Amplifying Black Women’s Voices

Silifat Yussuff-Mustapha ’97, vice president of nursing and clinical services for Unity Health Care in Washington, D.C., is committed to improving health outcomes for African American mothers.

By Marybeth Reilly-McGreen

A thought experiment: Imagine that a woman of color living in America learns she is pregnant and in need of prenatal care.

But she lives in an impoverished area unattractive to business development. And that situation creates a food desert (an area without access to healthy food). And the simplest exercise—walking—is difficult because her public housing facility doesn’t have sidewalks. And it’s not safe to walk anyway because the crime rate is high in her city. And it’s not safe at home because she lives with a smoker—or an abuser. And there are drugs or alcohol in the household.

What are her chances of receiving good maternal and infant care?

Before answering, consider a second scenario: A celebrated international tennis star and businesswoman, a household name, a woman in possession of serious power and wealth, experiences complications after a C-section. She is in a top hospital. She has access to the best doctors.

But she is Black. And her complaints aren’t taken seriously (despite telling medical staff that she has a preexisting condition for which she knows the protocol). And she has a blood clot.

What are her chances of receiving good maternal and infant care?

Not necessarily so different. The second scenario is not a hypothetical, but the actual and potentially lethal situation Serena Williams found herself in after the birth of her daughter. In the United States, Black women have the highest maternal mortality rate among American women, according to the Centers for Disease Control and Prevention.

The thing to keep in mind about health disparities is that they are entirely preventable from a societal standpoint but potentially insurmountable for a person prevented from accessing adequate care. African American women in America are, in general, disproportionately affected by health disparities, defined by the National Institutes of Health as preventable differences in the burden of disease, injury, violence, or access to health care.

This is the space in which Silifat Yussuff-Mustapha ’97, registered nurse and vice president of nursing and clinical services at Unity Health Care in Washington, D.C., situates herself. Yussuff-Mustapha, who received her master’s degree in public health from Benedictine University and is currently working on her Ph.D. in nursing at the Catholic University of America, oversees a department of close to 200 nurses, medical assistants, directors of nursing, and nurse managers who provide primary and specialty care to about one-eighth of all D.C. residents and make more than 300,000 patient visits per year. Unity oversees 10 community health centers as well as homeless shelters, the D.C. Department of Corrections, two high schools, and street medical service to the homeless.

“I am interested in maternal mortality and morbidity in African American women because we are three to four times more likely to suffer either death or serious illness during childbirth,” Yussuff-Mustapha says. “And there are a lot of implications to health-care disparities in the United States that still go on due to mortality and morbidity during pregnancy because they have a higher incidence of diabetes and hypertension—social determinants of health have a lot to do with that, as well.”

Social determinants are the conditions of the environment in which a person lives and works—conditions, such as poverty and access to clean water, that affect their health and quality of life.

“I am interested in maternal mortality and morbidity mainly in African American women because we are three to four times more likely to suffer either death or serious illness during childbirth.”

—Silifat Yussuff-Mustapha, vice president of nursing and clinical services, Unity Health Care

“My research focuses on African American women’s communication with their obstetrical providers, some of whom do not understand that a lot of these women have social determinants of health that prevent them from making their health and their baby’s health a priority,” Yussuff-Mustapha says. “There’s a lot of documentation and data showing that Black women don’t always feel heard by their health-care providers. And it’s not necessarily specific to poor women. Serena Williams could have died because she wasn’t being listened to by her providers.”

Yussuff-Mustapha is a proponent of evidence-based practice in nursing; that is, a holistic approach to care that relies upon knowledge, research, and best practices rather than tradition, habit, colleagues’ advice, or personal beliefs. One form that evidence-based practice can take—and one Yussuff-Mustapha has researched and published about—is involving frontline nurses in shared governance around nursing procedures and practice standards.

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Yussuff-Mustapha’s parents emigrated from Nigeria in 1972. She is their eldest child and only daughter. URI has been a central character in her life story; she remembers walking the Quad as a little girl when her mother was a URI student. Yussuff-Mustapha’s youngest brother is also an alumnus. “URI is in our family,” she says.

While at URI, the nursing major gravitated toward the arts in her downtime. Introduction to Jazz was Yussuff-Mustapha’s favorite course, and she danced at halftime during men’s basketball games with Flavor Unit, a dance team she co-founded.

