This text was produced as a challenge for the USC Annenberg Middle for Well being Journalism’s Nationwide Fellowship Dennis A. Hunt Fund for Well being Journalism and the Fund for Reporting on Little one Properly-being.
HOUSTON — By the third trimester of an already tough being pregnant, Moriah Ballard confronted two new issues: relentless complications and dizziness.
Over the earlier 31 weeks, she had already collapsed 3 times and seen blood in her urine. Every episode felt alarming, however on Aug. 8, 2019, her signs escalated so severely {that a} relative rushed her to the hospital close to her house simply exterior Houston. There, a physician shortly decided that her blood stress was dangerously excessive.
Ballard, who was then 22, was recognized with preeclampsia — a severe complication of being pregnant that’s marked by hypertension and elevated protein ranges within the urine. It impacts fewer than 10% of pregnancies, but Black ladies like Ballard face a 60% increased danger of analysis in contrast with their white counterparts.
The precise explanation for the ailment is unknown, however Ballard’s prognosis was evident. “The one treatment for preeclampsia,” she recalled a doctor saying, “is supply — or dying.”
“I simply had a headache and felt a bit woozy,” she stated. “I didn’t comprehend it was this severe.”
The physician provided two decisions: ship instantly on website, separating mom and little one, or switch Ballard to a specialised hospital to ship, the place she may very well be near her new child. She and her then-husband, Donnell Johnson, selected the latter, a choice that also haunts them.
4 days later, they confronted their worst nightmare when Ballard delivered their son, Denim Amari Johnson, stillborn by cesarean part.
“I believe I’ve cried all of the tears I can cry on this lifetime. Typically it nonetheless hits me, and I’ll cry randomly,” stated Ballard, who’s now 28, “However now it’s like altering it into advocacy.”
Moriah Ballard holds photographs of her deceased toddler son Denim supplied by the hospital from a memento field that she obtained after his dying in August 2019, Tuesday, Nov. 11, 2025, in Houston. (Douglas Candy Jr./Capital B Information)
For Black ladies in Harris County, Texas, which encompasses most of Houston, Ballard’s expertise is heartbreakingly acquainted.
Racial disparities in outcomes for pregnant moms and their fetuses have lengthy been established, however even in opposition to that backdrop, Harris County is an outlier. Dwelling to just about 5 million residents — one‑fifth of them Black — the county has in recent times reported maternal and toddler mortality and maternal morbidity charges that at instances exceeded each Texas and nationwide averages.
A current research by native public well being officers discovered that from 2016 to 2020, the maternal mortality price for Black ladies in Harris County was 83.4 per 100,000 dwell births — the best within the nation. In 2020, the nationwide price for Black ladies was 55.3 per 100,000; for white ladies, it was 19.1.
The toddler dying price for Black kids in Harris County has been equally troubling. From 2016 to 2020, the speed was 11.66 per 1,000 births. Nationally, the toddler dying price in 2020 was 5.4 deaths per 1,000 dwell births.
The severity of the disaster in Harris County has prompted public well being officers, researchers, and advocacy teams to deepen their efforts to reply a urgent query: Why are extra Black pregnant moms and their infants dying in Harris County?
Consultants say that formulating a solution to save lots of Black lives means inspecting a constellation of points: race and the enduring legacy of bias in Texas, inequitable well being care entry, delays in care, and systemic gaps in therapy.
Esohe Religion Ohuoba, a Houston-based obstetrician-gynecologist, stated that it’s clear that a number of elements are guilty.
Ohuoba stated a lot of the disparity stems from what researchers name the social determinants of well being. “Issues like entry to high quality care, monetary stability, housing, schooling, and even the stress that comes from navigating systemic inequities,” she stated. She added that the expansiveness of the state is one other issue.
Ohuoba stated a recurring problem is poor communication between physicians and their sufferers.
“It is crucial that we’re listening to sufferers, answering their questions, and paying shut consideration to their signs,” she stated. “That’s the place the standard of care and communication from the well being care workforce turns into crucial. Was the affected person heard? Have been warning indicators acknowledged, and was therapy well timed?”
