On a Saturday morning earlier this month, a diverse group of over 100 people gathered at a conference in Nashville, Tennessee to talk about legislative policies and reproductive health.

Echoes of excited chatter filled the space, but faces turned serious and heads nodded in agreement when Briana Perry, a Black woman and co-director of the reproductive freedom group Healthy and Free Tennessee, took the podium to say, "White supremacy is killing us."

In Tennessee, like many states throughout the Southeast, advocates have struggled to enact legislative solutions to improve racial disparities in reproductive health. Since 2012, Black mothers have consistently died at higher rates than white mothers due to pregnancy-related causes and Black babies are twice as likely to die than white babies, according to the Tennessee Department of Health. With high rates of rural hospital closures where maternity wards are often the first to go, all low-income women living in rural areas face limited options and longer travel times to get needed care.

While some new policies expanded reproductive freedoms during the 2019 legislative session, like the implementation of free menstrual hygiene supplies in public schools and a measure to offer alternatives to jail time for single parents, these were overshadowed by a stalled attempt at a near total abortion ban.

 The surge of abortion restrictions across the region this year and the likelihood of a renewed push in 2020, attracted people to the event from neighboring states contending with similar issues. As groups prepare for next year's legislative session, Perry and her white co-director Anna Carella wanted to challenge attendees at their annual conference to identify signs of institutionalized white supremacy and acknowledge its historical legacy in reproductive policies.

Briana Perry, Co-Director of Healthy and Free Tennessee, welcomes attendees to the organization's third annual conference held in Nashville in early October. Photo by Matt Ferry for Healthy and Free Tennessee.

"If we don't connect those dots then we think it's something new," said Jalessah Jackson, a lecturer of Gender and Women's Studies and African and African Diaspora Studies at Georgia's Kennesaw State University who spoke at the event. "It's just constant re-articulations of the same sort of policies and pushback that we've seen in the past."

Jackson explained how today's maternal mortality outcomes result in part from flaws in the medical system that can be linked to a history of eugenics and scientific racism.

In her talk, Jackson highlighted the roots of obstetrics and gynecology in experimental surgeries on slave women, the testing of birth control on Puerto Rican women, and involuntary sterilization carried out by the eugenics movement throughout the 20th century. She says these and other factors have led Black Americans to mistrust the medical industry.

"They (medical providers) tend to have a stereotype in mind that we are just drug-seeking or we need a place to stay, or we are not educated enough to know what we need or are feeling."

Studies now show Black Americans are systematically undertreated for pain relative to white Americans, and Black people believe if they were part of a different racial group, they would receive better care. In states like Tennessee, where Medicaid hasn't been expanded, women of color are more likely to be uninsured and face disparities in breast and cervical cancer diagnoses compared to their white counterparts.

Attendee Ranada Pamplen of Nashville has been a registered nurse for four years and also spent 16 years as an office manager of an OBGYN practice. She says knowing these disparities and being an African American woman, she feels an obligation to make sure all her patients are asking their doctors the right questions but especially her Black patients.

"I think a lot of things are just misdiagnosed with us," said Pamplen. "Because they (medical providers) tend to have a stereotype in mind that we are just drug-seeking or we need a place to stay, or we are not educated enough to know what we need or are feeling."

Another theme of the conference was the reproductive freedom and justice framework. Often when people think about reproductive rights, abortion is the first issue that comes to mind. But Jackson says this framework goes beyond abortion by requiring a focus on human rights and the collective experience of marginalized people. Do they want to parent? If the answer is yes, then do they have access to the medical care, income and a safe environment necessary to provide for a healthy family?

Advocates are using the reproductive freedom and justice framework to shape campaigns for 2020 policies, like an anti-shackling bill for pregnant incarcerated women; an expansion of family medical leave that would grant working parents time to attend school related events; and a Medicaid expansion to cover gaps in assistance for health insurance. The Pregnancy Fairness Workers Act also belongs at this intersection and an entire workshop at the event was dedicated to this and other work-family policies.

Briana Perry, Co-Executive Director of Healthy and Free Tennessee, speaks on a panel about the history of eugenics in Nashville in early October. Photo by Megan Jamerson for Scalawag.

Pregnant people first received protections in 1978 with the Pregnancy Discrimination Act, but the law did not set clear rules around accommodations in the work place. Feroza Freeland, a policy associate at the non-profit A Better Balance, led the workshop. She explained that a Pregnancy Fairness Workers Act would require employers to offer reasonable measures for pregnant people  like restricting heavy lifting, having a place to sit, or keeping water near work stations.

Freeland described a growing momentum around this law with 27 states passing their own version, including South Carolina and Kentucky. Tennessee, with a population of over a million women of childbearing age as of 2016, has its own active campaign and Freeland says the state can look to Kentucky as a guide.

An assessment by the Kentucky Department of Health and Wellness found that workplace accommodations can reduce the risk of poor health outcomes including low birth weight and preeclampsia. These conditions disproportionately affect low income women and women of color, and are common factors in maternal and infant mortality. The assessment also found nearly 75 percent of women entering the workforce in the U.S. will be pregnant and employed at some point in their lives, and approximately two-thirds of working mothers are the sole, primary, or co-breadwinner for the family.

"Without addressing some of these work-family policies and the gaps that we have," said Freeland, "we're continuing to see poor health outcomes."

Given the similar demographics and shared culture across the South, Perry believes that advocates in different states can find advantages in regional collaborations. This understanding led to the formation of a coalition called the Southern Alliance for Reproductive Equality (SEARE) where Healthy and Free and other organizations in Tennessee, South Carolina, and Georgia, share tools, strategies, and tactics to have a unified and diverse policy movement in the Southeast.

"We understand we are stronger if we work together and come together to fight these attacks because it's going to take all of us."

The group is also working toward healing fractures along racial lines in the reproductive rights and justice movement, and is focusing on the power of a cohesive multi-racial effort to build systemic change in the region.

"We understand we are stronger if we work together and come together to fight these attacks because it's going to take all of us," said Perry.

As the conference ended, she asked attendees to get involved in an organization tackling an issue they are passionate about and to vote. Perry said this can be hard for communities of color who feel disenfranchised from the political process, and admits that sometimes organizations and states get the policies wrong. She says groups and legislators need to keep trying to have difficult conversations and work to create sustainable communities.

Ash-Lee Woodard Henderson, Co-Executive Director of the Highlander Research and Education Center, gives the key-note address at Healthy and Free Tennessee's state wide convening in early October. Photo by Megan Jamerson for Scalawag.

For Perry, her guidepost of hope for a better future is remembering the sacrifices her ancestors made and the challenges they endured with her in mind. She says that in the past, change has come from people demanding it, and building broad movements like SEARE has led extraordinary things.

"I think that we have that same fire in us," said Perry. "We have even more resources than what those people had in previous generations, and that gives me hope all of this is possible."

Megan Jamerson is a freelance journalist based out of Knoxville, Tennessee. You can follow her on Instagram and Twitter at @mbjamerson.