Myriad factors endanger pregnant women of color

BELZONI, Miss. — The last day Byron Stribling spent with his wife, Harmony, was the Fourth of July in 2021.

The holiday fell on a Sunday. The congregation at their church in Belzoni, a small town in the Mississippi Delta, blessed the couple and prayed for a safe delivery for Ball-Stribling. She was eight months pregnant and scheduled to have a cesarean section five days later.

But around midnight that night, Ball-Stribling threw up and said her chest hurt. “She wanted to lay down, but I told her, ‘We need to go somewhere,’” recalled Stribling, 32.

Ambulances in the Delta are unreliable, and the only hospital in Belzoni closed over a decade ago. So they piled into his car and sped toward Yazoo City, Mississippi, the closest town with an emergency room, about 30 miles away.

On the way, Ball-Stribling had a seizure. Panicked, Stribling called 911. The dispatcher told Stribling to start CPR, so he slammed on the brakes and pumped her chest on the side of the road until an ambulance came. But he already knew he had lost her.

What killed Harmony Ball-Stribling? The death certificate says the cause was complications of preeclampsia, a life-threatening blood pressure disorder that can develop during pregnancy. But that’s not the whole story.

Because even though Ball-Stribling was just 30, the odds were against her: She was a Black woman in America, where pregnant women of color die at almost three times the rate of pregnant white women.

She lived in a rural health care “desert,” a county with no obstetrician or certified nurse midwife and no hospital that delivered babies — in a state with the worst maternal and infant mortality rates in the country.

Her story is a case study of how powerful social, economic and environmental forces conspire against mothers of color in the United States, undermining their health even when they have access to medical care.

Researchers have become increasingly aware of the importance of these so-called social determinants of health. Well-being is inextricably linked to life circumstances — like living in safe neighborhoods with good schools and easy access to healthy food — and it is powerfully diminished when everyday life is buffeted by crime, pollution and racism.

“How you live, where you live and what you eat actually affect the DNA and affect genetic expression,” said Dr. Yvonne Maldonado, a professor at Stanford University School of Medicine.

The American Heart Association, taking all these factors into account, has modified the calculator that doctors use to evaluate the risk of cardiovascular disease, reserving space in the formula for a patient’s ZIP code as a proxy for social determinants.

Ball-Stribling always stood out in a crowd. Her older sister, Cherrell Ball-Banks, remembers her sibling as warm and gregarious, with a voice like a nightingale’s and an intense energy, someone who was “always lovin’ on you.”

“We’re all firecrackers,” Ball-Banks said of her family. “But Harmony, she was a full-fledged firecracker.”

In 2008, a blood test during an ER visit for pain showed that Ball-Stribling was pregnant. Her son, Jadon, was born later that year, when she was 16. Ball-Stribling stayed in high school and graduated, but the high blood pressure she developed during her pregnancy never went away. The medications she was prescribed had severe side effects, including headaches and fatigue.

When her relationship with her boyfriend, Arsenio Robinson, fell apart, she started dating Byron Stribling.

She was struggling to make ends meet, juggling college classes with shifts at Kentucky Fried Chicken. Stribling had a scholarship to attend music school in Jackson, Mississippi, but he came home on weekends and helped out. He graduated in June 2015 and returned to Belzoni, and the two married a month later.

When Ball-Stribling’s son, Jadon, was about 9, his father, Robinson, was charged as an “accessory after the fact” to a gang-related murder. He was sentenced to 20 years in prison, which he is still serving.

Stribling took on the role of father to Jadon. But he and Ball-Stribling had trouble conceiving another child, and they decided to go to Dallas for fertility treatment.

Ball-Stribling conceived after two rounds of in vitro fertilization, and she continued prenatal care with doctors at the high-risk pregnancy care clinic of the University of Mississippi Medical Center in Jackson, about an hour from Belzoni.

But she was not doing well: Her blood pressure was often out of control, and she had splitting headaches, Stribling said.

In May 2021, when she was about six months pregnant, she was hospitalized and diagnosed with preeclampsia, a serious pregnancy complication that causes high blood pressure and organ damage and can be fatal.

Although preeclampsia is rare, affecting only 5% to 8% of pregnant women, half of all women who start pregnancy with uncontrolled hypertension will develop it. It also is one of several complications, including stroke, that are more common among women who undergo fertility treatment.

How women with preeclampsia fare varies by region. Women in the South have the greatest incidence of pregnancy complications; those in the Northeast have the lowest.

The Striblings saw doctors in Jackson twice a week, and “everything was looking good,” Stribling said. “Those last few visits, it was all smiles and giggles.”

But women with preeclampsia can experience sudden seizures or strokes, which are signs of a life-threatening complication called eclampsia.

Before dawn July 5, 2021, Ball-Stribling died. A hospital might have been able to save the fetus, a girl the couple planned to name Harper, but she died, too, on the side of the road.

Since then, Stribling and his mother-in-law have pressed the state to provide more health services in rural areas in Mississippi, where at least five hospitals have closed since 2015, several have stopped delivering babies in recent years, and 35 — almost half of the state’s rural hospitals — are at risk of closing.

In August 2021, Harmony Ball-Stribling was awarded her bachelor’s degree in education. The diploma came in the mail after she died, her mother said. Stribling bought a house and became guardian to Jadon, now a high school sophomore. Stribling is still paying off the debt incurred for the infertility services the couple received.

At family get-togethers, Ball-Stribling’s absence is palpable.

“When my father’s children all get together, we look around and ask, ‘Where’s that sparkle? That smile, that face, that sunshine?’” her sister said. “The light is gone.”

This article originally appeared in The New York Times.

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