“I miss my mommy. I want to go to heaven to see mommy.”
This is what 4-year-old Soleil Irving recently said to her grandmother, Wanda Irving. After the sudden death in 2017 of Soleil’s mother, Shalon Irving, from pregnancy-related complications, Wanda’s life has never been the same. And Soleil’s words haunt the living. They invoke the layers of loss faced by Black mothers and Black children in the ongoing Black maternal health crisis in the United States. Living the daily toll of this heartache, as Soleil and Wanda do, is the aftermath of maternal mortality.
Shalon Irving was an esteemed epidemiologist at the Centers for Disease Control and Prevention and a lieutenant commander in the U.S. Public Health Service. Through her research, Irving knew how the systemic roots of social inequities shaped health outcomes; as a Black woman, she lived the reality of structural inequality and medical racism. Three weeks after giving birth in January 2017, Irving, then 36, collapsed and suffered a cardiac arrest at home. It was just hours after visiting her medical provider. She’d repeatedly told her provider she didn’t feel well, according to her family, but her pain had been denied.
“There is nothing as heart-wrenching as seeing your child unconscious — connected to instruments that can only say she is dying but cannot save her — unable to open her eyes, to tell you she loves you one more time,” Wanda recalls.
After her daughter’s fatal collapse, Wanda learned that complications from hypertension had led to cardiac arrest. Hypertension and preeclampsia are two of the leading causes of maternal deaths, and studies have shown that these chronic conditions can result from the psychological stress created by systemic and societal racism.
In April, the same week the CDC declared racism a threat to public health, President Biden signed a first-ever proclamation marking Black Maternal Health Week. The administration’s initial early executive orders on reproductive rights and its repeal of Trump-era policies are a starting point in addressing the impacts of racial disparities in maternal health outcomes. However, more-holistic approaches to maternal health inequities are needed to address the many ways that societal and systemic racism shape the experiences of Black birthers and the medical care they receive. Black women are 3 to 4 times more likely to die because of complications in childbirth.
The sorrow in the living memories of Irving is interwoven with a notoriously established hierarchy of care wherein Black women experience a “cumulative de-prioritization” — which Tamorah Lewis, a neonatologist and physician scientist, describes as the many small decisions made by medical providers that lead to Black women receiving inferior care. These actions and practices are not always overt, but they do build up over time to determine who is valuable and, by extension, who is deserving of lifesaving care.
Irving’s life and death are examples of what we already know about the violence of Black maternal mortality: namely that medical neglect, systemic racism and sexism work together to ignore the pains and traumas that Black women experience. Yet the grief of her mother and daughter — Wanda and Soleil — highlights what we do not know about the prolonged impact of Black women’s pregnancy-related deaths on their children and families.
This grief is cyclical, profound and often incomprehensible.
Soleil will never get to see her mother in the flesh. She will never get to hold her. She continues to feel the loud absence of her mother in old photos, in the spaces she frequented in her home, in her grandmother’s memories. Wanda left her daughter’s house the same way it was when she died for three years. It is this absence that Wanda describes as the labor of grappling with the profound loss of her daughter.
“I make sure I keep her mother alive in her mind — who she was and what she was,” Wanda says. “[It] is hard because Soleil wants to see her mother. She sees pictures and talks about her all the time.”
And the guilt that accompanies the grief can be unbearable. As Wanda explains, she always felt “unrelenting guilt as a mother for not having done more to save my daughter.” Wanda knows she did all she could, but it still nags her. “She was my best friend,” Wanda says. “How many women can say they gave birth to their best friend?”
Wanda is no stranger to grief. She lost both her sons a few years before Shalon’s death. After losing her daughter, she continued to find it difficult to access emotional and social support to process her pain, she says, and the deep roots of grief have been further compounded by the isolation of the pandemic.
This grief is also writ large within a broken maternal health system that continues to devalue and denigrate the wombs and bodies of Black women across socioeconomic lines. It is in poor bedside care, in the disrespect by medical providers, in the intangible and tangible manifestations of unconscious bias, in ongoing delays in the provision of culturally informed care during pregnancy and throughout the postpartum period.
Perhaps this context is why Irving contemplated the prospect of her own premature death. As Wanda notes, her daughter placed a note in her medical record before she gave birth. It stated: “Mommy, I will fight hard, but if anything happens, if there is no hope, please let me go.”
Now Wanda is left to pick up the pieces as she mothers her grandchild, Soleil. She has to select her schools, to choose her activities, to decide her food choices — even as she shoulders the weight of maternal loss. The two are connected by this intergenerational trauma. This is the aftermath of maternal mortality.
Now, Soleil is developing the relationship she never had the opportunity to have with her mother. And like many Black girls who come of age in this era of anti-Black violence, she will be forced to confront more intimately the challenge of honoring the life of her Black mother in a world that often does not recognize that they are worthy of basic quality care. This is the aftermath of maternal mortality.
But Soleil isn’t alone. As Wanda notes, Shalon is helping to raise Soleil even amid her physical absence. She is alive everyday in Wanda’s memories and in the love shown through Wanda’s intentional care for Soleil. As Wanda puts it: “Shalon is there every step of the way, shaping her daughter’s life, just as she is here today, helping us shape a healthier future for Black women in the world.”
This is the aftermath of maternal mortality.
Jallicia Jolly is an assistant professor, reproductive justice organizer and writer of Dr. Shalon’s Maternal Action Project (DSMAP), an Atlanta-based nonprofit created in honor of Shalon Irving. The nonprofit’s mission is to increase awareness of the Black maternal health crisis and develop and promote evidence-based strategies that improve health outcomes for Black birthing people and families.