As of 2024, Black ladies are 3 times extra more likely to die a pregnancy-related dying than white ladies, and greater than 80% of those deaths are preventable, in keeping with the Facilities for Illness Management and Prevention.
“Usually it’s about systemic gaps in communication, cultural consciousness, and belief,” Ohuoba stated. “However the end result is similar: Girls of coloration don’t all the time obtain the identical degree of consideration or intervention as others.”
To eradicate the disaster, she stated, suppliers and the medical system should confront the foundation trigger — racism.
Ache dismissed, signs ignored
Two years in the past, when Rayna Reid Rayford was about seven months pregnant, she went to a Houston hospital with extreme belly ache — and felt ignored by docs who, she stated, insisted she was merely dehydrated regardless of her consuming a gallon of water a day. That modified solely when she encountered a Black doctor and, coincidentally, had a number of kinfolk on the town for her child bathe — all physicians — who advocated on her behalf.
Rayford was in the end despatched for an MRI, which revealed she had acute necrotizing appendicitis, a uncommon however extreme complication of appendicitis that have to be handled instantly. She was rushed into emergency surgical procedure, recovered and delivered a wholesome child lady two months later.
“I’m right here as a result of I had 5 docs in my ready room. Not each girl has that,” Rayford stated of her household of physicians who helped save her and her child’s life. “Being pregnant is meant to be a joyous time, however so lots of my associates and Black ladies are fearful of being pregnant.”
Latest analysis has highlighted reviews from Black ladies who say their pregnancy-related ache and discomfort are sometimes ignored or dismissed by physicians, reflecting a broader sample of medical racism rooted within the historical past of experimentation on enslaved individuals and bolstered in medical schooling and observe.
These elements aren’t disputed by well being officers in Harris County, who, in a report launched final 12 months on maternal and toddler well being of their group, acknowledged that along with entry to high quality well being care, diet, and schooling, “prejudices in opposition to particular racial teams may contribute to present well being disparities.”
County officers pointed to increased charges of diabetes, sexually transmitted ailments, and hypertension as elements that disproportionately worsen well being outcomes for moms and infants in sure racial and ethnic teams.
The maternal morbidity charges for Texas elevated 24.5% from 2019 to 2024. The maternal morbidity charges in Harris County weren’t solely increased than these in Texas annually, however additionally they elevated by 34.7% throughout the identical time-frame, in keeping with an evaluation by Teresa Do, a fellow with the Media Innovation Group — an experiential studying challenge throughout the Faculty of Journalism and Media on the College of Texas at Austin.
Native hospitals say that they’re working to handle the disparities in extreme maternal morbidity, which incorporates sudden outcomes of labor and supply that can lead to vital short- or long-term well being penalties. In 2024, Memorial Hermann-Texas Medical Middle, the place Moriah Ballard delivered, recorded a extreme maternal morbidity price of about 250 circumstances per 10,000 deliveries, in keeping with Do’s evaluation.
A spokeswoman for Memorial Hermann Well being System declined to debate Ballard’s case particularly, or its protocols for managing preeclampsia and monitoring excessive‑danger sufferers basically.
“Memorial Hermann is dedicated to enhancing the well being of the communities we serve, together with ladies and youngsters of all ages,” the spokeswoman wrote in an emailed assertion. “Considered one of our system’s key areas of focus is decreasing and in the end eliminating maternal mortality and morbidity.”
Memorial Hermann-Texas Medical Middle is amongst 4 Harris County space hospitals that had among the highest circumstances of extreme maternal morbidity, upward of 100 circumstances per 10,000 deliveries.
The spokeswoman additionally highlighted a few of Memorial Hermann’s present initiatives geared toward decreasing maternal mortality and morbidity, together with the institution of its maternal well being entry committee in 2021, when county officers stated the toddler dying price decreased. The committee was created to know extreme maternal morbidity higher and start addressing its underlying causes earlier than labor and supply.
