The Vanishing Black Family

"There's this idea that family can be detached from marriage, and because of that, the focus is always on moms and babies, and never on the unified household bonded together and built on the foundation of marriage."

This trenchant quote sets the stage for MDHHS's Oct 13 Maternal Infant Health Update, below.

The receipts and more from Delano Squires discussing his recent book The Vanishing Black Family in Thursday's Hillsdale Podcast. https://podcast.hillsdale.edu/the-vanishing-black-family/

When The System Becomes the Barrier: Transforming a Patient’s Experience into Healthcare System Change

“If the patient encountered the same problem at multiple points within the healthcare system, we must examine the system—not only the individual.”
—Mary Dixon‑Woods

Patient experience is an important indicator of healthcare quality, yet experiences of stigma, discrimination, disrespect, and poor communication are often addressed as isolated interpersonal events rather than potential indicators of system level problems. This article examines how a patients experience involving a young, Black, pregnant woman living with HIV can serve as a catalyst for healthcare-system improvement. When concerns occur at multiple points across a patient’s healthcare journey, healthcare leaders and clinicians should examine organizational processes, communication, care coordination, policies, culture and accountability in addition to individual behavior.

The Patient Experience: A Case That Reveals System Failure
Background Summary: J.S. is a 32-year-old HIV positive pregnant woman who moved to the US from Somalia 5 years ago. When J.S. arrived in the U.S she was about 7 months pregnant and had not received any prenatal care. J.S. had a spontaneous delivery on December 25, 2023. The infant was born with severe medical complications. It was later determined the infant was HIV positive with advanced AIDS.

Fast forward two years later, J.S. is in and out of HIV care, returns to the Ryan White agency pregnant, and seeks assistance for medical care and resources. The Ryan White agency re-engages the client in medical care and helps her navigate her OB, ID, and other medical needs while addressing her social needs. Ultimately, the patient maintains viral load suppression and a plan in place to deliver her baby vaginally

Through complex social determinants and life circumstances. J.S. pushed through to maintain viral load suppression and have a non-complicated vaginal delivery and an HIV-negative infant. After delivery, the following events occurred throughout her postpartum stay on a labor and delivery unit.

The following account is not simply a report of poor bedside manners—its details signal broad structural issues:

Delayed discharge four days after a vaginal delivery
No nutritious meal offered after labor and delivery
No welcome/gift bag or infant discharge teaching
No infant medication administration education
A nurse questioning the authenticity of a new, in‑box car seat
Missed long‑acting ART dose due to poor coordination during the hospital stay
These failures highlight critical gaps in:

Care coordination between obstetrics and HIV providers
Respect, dignity, and equitable treatment
Maternal and infant discharge processes
Communication and patient education
Organizational culture and accountability
Why This Case Matters: Maternal Health and HIV Care Are Intertwined
This is more than a patient complaint—it is a structural failure that directly implicates maternal and infant health. Stigma, inequitable treatment, inadequate discharge processes, and fragmented care coordination erode trust and create downstream consequences:

Avoidance of care
Missed appointments
Reduced engagement in HIV treatment
Delayed symptom reporting
Compromised maternal and infant outcomes
Her experience illustrates how disrespect, disorganization, and bias can silently undermine both maternal and HIV care.

In a state where dozens of maternal deaths occur annually- and where maternal mortality review committees consistently find preventable causes—experiences like hers must be treated as critical data points showing us where change is urgently needed.

From Patients Story to Systems Change: A Call to Action
A call to action for Ryan White Providers, Obstetricians, Infectious Disease Specialists, and Healthcare Leaders

We cannot allow this experience to be dismissed as unfortunate or uncommon. It is symptomatic of larger failures identified in statewide maternal mortality reviews. Addressing this case is not optional—it is part of our responsibility to ensure equitable, safe, patient -centered care for pregnant women and women living with HIV.

The United States Department of Health and Human Services and The Centers of Medicaid have outlined evidence-based strategies to reduce morbidities in healthcare systems, hospitals and birthing facilities to transform the maternal health model. One health system at a time, one pillar at a time and the time is now. Small changes create meaningful differences. But systemic accountability creates lasting transformation. If your health system is interested in learning more about stigma women with HIV face during prenatal care, delivery, infant feeding, and post-partum, please contact Sabrina Sanders.

Sabrina Sanders MSN,BSN,RN
HIV Clinical Nurse Consultant
Michigan Department of Health and Human Services
Cell: 517-275-2017
SandersS13@michigan.gov

Sabrina would be happy to provide opportunities for educational information.

Mother Infant Health Collaborative Meetings
Graphic that looks like triangle people in many different shades of blue
All meetings are virtual and scheduled from 1-3 p.m.

2026 MIHC meetings:

Nov.12.
2027 MIHC meetings:

Feb.11.
May 13.
Aug.12.
Nov. 4.
Registration is available on the Division of Maternal and Infant Health website.

Triangle People Graphic
For more information on maternal and infant health in Michigan visit:
Michigan.gov/MIH
Contact the Division of Maternal & Infant Health at MDHHS

Delano Squires is Director of the Center for Human Flourishing at The Heritage Foundation, focusing on the impact of marriage and family structure on social outcomes. He has written extensively on topics related to faith, family, and culture.

He earned a Bachelor of Science in Computer Engineering from the University of Pittsburgh, and his Master of Public Policy from George Washington University. He worked for over a decade in the District of Columbia government, and founded Civitas Consulting Group to assist organizations in creating opportunities for community prosperity.

How Welfare and Feminism Made Marriage Optional and Children Vulnerable comes from Penguin Press and wherever books are sold.

https://www.penguinrandomhouse.com/books/763688/the-vanishing-black-family-by-delano-squires/

Previous works are published in The Root, Newsweek, National Review, The American Conservative, The Federalist, Blaze Media, and The Institute for Family Studies.