"Our moms are angry when they get here. They've called 20 doctors, they've called 20 places; no one wants to take their insurance," said Wanett Mims, the co-founder of Galatians Community Health.
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For two decades, Mims watched as underinsured and uninsured patients were denied or limited access to health care.
This year she decided to do something about it.
She opened Galatians Community Health, a nonprofit organization offering primary care, pediatric and OBGYN services.
"Our goal is for underinsured women and African-American women to have the same type of access of those that are insured and those of other races," Mims explained.
Around 90% of the East Raleigh clinic's patients are on Medicaid. Mims said the current options for moms on Medicaid are limited to less than a handful of places in Wake County.
"So those moms are waiting to get an appointment, sometimes five or six months have gone by and they have not received access to care," Mims said.
These barriers of affordability and access disproportionately impact women of color and can have fatal consequences.
The ABC Owned Television Stations Equity Report found twice as many Black residents and six times as many Hispanic residents do not have health insurance in Raleigh and Durham metro areas compared to white residents.
Black infants die at rates double the state average, according to data from the NC Department of Health and Human Services. The latest data from 2020 revealed 12.8 Black babies out of 1,000 died before their first birthday. This rate is the highest in the last four years and is nearly three times higher than the mortality rate for white infants and two times higher than the rate for Hispanic infants.
Wake County reported a higher than average Black infant mortality rate in 2020 with 13.1 deaths for every 1,000 births (or 1.31%). Around eight counties report rates higher than 3% with Davie reporting nearly 77 Black infant deaths for every 1,000 births (or 7.7%).
Mims is hoping to close those gaps. She said since Galatians Community Health opened in May, they have served nearly 300 Black moms.
"293 African American moms, that we have provided prenatal care for, that if we were not here, or if there was better access, then those moms would be a part of those rates," she said.
Mims explained the high-death rates Black moms and infants face are connected to the barriers they face in receiving prenatal care.
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"If we do not change the quality of care, the access of care, and the implicit bias of racism, it is going to continue to go up," she said.
In addition to affordability and availability, Mims pointed to implicit bias within healthcare as another barrier that prevents some mothers from receiving the care they need; it's something she experienced firsthand when she was pregnant.
The March of Dimes 2021 Report Card gave the state a 'D' for the health of moms and babies. The report found there has been no improvement in North Carolina's disparity ratio for the preterm birth rate between races. The preterm birth rate for Black women is 48% higher than all other women. Preterm birth rates worsened last year in Cumberland and Durham County, according to the March of Dimes report.
It's not just Black babies that are dying at higher rates, Black mothers are also at an increased risk.
The CDC reported in 2019 that Black women were three times more likely to die a pregnancy-related death than white mothers.
The CDC data pointed to the quality of care as one factor in pregnancy-related deaths.
"Studies have suggested that Black women are more likely than white women to receive obstetric care in hospitals that provide a lower quality of care," the CDC reported.
The federal study also pointed to implicit bias within the health care system that can impact treatment decisions, recommendations, and ultimately patients' health outcomes.
"Reducing disparities in pregnancy-related mortality requires addressing multifaceted contributors. Ensuring robust comprehensive data collection and analysis through state and local maternal mortality review committees, which thoroughly review pregnancy-related deaths and make actionable prevention recommendations, offer the best opportunity for identifying priority strategies to reduce disparities in pregnancy-related mortality," the CDC stated for possible solutions.
This year the state's Perinatal Health Strategic Plan's central goal is to eliminate the racial disparity in infant mortality. Over the next four years, state leaders also aim to eliminate disparities in maternal morbidity, decrease the percentage of preterm births across all racial groups and increase health insurance rates for all.
Karida Giddings is the access to healthcare program coordinator for NC Black Alliance. She works to eliminate disparities in healthcare across the state. She said one big solution to close these gaps is to expand Medicaid.
"In states that have expanded Medicaid, the percentage of uninsured black women, in particular, compared to the right here in North Carolina has almost been cut in half," Giddings explained. "When you provide that access through affordability, people have the insurance that they need to get the care that they deserve."
Giddings also said part of the path toward improvement involves educating people on the issues.
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"We also have to educate them on how it can be accessible to them. Those providers, legislators that have a direct stake or say kind of in expanding access, so it's important for them to know the issues, but to also understand how they can move from just advocating around these issues to seeing real policy change," she said.
In the absence of Medicaid expansion, Giddings points to grassroots organizations, like Galatians Community Health, stepping in to fill coverage gaps. Mims is already running into challenges with the rates providers get reimbursed for providing care to Medicaid patients.
"We're talking about thousands of dollars difference. So sometimes it's not that the health care professional doesn't want to take care of the patient. They can't --(it's not) financially feasible -- stay open to take care of the patient because of the reimbursement," Mims explained.
She said her organization hasn't received any grants or donations yet and has around a million dollars in deficit from operation costs.
"Every day is a faith walk," she said.
Mims said real change is needed to ensure her clinic's doors and others can stay open to fill these gaps.
"We need changes. We need political changes to get this done," She said. "There's no reason why North Carolina Medicaid or any other Medicaid should pay a doctor any less to take care of a patient who has limited access to care."
Giddings also said funding and policy changes are needed at the state level to continue to offer these solutions.
Without these changes, Mims said her organization's long-term future is uncertain but she continues to fight to stay open and reduce the fatality rates for mothers and children in Wake County.
"I come to the clinic purposely to see the impact that we are doing, because it's the impact and the change and the care that we're providing for the moms and knowing that I know we have 348 African-American women that have a chance at living, them and their baby at childbirth and that's what keeps us going here," Mims said.