Memorial Hermann-Texas Medical Middle is amongst 4 Harris County space hospitals that had among the highest circumstances of extreme maternal morbidity, upward of 100 circumstances per 10,000 deliveries, almost yearly from 2019 to 2024, in keeping with Do’s evaluation.
Every of these hospitals, together with Texas Kids’s Pavilion for Girls, Harris Well being Ben Taub Hospital, and the Lady’s Hospital of Texas, is housed throughout the Texas Medical Middle and is a specialty establishment that treats essentially the most extreme, advanced, and high-risk circumstances from throughout Texas, the nation, and overseas.
The focus of particularly difficult circumstances in these hospitals might clarify increased maternal morbidity charges in contrast with different amenities, a Texas Kids’s Hospital consultant stated.
In 2019, the Texas Kids’s Pavilion for Girls recorded its highest price of extreme maternal morbidity — 203.7 circumstances per 10,000 deliveries, Do’s evaluation exhibits. That 12 months, the hospital additionally fashioned a high quality‑assurance and efficiency‑enchancment committee to assessment each case and establish alternatives for enchancment, a spokesperson stated.
Upon assessment, the hospital stated it had applied a number of high quality‑enchancment and affected person‑security measures for obstetric hemorrhage, together with a security bundle and in‑depth case critiques of adversarial outcomes with a well being‑fairness focus.
“On account of our focused concentrate on respectful care, we eradicated racial disparities concerning SMM (extreme maternal morbidity) associated to hemorrhage. We have now additionally developed high quality enchancment initiatives for obstetric hypertension that resulted in an enchancment in our timeliness of therapy for hypertension,” a spokesperson stated in an announcement.
A false sense of safety
In hindsight, Ballard stated Houston’s focus of excessive‑degree hospitals gave her a false sense of safety about her supply, influencing her choice to switch to Memorial Hermann–Texas Medical Middle regardless of her worsening issues.
When she arrived on Aug. 8, 2019, anticipating to ship, she realized the plan had modified. As soon as there, she stated, docs advised her that they hoped to stabilize her with treatment and delay supply, hoping to increase the being pregnant a minimum of three extra weeks — or when she can be 34 weeks pregnant — and enhance the child’s probabilities of survival. It turned a race in opposition to time, balancing maternal danger and fetal improvement.
The American School of Obstetricians and Gynecologists recommends supply at 34 weeks or later for sufferers with extreme preeclampsia.
For sufferers with preeclampsia, Ohuoba stated, therapy can vary from low-dose aspirin to hospitalization, or in extreme circumstances, early supply, however the protocol depends upon the severity of the situation.
Over the subsequent two days, Ballard stated, her ache had grow to be excruciating, complications ensued, her sight started deteriorating in her proper eye, and her blood stress spiked, at one level reaching 186/106. In accordance with the American School of Obstetricians & Gynecologists, her signs signaled “extreme options” of preeclampsia.
On Aug. 11, Ballard stated she felt a burning sensation in her stomach. She stated that she repeatedly pressed her name mild, however nobody got here.
Ballard stated she felt her pleas had been ignored.
“I bear in mind telling God that I do know you’re going to take me, however save my child,” Ballard stated. “I used to be prepared. That is what occurs to Black ladies. That is the way you die. You’re dying, however you need your child to outlive.”
A Memorial Hermann Well being System spokesperson stated the hospital can’t touch upon particular person sufferers or their care, citing privateness legal guidelines.
“For all of our sufferers, we’re dedicated to delivering protected, compassionate and high-quality care,” they wrote in an announcement on Nov. 5.
Ballard stated that she was given some Tylenol and that the chief nurse on her ground got here to her room about two hours later.
It was then, after utilizing a monitor, that Ballard stated the nurse advised her that she couldn’t detect her son’s heartbeat. When a vaginal supply try failed, Ballard was taken for an emergency C‑part, the place her son was delivered stillborn.
Ballard stated that she awoke from her C-section surgical procedure experiencing blindness in a single eye — a facet impact of extreme preeclampsia — and that an MRI revealed that an epidural needle inserted earlier than the process had been left in her again and was undetected for 2 days.
