism. Um this report was a first of its kind and we need more data.

Nam Kiwanuka: But there are concerns. So Jennifer um what are some of the concerns of having race-based data? Yeah.

Jennifer Dockery: So I mean some of the concerns that have been raised around collecting race-based data um is about uh issues of whether or not folks might um unintentionally be further marginalized. Um obviously there's history around um the Black community and research and medicine. Um as we know there are a lot of um procedures and um I'm going to call them experiments that were done way back um using Black women. You've heard about you know testing of you know vaccines and other things on Black bodies. Um and so that piece of history is not insignificant. Um so that's on the I guess that's on the on the kind of the Black community side about lack of trust. Um on on the other side funding pays for research and um people fund things that they're interested in. Um they fund things that they want to see a difference made in and I'm not sure that there is that same uh drive right now or interest in actually funding um race-based

Janelle Ambrose Dash: Um but I I actually want to add something else to to the point Jennifer is making around the um the use of of this particular type of data. Yes, there is a fundamental lack of trust I think within our community but also I think there is a a a bit of fear or potentially even resistance of appearing to be racist in asking for certain types of data. So it goes both ways. It's not just community members not necessarily feeling comfortable but also other people who would who have opportunities in either health care institutions or to ask and to even support using the data in particular ways for fear of being um categorized in a particular way as as potentially as being so That's right.

Nam Kiwanuka: That's really interesting. So there's like this kind of like weird dance that's being done um because and and and I I respect that. I think it's great that people are more aware of the past because you're trying to rebuild that trust. So if we're at this weird impasse where we don't have that information and then the providers are kind of like well we don't want to offend anybody. Um what's the case for having race-based data? Why is it important?

Jennifer Dockery: Well, um having race-based data helps um both provide helps the system I was just going to say the system overall, right? Because this is not just a a provider-based issue. The system is actually set up to um not allow folks to actually uh in a in a intentional way to individualize their care, right? Um and uh if we can collect the race-based data then we can actually figure out strategies that can target specific issues. We'll tell our clinicians about approaches that they can use with communities that they're that they are serving, right? Jenna's absolutely 100% correct. We've been trying to move um in the province on collecting just demographic data asking people about their household incomes, their their um their gender identification and had tons of pushback um from patients as well as providers around um asking those what we call sensitive questions but it's part of informing how how do you how do you get to to put together individualized care if you don't actually have that information about the person that's sitting in front of you, right?

Janelle Ambrose Dash: And I I think I'd I'd like to add to that I it's important to recognize that maybe the approaches that were once used and had a level of um understanding of particular community that community has evolved. Right. Um and you know, does your research um do your institutional approaches reflect the fact that there's been this evolution? Um and so maybe there is maybe at one point in time there there was a primacy placed on privacy and and and I appreciate that but that can't be used as a sword.

Nam Kiwanuka: Can you expand on evolution? What did you mean by that?

Janelle Ambrose Dash: I I you know our our communities you know are more than just you know one or two colors or races or ethnicities, right? They're more people within our environments here within Canada. And so the that evolution means within our society means that there should possibly be a policy evolution as well that supports that. Um so this color blind care that I I referred to is really a reflection of the fact that that was possibly the standard of care at one point in time and and have we questioned whether or not that standard of care um has has changed.

Nam Kiwanuka: Right. And we're not in monolithic societies even within different communities they're very different. Um the Toronto Star described Black Mothers' Health experiences as quote a silent epidemic in an article from January 2026. Last year was the inaugural Toronto's Black Maternal Health Week in in where you identified the problem. Um what has the collective focused on since? Where are you heading to now?

Jennifer Dockery: So I would say that you know la- last year which was our inaugural year was really focused on uh building awareness. Um so in the US Black Maternal Health Week has been uh recognized since 2019. So they're many years ahead of us in in what they've been doing around promotion um and bringing bringing about awareness of the of the issues facing um Black women and birthing people. Um so last year was our kickoff wanted to uh bring the the the issues to the forefront make people aware. It's the you know starting from place of maybe you didn't know so we're going to tell you what's been going on. Um and this year we've shifted now to looking at uh now that you're aware it's time to take action. It's time to build some accountability and that's across the board, right? With our policy makers, with our community, um with our with our our clinicians, our education system, all of it. Um so that's what we've been working on uh to try to drive forward to get some more momentum into actually seeing the changes started that are actually needed to move this forward.

Nam Kiwanuka: Uh Jenna, what does accountability look like?