Nursing appealed to a different aspect of her personality. She says her mother “nudged” her into health care because she believed it was a safe and lucrative field, but it also proved to be a path of purpose.

“I am a nurse because my mom said, ‘You should be a nurse.’ People talk about their passion all the time,” Yussuff-Mustapha muses. “I don’t think of nursing as my passion; I think it’s my purpose. Not to minimize art, but I am so much more into health justice.”

Ana Barazza ’94, M.S. ’04, shared many meals with Yussuff-Mustapha at Hope Dining Hall. They were sorority sisters (Alpha Kappa Alpha) and would often hang out together during Barazza’s Monday afternoon radio show at WRIU. A Mary J. Blige tune would have Yussuff-Mustapha up and dancing in the station, Barazza recalls.

“What really bonded us was that we understood each other and understood the challenges that we were facing—there were serious conversations about relationships or struggles with our grades, classes, financial aid. And it was also a lot of just enjoying ourselves and having a grand old time.”

It’s a bond that’s lasted more than 30 years.

“Right now, we have a sorority sister who’s going through a significant medical crisis, and Silifat stepped up and kept us all in the loop, translating medical terminology into plain English,” says Barazza. “We’ve had 30-plus years of friendship. She’s always been a person who really cares.”

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And while Yussuff-Mustapha is the first in her family to practice medicine professionally, she isn’t its first caregiver. Her paternal grandmother was something of a midwife to her community.

“Back then, and with Nigeria being a developing country, not every job was degree-based or something you went to school for,” Yussuff-Mustapha says. “My grandmother used to deliver babies for people. I’m told she was sort of a midwife as needed in the neighborhood.”

For much of human history, it fell to women like Yussuff-Mustapha’s grandmother to care for a community’s sick, elderly, and pregnant members, and a more informal education, such as an apprenticeship, was a viable path to a kind of professional standing, say Barbara Ehrenreich and Deirdre English in the introduction to the 2010 edition of their book Witches, Midwives, and Nurses: A History of Women Healers, first published in 1973.

Ehrenreich and English call for health-care reform—both in how the medical system functions and in how it treats the most vulnerable patients. They write, “Compared to what we confronted in the 1970s, today’s American health-care system features far more women as practitioners and even decision-makers … but basic problems of access and affordability will remain. For all our gains, we clearly have our work cut out for us.”

When you step into a doctor’s office, there are power dynamics at work immediately, Yussuff-Mustapha says. And there is also history that has led to Black distrust of the medical establishment. Just google “Tuskegee syphilis experiment,” “Henrietta Lacks,” or “Vermont eugenics apology.” As recently as 2020, the American Civil Liberties Union reported that a for-profit U.S. Immigration and Customs Enforcement detention facility in Georgia was performing sterilization procedures on immigrant women without informed consent.

And then there is Dr. James Marion Sims, father of modern gynecology, inventor of the modern speculum, who performed medical procedures on Black women without permission or anesthesia. Yussuff-Mustapha offers the example of Sims to show how institutional racism and implicit bias travel through time.

“Enslaved Black women were used by gynecologists for experimental surgeries without any anesthesia,” she says. “These are documented occurrences, which link to the bias that occurs right now where it’s felt or implied that people of color have a higher tolerance for pain—which is, of course, not true at all. Melanin doesn’t determine your tolerance for pain.”

Thus, assumptions become implicit bias. “Practitioners are taught or hear things without stopping to think if it makes sense, and it just becomes a part of their everyday practice,” Yussuff-Mustapha says. “It’s been happening for so long, too long.”

Practitioners cannot solve health disparities on their own, though. Change will come when ending inequity becomes a societal priority, Yussuff-Mustapha says.

“We must amplify the importance of accessible health care for every individual, regardless of their background. By focusing on equity, we can ensure that all members of our community have the opportunity to live healthier, longer lives,” Yussuff-Mustapha says.

Or to live life at all.

“Black maternal health is at stake. The maternal mortality and morbidity of pregnant Black women has been deemed a public health emergency by the CDC,” Yussuff-Mustapha says. “We must keep talking about it and providing answers to the questions of why this continues to happen, and how we can advocate for ourselves.”

PHOTOS: LISA HELFERT