Three days after her son’s dying, Ballard stated physicians advised her they wished that they had delivered sooner and communicated extra clearly about her therapy plan, including that the affected person expertise can be dealt with in a different way sooner or later.
Ballard, who has just lately obtained her case file from the Medical Middle, stated that she grapples with many points of her therapy.
She questions every thing, from why she wasn’t recognized with preeclampsia sooner, to the variety of physicians’ visits she obtained whereas within the hospital, to the form of treatment she was given, as to whether she ought to have merely given delivery at her native hospital as a substitute of selecting to be transferred to the Medical Middle.
She additionally stated that she has a lingering distrust of physicians and nonetheless will get triggered when driving previous the Texas Medical Middle.
“Once I’m in ache, it takes a lot for me to go to the hospital as a result of I don’t belief something in any respect,” Ballard stated. “I simply can’t pull myself out of that PTSD.”
Moriah Ballard goes by way of objects from a storage field that holds objects she saved following the misplaced of her toddler son Denim throughout delivery in August 2019, Tuesday, Nov. 11, 2025, in Houston. (Douglas Candy Jr./Capital B Information)
Transferring the work ahead
Rayna Reid Rayford has turned her ache, trauma, and grief into goal by elevating consciousness and pushing for modifications to advertise well being care fairness for Black ladies.
That’s why she began her personal nonprofit, Pregnant and Black, which goals to foster group and assist amongst different Black expectant mothers, connecting them with culturally competent care, well being care advocates, and lifesaving assets by way of a cellular app set to launch on April 11 at the beginning of Black Maternal Well being Week.
One other Black Houstonian, Kay Matthews, based The Shades of Blue Mission in September 2013, 4 months after delivering a stillborn little one, to boost consciousness concerning the correlation between toddler loss and psychological well being.
“I used to be attempting to get individuals to know that, truthfully, I used to be experiencing postpartum melancholy versus grief on the time,” Matthews stated. “In actuality, my grief was delayed.”
Advocates agree that efforts like these of Rayford and Matthews are an important subsequent step in addressing racial disparities for African American moms and their infants. It’s a step that depends upon collaboration — well being care organizations partnering with communities, listening to affected person tales, and harnessing innovation and know-how to make sure each mom receives equitable, compassionate care.
“Once I’m in ache, it takes a lot for me to go to the hospital as a result of I don’t belief something in any respect. I simply can’t pull myself out of that PTSD.”
Moriah Ballard
Angela Doyinsola Aina is the co-founder and government director of the Black Mamas Matter Alliance, a Black women-led cross-sectoral alliance and advocacy group greatest recognized for coining the phrase “Black Maternal Well being Week,” which turned a motion in 2016. She stated that Houston has a “groundswell” of alternative.
“It’s going to take extra funding to permit the Black-led entities to take the helm and transfer the work ahead,” she stated. “We’d like funding.”
Harris County has obtained a big quantity of funding to handle its Black maternal mortality and morbidity price — roughly $9.1 million, which has funded programming for the county’s maternal and little one well being program, a five-year initiative that gives every thing from one-on-one house assist to prenatal and postpartum care help. From its launch in April 2023 to Sept. 30, this system has served 409 households, spokesperson Eduardo “Eddie” Miranda stated.
Sadly, these assets had been put in place too late to assist Moriah Ballard. She and Denim’s father — the couple have since divorced — had carried out all the required preparation for his or her child: shopping for garments and onesies, planning a child bathe, and even buying a brand new house. Earlier than, she stated, their world collapsed.
“We had been full-fledged, able to go — we had simply purchased a four-bedroom home,” Ballard stated, as she sifted by way of a tote bag of Denim’s belongings on a Tuesday night in November — inside had been hospital mementos like his diaper, blanket, and pictures, together with ultrasound photographs, a naming certificates, and the garments and books they ready.
Every year, she stated, she pulls the tote out of storage on Aug. 11 and appears by way of its contents as soon as once more as a means of honoring Denim’s birthday.
