Bold Voices from the Maternal and Child Health (MCH) Field
January 2021

​The Urgency of Accompliceship to Advance Racial Justice


Grace Guerrero Ramirez, MSPH, AMCHP Program Manager, Workforce Development and Capacity Building
Assisted by Ben Kaufman, MSW, AMCHP Associate Director, Workforce Development and Capacity Building

This article was developed from an interview with Marilyn Johnson (MCH Director, Mississippi State Department of Health) and Kimberly Seals (MCH Director, South Carolina Department of Health and Environmental Control)

Disclaimer: The views and opinions expressed in this article are personal and belong solely to Marilyn Johnson and Kimberly Seals. They do not reflect the opinions or views of their organizations. 

Authors’ note: Our intent in writing this article is to contribute toward building our collective narrative to push for racial justice. It is beyond the scope of this article to fully capture the array of issues that the MCH field must confront. Rather, our intention is to advance a more urgent dialogue that will lead to collective action, resulting in equitable processes and solutions.

Many of us in the MCH field know that building equity and justice requires continuous learning and unlearning, doing, and undoing. But what does that require us to do? As many in the MCH field seek to practice anti-racism, it’s important for us to answer the following question: What are we willing to give away or give up to first build and then sustain racial justice? This uncomfortable question is the result of uncomfortable truths—truths that many of us have had the privilege of being eased intonot forced into, as is the experience for Black, Brown, and Indigenous colleagues and communities.

Ben Kaufman and I spoke with two Black MCH Directors: Marilyn Johnson of Mississippi and Kimberly Seals of South Carolina about their personal experiences with racism, barriers to dismantling racism, and pathways to effect transformational change.

Marilyn’s Perspective 

Marilyn emphasized that her need to become a change agent and uphold racial justice stems from her and her family’s painful experiences with racism in the deep South: “There’s a history in my family and in my state that makes it important to me, and there’s a value system that I have that makes it increasingly important to me.” Marilyn’s grandmother grew up picking cotton and to this day, she avoids going to certain places in Mississippi. Her mother, who went to the first desegregated high school in a small Mississippi town, remembers people spitting in her face; she’s still forced to relive the trauma that she suffered growing up. Marilyn’s experiences growing up and living in Mississippi has shaped her understanding about the cultural and historically traumatic contexts that undergird Black communities’ health. For example, she recognizes the legacy of abuse of Black women’s bodies by medical and public health institutions and that this contextualizes Black women’s skepticism of birth control methods like the intrauterine device. Ignoring this context of systemic abuse and distrust risks putting blame on Black communities for their low “uptake” of or “adherence” to medical and public health interventions. Understanding these nuances from a racial equity lens is critical to Marilyn’s approach as a public health professional. 

Kimberly’s Perspective 

Kimberly grew up in neighboring Alabama. Although her family rarely engaged in conversations about race and racism, eventually she grew to understand what it meant to be a Black woman in the United States—to carry the weight of fear and mistrust that not even her extensive education can fully insulate her from. In public health, we know that Black communities bear a disproportionate burden of death and disease. Kimberly noted: “I may not be having these experiences, but I’m not far from it… I’m not far from my sister and brother who had a different outcome.”

These experiences inform how Marilyn and Kimberly view their roles as MCH leaders and how they view the broader MCH ecosystem’s responsibility for advancing racial justice within and across systems, particularly those entities that haven’t consistently operated with the urgency that justice demands. 

Calling Out Our Silence and Complacency

Although it’s true that many MCH leaders, including those at the grassroots level, have championed racial equity, their efforts co-exist with others that demonstrate a collective lack of urgency to address racism at a structural level. This includes how we, as a field, underplay and disregard the ways in which our field has insidiously perpetuated oppressive practices.

Silence is deafening and complacent, perhaps a symptom of paralyzing fear. Kimberly and Marilyn noted the silence of colleagues when there have been opportunities to stand up to or talk about racism, especially during recent mass unrest. This hesitancy to speak up may be rooted in discomfort, fear of saying the wrong things, or not knowing how to navigate these conversations. Although agency dynamics can make conversations about racism difficult, now is the time to have them. If we fail to do this, we miss the opportunity to engage in open and long overdue conversations about racism and what to do as a field.

Silencing also operates in other ways. While we often discuss the importance of ensuring that Black, Brown, and Indigenous colleagues have a seat at the table, we acknowledge that the MCH table (like many other tables) has been built by and for white people. Kimberly and Marilyn have distinct yet thematically similar experiences of not only being the only Black woman in the room, but also being excluded as a result. Marilyn shared her experiences of being left out of meeting invitations and programmatic decisions; she was only included after a white colleague intervened.

We must also stop diluting necessary approaches to advance racial equity to be more palatable to predominantly white leadership. In the interest of pledging some form of commitment to health and racial equity, agencies often water down intentional frameworks into “cultural competency.” But the cultural competency approach, which is one of the MCH Leadership Competencies, can perpetuate the assumption that communities are monoliths. It also risks placing blame on culture instead of on oppressive systems and avoids naming structural racism as a fundamental problem that we must address head-on.

Building awareness of systemic oppression is one thing. Acting on it is another. Marilyn emphasizes the need for agencies to step up: “We’re tired of hearing the conversation—where is the action, what are we going to act on, and when?”

Transforming MCH Systems

The Title V MCH Block Grant can play a critical role in advancing anti-racist MCH practice and leadership; however, Kimberly urges us to scrutinize how we have done ourselves an injustice by not creating more effective structures for our programs and evaluation mechanisms to address racism. As examples:

  • None of the current National Performance Measures assess the extent to which programs are producing equitable outcomes across all functions.
  • Similarly, the Five-Year Needs Assessment is another key opportunity to center racial equity. Achieving equitable outcomes demands equitable processes, and the assessment process needs to be overhauled. State and territorial Title V programs are positioned to facilitate this change, starting with how they listen and respond to their communities.

Federal agencies cannot continue to miss these and other clear opportunities to prioritize and push the field towards dismantling racism and building equity. Our field needs strong guidance to establish and actively support mechanisms that will ensure systemic accountability to populations that have been marginalized. Achieving this objective starts with embedding racial equity in the Title V MCH Block Grant writing process, and perhaps including a specific equity-focused domain. We need a national charge to partner with and allocate significant, sustainable funds to grassroots community-based organizations, particularly those led by Black, Brown, and Indigenous community members who are doing critical work on the ground to address key drivers of injustice. 

Forging Accountability: From Allyship to Accompliceship

How do we come together as a field to transform systems toward justice? When I posed a question about the meaning of allyship, Marilyn powerfully re-framed it: “Allyship to me is someone who operates in solidarity with marginalized groups… an accomplice is someone who is not afraid to give away their own safety and privilege to directly challenge oppressive power structures.” Kimberly added that accomplices are “willing to go down with you.” 

Leaning into discomfort is necessary to move toward racial justice. As Kimberly said: “I believe in a little bit of friction… I value being uncomfortable. That’s how you remove stains, the things that need to get you to a better place.” We must also recognize, individually and collectively, that the discomfort a person may feel when engaging in necessary conversations about racism or carrying out actions to achieve real racial equity is minor compared to the unrelenting trauma that Black, Brown, and Indigenous people live through daily—and have lived through for generations. 

Being accomplices demands the discomfort and determination of letting go of white supremacist behavior: our white-centric and savior narratives, flaunted expertise, power, and safety. It means forging a unified mission that’s explicitly, courageously, and unapologetically anti-racist without contributing to the burden that many Black, Brown, and Indigenous people have had to shoulder. MCH friends and colleagues, we’re beyond calls to action. This is our burning platform.