Kendra Outler, MD, MPH
Founder, Uzima Health & Wellness
FINDING FOZIE LEE
This Mother’s Day we reflect on the women who gave us life and life’s lessons. Many of us have not been able to hug and see our grandmothers due to COVID-19. This month made me reflect on my grandmother’s lifelong heartache. She gave birth to ten children with the help of only a midwife, her only daughter could not deliver one.
In my grandmother’s home there were two pictures that could not be moved or touched. A picture of Jesus, with his blue eyes, middle-parted hair, and outstretched arms hung in the formal dining room. The other picture of a smiling mocha skinned brown girl, hair with a side part in a classic 60’s bob framing playful eyes sat on my grandmother’s nightstand. Every morning, she would awake to this photo and the alarm. As all kids do, I would ask repeatedly, who is that? The response was always the same; that’s Fozie.
While snooping around in the formal living room on a visit from college, I found the family Bible in the piano bench. Family names and historical dates were listed on the inside. I saw my brother’s date of birth, the record of my birth, and my grandfather’s death and then there she was. I found Fozie. She died Christmas 1973. But who is she? I go back into the sitting room and look at my grandmother differently. The meanness that she possessed was now a mask for a woman who had in a span of three years gained and lost. Only in her thirties, she was widowed and daughterless. The girl in the picture that was never to be moved or touched was her only daughter out of ten births. Fozie was born after my father. She was the second oldest.
I continued to search for Fozie throughout the house, thinking perhaps I could find her picture in one of the old year books, maybe there was an old dress she either made or wore. I asked questions about what happened to Fozie. My grandmother, her sisters, nor my great-grandmother ever said to me what happened to her. My father has never fully told me the story in one sitting. However, in my search, I realized Fozie came to visit every year. The daughter she gave birth to, my cousin, would give my grandmother so much joy. Just like the picture, I could not touch her, nor play with her. She was precious. She was Fozie Lee.
The story goes that my aunt who had married her college sweetheart, worked as a schoolteacher, gave birth and became very ill. She died the next day. My grandmother and my young dad, made haste but Fozie Lee was gone. There was a baby girl who would never know her mother’s smell or smile and a young dad, a widower. That Christmas and New Year for the family would set the pattern of this holiday week for us in the future. After Christmas dinner, my grandmother or one of my uncles would go to Fozie’s grave site and place the flowers. Her tombstone is engraved with the words, “Just sleeping.”
Black women have the highest maternal morbidity and mortality than any other racial group.
According to data from 2014 to 2017, there were 41.7 deaths per 100,000 live births for non-Hispanic Black women. For every maternal death, 100 black women suffer from pregnancy related illnesses that are life-threatening. Serena Williams discussed her near death experience after giving birth in Vogue magazine. She developed acute shortness of breath and had a blood-clot in her lungs. Queen B, Beyonce Knowles, who is a notoriously private celebrity, added to the short list of Black female celebrities who have spoken about their life-threatening complicated pregnancy experiences. She developed severe preeclampsia or toxemia of pregnancy. She states she was swollen and had to be on bedrest and knew her life was in the balance. I was in survival mode she tells us in her Netflix documentary Homecoming.
The CDC initiated the National Surveillance of Pregnancy -Related deaths in 1986 to be able to capture events that surround maternal deaths to help develop better treatment protocols for expectant women. However, Olympian, Allyson Felix, who suffered from severe preeclampsia and had to deliver her daughter prematurely by emergency caesarean took this issue to Capitol Hill. This near-death experience forever changed this world -famous American sprinter. “Mothers don’t die from childbirth, right? Not in 2019. Not a professional athlete, not at one of the best hospitals in the country.” She had learned that she lived to tell her story. My aunt and so many others did not. We have had to silently live through losing Fozie Lee for years.
Hypertensive disorders of pregnancy, such as toxemia or preeclampsia, thrombotic embolism, amniotic fluid embolism, and hemorrhage contribute to the high morbidity and mortality in Black women. Black women also die because of structural racism such as lack of access to prenatal care created by maternity deserts. Beyonce, Serena, Allyson all described feelings of being vulnerable and near death while trying to bring life into the world. They all agreed that on some level more could have been done for them. Serena stated that she knew the signs of a pulmonary embolism because she had one previously. She alerted her health-care team immediately, but her complaints were dismissed initially.
Black women’ s lives are undervalued. In the maternity ward studies after studies are documenting less monitoring, unequal treatment and less care in maternity wards based on race. Child- birth comes with its own risk given the physiological changes that the mother endures. There is supposition that low socioeconomic women, and Black women are less healthy when they get pregnant, but this theory alone does not explain the persistent upward trend of maternal deaths or severe illnesses of pregnancies during the pregnancies of Black women.
We have to accept that there are real racial disparities in maternal outcomes. By stratifying data based on if a woman delivered at a primarily Black- population serving hospital versus a medium to low Black population serving hospital, Dr. Howell found differences in outcomes. The study, she authored, found that both Black and White patients who delivered in primarily Black serving hospitals had a higher risk of severe maternal morbidity. Dr. Howell affirms the fact that there is a high risk of adverse outcomes faced by Black women giving birth in comparison to White women in the U.S. These deaths and poor outcomes are preventable. We must do implicit bias training for obstetrical care teams. We need to create incentives for protocol-driven prenatal, antenatal and postpartum care that will hold hospitals accountable for the care they provide for pregnant women, particularly ones that see a large volume of Black women.
My great-aunt, our oldest living relative at 91 years of age, looked around her tiny apartment in Harlem and pointed to the kitchen. “I was standing there, cleaning the greens to prepare for the New Year when I got the call about Fozie. I thought to myself, losing Fozie was so traumatic that seventy years later, she still remembers that moment in great detail. The death of a young mother, a sister, wife, daughter changes the family forever.
Taking a moment to look around my grandmother’s room after her passing, I cannot find Fozie on the nightstand. I closed the door, comforted in knowing she found her at last.
Olympic Medalist Allyson Felix and Daughter. Photo Credit: TheTodayShow.com