Kimberly Seals Allers on Black Maternal Health

Your own birth experience is so fascinating and really fueled you to advocate on behalf of Black mothers and to, ultimately, create the Irth app. Can you share about that experience and how it inspired you?

One of the things that was pivotal for me was certainly this realization that I had that after speaking to so many people and reading reviews and getting referrals from girlfriends and people who lived in the city, I had a completely different experience. And that was very troubling. I was in grad school when I was pregnant and I was not yet married. And at the end of the day, despite what I was told by many women who in retrospect were my white girlfriends from college and colleagues at Columbia, and reading the U.S. News & World Report, all of those things, I did all of the research and I left having a very negative experience. I felt unseen. I felt traumatized. I had a C-section I really couldn’t explain. I fought to breastfeed my baby when this was supposed to be the place where that was welcomed and supported. It seemed like I had to fight for everything. And in reality, I realized that I was not yet married at that time and I was on student insurance. I was treated like an unwed Black woman with basic insurance.

When I had that moment of, Oh, I was sitting with my girlfriends and I remember them being like, Wow, you were at the same place? Are sure you were at this place? And I said, Yeah, I was there. So this idea that people are not being treated the same way even at the same place was an early lesson in my mothering journey that really stayed with me. It certainly shaped me. It made me upset and frustrated because it didn’t dawn on me that even though these were my peers in many ways—we worked at the same places, went to the same schools, but in terms of my life circumstances they were perhaps not the best people that I should be asking. So Irth is all about getting reviews from people who are actually like you and then using those reviews to generate data on the back-end that we can use to push for change at hospitals and providers. So I would say that was pretty formative for me.

At the center of both Irth and your podcast, Birthright, is the idea that stories have power. But with the app, it’s not just about shared experiences and changing the way something is perceived, it’s also about data. Can you explain why that’s so important and how you plan to harness that power?

Absolutely. I always say, Yes, stories have power but only if we harness them and use them collectively. As much as I love people sharing their experiences in Irth, I am not here just for the catharsis. I am here to push for systemic change. That’s why the digital platform is so important because I think earlier in my creative genesis, I thought we just needed all of these stories in one place, but really, we needed to be leveraging them, turning them into data and pushing for institutional change.

What we have seen is that when we hear these stories, whether that’s Serena Williams, one of the greatest athletes of all time, or Amber Rose Isaac who died in New York City during the pandemic, these stories are silenced and they’re dismissed. It’s viewed as a one off. But I said, What if we had 5,000 of those experiences in one place, on one digital platform and we used that to push for change?

As much as we say Irth is yelp-like, I remind people that it is not a free-form commenting space. You are asked very specific questions about the things that happened to you via the doctors, nurses and lactation consultants specifically, and then we have a whole series of what I call provider behaviors that we ask you to tell us about. Was it dismissiveness about your pain level? Which we know is a very common thread among Black women when they are seeking care. Was it a diagnostic test that was delayed? Was it a rude comment? A long waiting time? Was it a stereotypical comment? We see a lot of Irth reviews where users say that they are giving birth and the doctor’s talking to them about birth control and he wants to put in an IUD, completely inappropriate, and really is based on a stereotypical idea that people are here to control how Black women have children and if they have children. So those are the things that we are counting.

And now we can go to that hospital and say, Listen, we’ve got 5-10,000 reviews in the app and 80% of them are saying the pain levels are being dismissed, 90% are saying they’re getting this type of rude comment. Now we can put some weight and numbers behind it so they can’t be so dismissive and explain everything away as they have always fought to do.

The other piece about the power of stories is that now we get to fill in the gap. Because right now hospitals think they’re doing something. Well, they’re doing something. They’re doing anti-bias trainings, which unfortunately has become a tick the box exercise for far too many of them. But providers are often unaware of what they are doing and how that’s being perceived by the patient on the other side. Now we can say these are the specific behaviors that people of color are reporting as disrespectful, traumatizing, harmful and rude and these are the things that you need to stop.

Can you talk about the racial disparities in maternal health care now and how the Irth app works to illuminate and eliminate them?

In the national data, Black and brown women are 3 to 4 times more likely to die during childbirth. In New York City, the Black maternal mortality rate is 12 times that of white women so it varies and gets worse in different places. And I’m very concerned about the fear that comes up around this topic. We’ve seen in DM’s from Irth users really being frantic. It’s very scary. When people got the app, some people couldn’t get in. They didn’t have an email or they couldn’t get the confirmation code and they were speaking to us on social media with real desperation saying, I’m giving birth, I need to see what people say about this hospital. I’m so afraid. We've heard people who feel like they need to prepare their will and they’re checking their death documents before they go into have a baby. It’s ridiculous.

That’s why it’s so important how we look at what’s happening and find lessons to prevent adverse events. There’s way too much study around Black women after they die. I don’t want any more Black women and birthing people to die. I’m trying to prevent people from dying by learning about their experiences while they’re still alive and using that as a way to prevent death. Because right now we wait until somebody dies, then they do the maternal mortality review and try to figure it out. I find that incredibly disrespectful and backwards. For example, dismissing pain. If you read pretty much every story about Black women who have died, at some point in that story, their pain levels were dismissed, I assure you that. They were ignored. So how are we elearning these things before they turn into another tragic headline?

What about your podcast, Birthright? How do these two tools work together to make change?

I see them as two complementary things mostly around narrative shifting. One of the things that I want to do with Birthright is shift the narrative from fear to joy. We also have positive birth stories and we need to learn from those, too. I’m very interested in developing learnings that can be shared with hospital providers not just about what keeps us from dying but actually what makes us have happy experiences.

I see Irth really around shifting dynamics from Black women as victims of the maternal mortality crises to Black women as powerful consumers. It’s all about tapping into our strengths and our consumer power to reframe the story. Because actually if we build this platform and use it to move the industry to respond we have shown that we are actually a powerful group that can influence how we are being treated. So Irth and Birthright are both strength-based models for how we address Black maternal mortality.

You have dedicated yourself to making life better for all mothers. What does that mean to you, from the day to day to the bigger picture?

Mothering is everything to me. Motherhood changed my life. Prior to motherhood I had a wonderful career in journalism and I was not thinking about having anybody’s children ever. When I became a mother, everything really shifted for me. It really became a pivotal moment in my life. It has been a driver. My whole life’s work has been around how do we make the motherhood experience better for all? Whether I’m advocating for paid leave or my fifth book around breastfeeding and how we can make infant feeding less commercialized and more socially and culturally acceptable for all people. These are the bigger issues that drive me every day. In that is a core belief that if we get it right for those who have it the worst at the moment, then we’ll get it right for everybody. It’s a tide that lifts all boats.

Finally, you ask this question at the end of every podcast and I want to ask you: What is our birthright?

To me, our birthright is joy. That’s why I always center that. To have joy and to be joyful is our birthright. That was taken from my ancestors so long ago and we’re still trying to fully reclaim that as humans and to be seen as full humans, so those two things are really the key tenants of Birthright, to be seen as humans and to have joy. That is our birthright.