Janelle Ambrose Dash: Um accountability means a lot of different things to me but in particular um my hope is that um it will lead to not only the systems and the allies and the families that we've described but for people to have um connection within our community um to recognize that they have a role to play in um in in changing um the outcomes for many people within uh their community and so for me um in in particular um um I I I like the idea that of or of corporations or organizations um having a role to play here. Um it means specifically financing um either research or um other types of funding opportunities that will lead to either not only greater awareness around the subject itself but but actually um leading to to funding and potentially policy change.

Janelle Ambrose Dash: Um one of the the things that um that I'm really um happy to support is the Preeclampsia Foundation Canada. They have um been in the space since 2015 um and specifically they've had opportunities to fund research within Canada um for that period of time for over 10 years now. But uh as of um May uh 2026 uh we're going uh Preeclampsia Foundation Canada in conjunction with um my firm Don Grant Thornton Foundation will be launching the My B-Dash um uh Memorial Grant and that grant will be supporting specifically Black Maternal Health research within Canada.

Nam Kiwanuka: So That's great news.

Janelle Ambrose Dash: That that is accountability to me and I'm I'm my hope is that there are many other organizations out there who will take the time to figure out whether or not their employees uh the members of their organizations are um have particular opportunities to support initiatives like this. So really happy that my organization did that but I I would love for other organizations to find ways to support as well.

Nam Kiwanuka: Um so that brings me to this cuz it's like when we talk about corporations one of the things in the past few years has just been pushed towards diversity, equity, and inclusion. And um prior to this Trump administration, the United States was leading research around women's health. But due to the attack on DEI, the word woman can't even be used when you're applying for research grants. So that's considered to be something around DEI. So you don't get approved for those research grants. And then if you add black or anything else, that's not approved. Um So what impact do you think this will have around the push for more research into not only black maternal health, but into women's health research? Yeah.

Jennifer Dockery: Um you know, we on the Canadian side usually take our lead from the from the Americans. And so it is actually um disturbing um what we're seeing happen on on across the border. Have I seen heard conversations um that are making me nervous about where we're going to go? Absolutely. But I've also seen conversations and action that actually gives me um cause for hope. So you know, the federal health minister has actually made a declaration um asking all the provinces to um ensure that they are actually establishing um black health plans and strategy. Um there's a number of hospitals that have gone ahead and released their own black health strategies. So there's focus on the issue and that means they're also tying it into some of the research that they're actually doing.

Nam Kiwanuka: Why is it important to highlight that?

Jennifer Dockery: Um I I think to be quite frank, uh too often I think sometimes in our society or at least in the way things have evolved in our society currently it there is um um often a a mistaken sort of um a a potential thoughts around the idea that you're if you're serving one group, then you're disenfranchising or marginalizing others. And I wanted to make it clearer that um you know, we aren't I don't think that anything that we're asking for is really about marginalizing or taking anything away from any other group. But it um it's important to understand that if if one person is underserved in your community, that that is should be an issue for all of us. I absolutely see it exactly the same way.

Janelle Ambrose Dash: Uh black maternal health is a woman's issue. And women and pregnancy um um and uh reproductive health, um uh those issues transcend it's it's it's all it's all of us. And so um all women have a risk for high blood pressure and preeclampsia and all the other yeah, you know, issues with with uh childbirth, um breastfeeding, all all of it. It's it's all women. And then when you start to layer on and look at, oh, if there's a particular group that's having a disproportionate impact around some of these, if you have fix it for them, then you fix it for everyone, right? And you're fixing it for women and children broadly. It's not just about it's not just about black women. So people don't have to experience that same heartache, right?

Nam Kiwanuka: Right. Um I mentioned the UK before. What are they doing that Canada can learn from when it comes to maternal health?

Jennifer Dockery: So um the things that are happening in the UK, I mean one is that they're actually collecting the race-based data. So it allows them to actually make changes, the policy changes um is actually having them make changes in their approaches to the uh care provision um um in ensuring that that uh the care providers are actually being provided with protocols and processes to actually address um some of the key issues. We've talked about preeclampsia preeclampsia as one. Um but looking at, you know, how can you reduce the risks around having premature deliveries um for women who are at higher risk. Um and so the the protocols and processes that are in place are actually helping move things along along with the research that they're actually doing in the area.

Janelle Ambrose Dash: Just wanted to add that I and the these are uh the steps that you've described or the process changes if you try you've described in the UK aren't things that are astronomical in terms they're they're they're quite feasible, quite doable. Um and in fact, it was very heartbreaking for me to read some of the different processes that they have in place there because of my own story um of loss and you know, the things that I encountered um you know, in the UK quite you know, I'm not 100% sure, but had I had the types of issues that I presented and in a UK setting, the outcome might have been different because of the processes that they now have in place. So I think it's just important to recognize that these things are not um you know, outlandish. They're not that super uh difficult to to achieve. Um and sometimes I think when people hear these conversations, they think that you know, they're they're a high-level sort of institutional sort of over over um that that they need to be overhauled completely in order for some of these things to be achieved and that's just just not the case.

