Miracle Allen used her last tank of gas to drive an hour and 15 minutes to the closest clinic that would care for her and her unborn baby.
Allen, 29, was four months pregnant when Hurricane Ida ripped through her Houma, Louisiana, community. She spent three nights in the remnants of a house with a torn roof and no electricity. Her car was all she had left. So Allen — along with her 6-year-old daughter, her mother and a niece — fled in it to the rural Mississippi town of Kosciusko, where family lives.
Her first priority was finding a doctor to check on her baby boy. But the lone local obstetrician splits her work between two rural counties and wasn't taking new patients. Allen couldn't find another doctor even within an hour's drive — certainly not one who'd take a patient without insurance or an ID, which was destroyed in her home by Ida.
Finally, a Jackson-area hospital that turned her away suggested the Sisters in Birth clinic. On that last tank of gas, she arrived in a panic. Would they see her? Had the stress of the storm affected her pregnancy? Where would she go if this place turned her away?
Almost all the mothers served at the clinic in Mississippi's capital are Black women without insurance, like Allen. Many haven’t been to a doctor for years, until they became pregnant and qualified for Medicaid. Most are at risk for conditions such as hypertension and heart disease. Nearly all have nowhere else to go.
Clinic CEO and founder Getty Israel says Mississippi leaders are failing these women every day. As state Republican officials spend time and resources trying to ban abortion and awaiting a ruling that could overturn Roe v. Wade, advocates say nothing is being done to support women who choose to give birth.
“We’re doing everything wrong,” Israel said. “Mississippi is pro-birth, but not pro-life. If we really are a pro-life state, we have to do more than try to end abortion and make sure that women are healthy.”
Mississippi has the highest infant death rate in the nation, and Black babies die at roughly twice the rate of white children, federal statistics show. Mississippi also ranks among states with the highest maternal death numbers, with Black women again disproportionately affected. And rural hospitals are closing at an alarming rate, leaving gaps in health care, while about 20 percent of Mississippi women are uninsured, according to census figures.
All these issues plagued Mississippi before the pandemic, but Israel and others said COVID-19 made matters worse, with overwhelmed hospitals and a flailing economy.
Israel opened her clinic amid the pandemic need, in June 2021. She wanted to teach patients, especially Black women who she's seen taken advantage of in the medical system, how to take control of their bodies and advocate for themselves.
Sisters in Birth is a midwifery clinic that provides education and care to pregnant patients — ultrasounds, prenatal vitamins, checkups with the nurse midwife and doctor on staff. But Israel also tries to focus on more than medical care; she said she takes a holistic approach to women's physical, social and emotional health.
The clinic's community health workers help create eating and exercise plans, meet with patients at home, and join them in the hospital for labor. Employees help with enrollment in Medicai d and community college. In particular, Israel wants Sisters in Birth to address any health disparities before patients — many of whom are at risk for complications given demographics and prior lack of access to care — give birth and offer them social support.
When Allen arrived, she was greeted by art of female activists on the comforting sea green walls: Toni Morrison, Dolores Huerta and Madonna Thunder Hawk. Magazines with Black women on the covers sit in front of colorful couches.
Staff members agreed to see Allen — a single mother and waitress who lost her job of 12 years during the pandemic — without insurance. They helped her submit a Medicaid application, set up exercise and nutrition plans, and offered her gas money to get home.
“I felt like I could finally breathe,” Allen said.
Once she reached month seven, Allen said thanks to Sisters in Birth, she'd already had more medical care than in her entire last pregnancy. Israel calls her on days when the clinic is closed to check in.
The stability has helped her transition to life in Mississippi — finding a place to live, replacing documents, enrolling for food stamps — all while pregnant.
“They know me by name when I walk in,” she said. “You don’t have to remind them who you are and what you’re going through.”
Now, Israel wants to expand — but she needs money to do it. With the help of Mississippi's only Black and Democratic congressman, Rep. Bennie Thompson, she is pursuing $3 million in federal money from the Community Project Funding program to open Mississippi’s first birth center. She imagines a place where Black women can give natural births and reclaim their agency.
Currently, there's a nurse midwife on staff — one of a handful of midwives in Mississippi. Despite shrinking numbers, there's a rich history of midwifery in southern states. For generations, most Black babies were delivered by midwives because of racist policies that barred Black women from hospitals. In the late 1950s and 1960s, midwives were pushed out of the industry as hospitals became desegregated and white physicians sought control over the birth market.
Israel wants to hire more midwives, for a total of four, and offer training. She also plans a cabin for women to stay so they're on site and supported before labor.
Although Sisters in Birth does not provide abortions — the clinic generally doesn't counsel women on them, either, as the focus is providing services to women who want to give birth — Israel expects that if abortion banned, she'll see an increase in patients.
“Poor women who are now pregnant, because they can’t get an abortion, will be looking for clinics like mine that don’t have a limit on the number of Medicaid patients they accept,” she said. “Support makes a difference, whether a woman wants to have an abortion or not.”
She wants to be able to support more women, and for them to have the opportunity to give birth at the center instead of at hospitals. There, Israel said she often sees doctors pushing inductions and cesarean sections that aren’t medically necessary. Federal data show Mississippi has the highest rate of c-sections in the U.S. Black women have experienced the highest c-section delivery rates in the country since the 1990s.
In 2018, a five-year study conducted by the federal government comparing birth centers with other forms of maternal birth care for women on Medicaid revealed a dramatic reduction of preterm, low-weight and cesarean births for patients at birth centers. The results showed a reduction in racial inequities — there were no differences by race for rates of cesarean birth and breastfeeding, for example — and Israel wants to replicate that for the women of Mississippi.
Yasmin Gabriel of Jackson said she sought out Israel's clinic because she wanted to have a woman of color in the room when she gave birth.
“So often, we just get ignored,” she said. “I wanted our babies to come into this world without stress, without me having anxiety, because of the fact that I’ve experienced other people not listening to our threshold of pain or listening to what we would desire.
“I just wanted to make sure that I had someone who looked like me who understood what I was going through."