When Timoria McQueen Saba was approached last spring by the nation’s premier obstetrics and gynecology organization about serving on its patient safety council, she jumped at the opportunity to highlight the patient voice in the nation’s maternal health crisis, which disproportionately affects Black women.
Saba, who lives in Milton, is a maternal health advocate who makes no secret that she is a survivor. She suffered a near-fatal hemorrhage in 2010 after the birth of her daughter and was diagnosed with post-traumatic stress disorder. Thirteen months later, she had a miscarriage in a frozen yogurt shop.
“People don’t understand the trauma of a survivor,” said Saba, 42. “I really decided that it was important to talk about this and try to connect with people.”
The former professional makeup artist has spent the past 10 years speaking and writing about postpartum mental health and connecting women and families to therapists and support groups. So, collaborating with the American College of Obstetricians and Gynecologists looked to be a good move.
But her experience with ACOG was short-lived. Just four months after she was recruited by employees to sit on the affiliated Council on Patient Safety and Women’s Health Care, Saba said, the group rescinded the offer.
Now, the wife and mother of two young children is suing ACOG, alleging she was denied the volunteer position on the council after she raised concerns about a member’s racist remarks made in the past.
The case speaks to larger issues that are surfacing about racism and transparency in maternal medicine.
“Timoria is a Black woman who was approached by ACOG to be on the patient safety council, promised a seat . . . and ultimately denied for no valid reason,” said Saba’s lawyer, Benjamin Klein. The civil suit was filed under Title VI of the Civil Rights Act, which prohibits discrimination on the basis of race, color, or national origin in programs receiving federal financial assistance.
The lawsuit seeks monetary damages for the harm caused by what it said was ACOG’s intentional discrimination; Saba’s return to the council; the creation of a paid leadership position for a Black woman; and the appointment of members from Black, Native, Latina, Asian, and LGBTQ communities. The case is set for discovery next month in US District Court in Boston, with a trial scheduled for next July.
The American College of Obstetricians and Gynecologists, which provides guidelines for providers and promotes programs aimed at improving women’s health, declined to comment on the pending litigation. In court filings, the organization denied that it controls the Council on Patient Safety, which it called “an unincorporated nonprofit council, independent of ACOG, with its own governing body, policies, and procedures.”
Saba and other maternal advocates say their voices are sorely needed at a time when alarming maternal outcomes persist in the United States. Pregnancy-related deaths have increased in the last two decades, with Black women having the highest rates, compared to other groups, according to the Centers for Disease Control and Prevention.
CDC data also show that rates of unexpected adverse outcomes from labor and delivery, primarily excessive bleeding, increased almost 200 percent from 1993 to 2014. Black women are more likely to experience these health consequences, according to a 2019 study by Stanford University researchers.
Saba said ACOG employees courted her to join the council and help with the formation of a related patient advocate subgroup in May 2019. The collaboration initially seemed genial.
Yet, she said, the warm welcome turned icy when she spoke out last year, at the council’s biennial meeting, about the lack of racial and LGBTQ inclusion. Saba said the meeting room “got uncomfortable.” The chair of the council cut her off from speaking, saying, “Your time is up, we’ve heard enough,” according to court documents.
Weeks later, according to the suit, Saba alerted ACOG employees that a white council member had “perpetuated racist ideology” by downplaying the role of racism in maternal health disparities and suggesting bad outcomes may be linked to genetics. Saba said she learned of the comments from another maternal health advocate with knowledge of the statements.
Saba said ACOG employees apologized and assured her that she would not work with this individual and that they would “discuss with our leadership.”
Weeks later, according to the suit, an ACOG employee notified her that the offer to sit on the council had been rescinded. The first explanation was that the council wanted to hold open her promised seat until “initial group members were selected” for the patient advocate subgroup that Saba had worked to form. Later that day, the same employee sent another explanation: that ACOG’s “active solicitation” of Saba was a deviation from the “traditional nomination process.”
“I was completely blindsided, devastated, and upset for weeks because I thought that this is really going to be a catalyst for real improved outcomes,” Saba said in an interview.
ACOG says on its website that it founded the council in 2011 with 18 other organizations, and that it “partners with” and “supports the council’s mission, vision, and programs.” One of those programs is the Alliance for Innovation on Maternal Health, which creates ACOG’s “patient safety bundles,” evidence-based recommendations on patient care that providers and hospitals follow.
ACOG received $4 million in federal grants to implement the AIM program in 2014 and another federal grant in 2018 for $2 million per year over five years, according to an ACOG news release.
While it does not license practitioners, ACOG guidelines set the standard of care in the field, and OB/GYNs turn to the organization for guidelines on day-to-day practice.
Dr. Cindy M. Duke, a board-certified fertility physician who founded the Nevada Fertility Institute in Las Vegas, said Saba’s case highlights the issue of closed selection processes for governing committees in professional medical organizations.
“I think it brings to the fore a conversation that needs to happen because you have a college where somehow you don’t make these openings public, you don’t invite people to apply for these positions,” she said.
For OB-GYNs, the case highlights a culture of racism in medicine, including the lack of Black leadership in professional organizations.
Duke said that she no longer uses the word “racism” when making presentations about health disparities, but “bias” or “prejudice,” because “the moment you use the word ‘racism’ towards doctors, they get angry . . . they immediately say, ‘How can I be racist?’ ”
For maternal advocates with traumatic birth experiences, the lawsuit highlights how Black maternal patients are often silenced or ignored by physician authority.
“When you have a predominantly white, male-dominated board making the decision over women’s reproductive parts, that’s a problem,” said Nneka Hall of Boston, a doula and advocate who founded Quietly United in Loss Together, a bereavement organization for families dealing with infant and child loss.
Amid national protests in June, ACOG and the patient council released statements stating that “ACOG is an organization committed to inclusion and equity.” ACOG has also collaborated with maternal health organizations led by Black women, including the National Birth Equity Collaborative, Black Mamas Matter Alliance, the Shades of Blue Project, and SisterSong.
Representatives of these organizations attended a meeting hosted by the patient council in January. “It was a good meeting; we prepared to talk to them about racism,” said Dr. Joia Crear-Perry, an OB/GYN and president of the equity collaborative. “They wanted to hear and learn.‘'
But Saba is not convinced.
“How integrated are Black individuals, health care providers, and advocates and educators into the fabric of these maternal health organizations?” she asked. “The answer is they’re not. If you really want to improve outcomes, there has to be all those voices at the table when these decisions about health care are being made.”