Jennifer Dockery: Or that they'll be overly expensive, right? And if you're actually able to manage somebody's health care proactively, you actually save the system money. Mhm.

Nam Kiwanuka: Can you explain that a bit for people? How do you save money? How do you save money?

Nam Kiwanuka: Um Janelle, I we don't I don't want to talk about what happened to you because I think you've talked about it before. But um you've mentioned it a little bit. I just wanted to cuz this work must be very difficult to do, but it's important work. And I just wanted to ask you, why do this work when when you're dealing with what you've had to deal with, you could just kind of take a step back.

Janelle Ambrose Dash: Oh, um you know, I think for me um uh healing shows up in different ways. And unfortunately for me that I I I or fortunately, um I this is the best way to to for me to heal.

Jennifer Dockery: I I think that we all admire Janelle's courage in how, you know, um she took her pain and actually has actually pushed it into a passion now to try to ensure that the system can be different for those who are going to come after her. Right? And the idea of um you know, having the collective, we we are a collective um that is actually steeped in pain, but also in joy, right? And in resilience. Um and the with the ability to actually um Mhm. put aside um some of the personal stuff thinking about what can we do for the greater good? What can we do that's actually going to shine a positive light on uh this issue and trying to make sure that um you know, the pain wasn't for not. Um and that out of pain, some really positive things can actually come forward. And so the collective is one piece of it. The the week is another piece that's allowed us to actually profile over the course of 7 days. We've pulled a lot of folks together in this. The city's on board. Toronto Public Health is on board. Um and that makes all the difference um in the world. And you're coming into community because I think also when you are in a community and you have a baby, going through it's community.

Nam Kiwanuka: Community comes together, right?

Nam Kiwanuka: Exactly. Um So if we're having this conversation again in 5 years, what needs to have changed for you to feel like real progress has been made?

Janelle Ambrose Dash: Wow. You know, that that's a tough one for me.

Janelle Ambrose Dash: Uh I would hope that we would have at least gotten to the point where the research funding is you know, in the millions. You know, maybe that's uh a a a huge ask, but I think at least for black maternal health, I would love for there to be dedicated research funding um in 5 years' time. Um I'd really like to see um the week expanded across Canada and so it not just be a Toronto-based um week, but a a a a national week. Um and then um more importantly, I would love to see policy changes that are very reflective of what's happening in other jurisdictions like the UK. Um as I said before, I don't think these are earth-shattering ask and I I think they're doable. So someone if someone's out there who's listening and it's like, please like prove me wrong, but I would love to see that check.

Nam Kiwanuka: Please write that check.

Janelle Ambrose Dash: Please or send that Bitcoin. Find your policy makers in the in you know, and you know, if there are you know, um politicians who have the ability to to really um influence um institutional change. I'd love for this to be one of the things that you take on as a as part of your mandate.

Nam Kiwanuka: And Jennifer? Five years.

Jennifer Dockery: I would like to see that black women are comfortable seeking health care. That they don't wait until they're really sick before they actually end up in our emergency departments. I would like to see that the federal government around health mandates that we actually collect the race-based data and so then the hospitals won't have an option but to actually implement, right? And that means at the provincial level also. And that we will have the beginnings of some information, some data to help to try to focus the changes, the action that's actually needed to improve black maternal health.

Nam Kiwanuka: This was Mistreated. Thanks for listening. You can follow our show wherever you download your podcast so that you can get notified each time a new episode is available. We would love to hear your feedback. You can write me an email at mistreatedpodcast@tvo.org or reach out to me on social media. I have an email from Sam which reads in part, "I just recently discovered this podcast and wanted to send a long thanks. As a woman who has dealt with chronic pain for 15 years and a chronic form of leukemia for six, I have seen firsthand the troubles women face within the health care system. You're doing an absolutely amazing job shining a light on this and I very much appreciate the work you are doing." Sam, thanks so much for taking the time to send us that email. This week's episode was produced by Tiff Lamb and me, edited by Colin Kish, digital shorts by Ariana Longley, camera work by Max Dussy, teleprompting by Christie McCloud. Production support from Jonathan Halwell and TVO's digital media services team. Lori Few is executive producer of digital. Stacey Dunseith is the acting vice president programming and content. Thanks so much for listening.