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HOUSTON — Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child.

But, just five weeks after confirming her pregnancy, and the day after a gender-reveal party where she announced she was having a girl, she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain.

“I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.”

An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby, Tabitha Winnie Denkins.

“This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.”

In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. That means the counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants.

No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.

These miscarriages and deaths can occur even in communities that otherwise appear to have vast health resources. In Harris County, for example, home to two public hospitals and the Texas Medical Center — the largest medical complex in the world, with more than 54 medical-related institutions and 21 hospitals — mortality rates were 11.1 per 1,000 births for Black infants from 2014 through 2019, according to the March of Dimes, compared with 4.7 for white infants.

The abundance of providers in Harris County hasn’t reassured pregnant Black patients that they can find care that is timely, appropriate or culturally competent — care that acknowledges a person’s heritage, beliefs and values during treatment.

Regardless of income or insurance status, studies show, medical providers often dismiss Black women’s questions and concerns, minimize their physical complaints and fail to offer appropriate care. By contrast, a study of 1.8 million hospital births spanning 23 years in Florida found that the gap in mortality rates between Black and white newborns was halved for Black babies when Black physicians cared for them.

In 2013, Houstonian Kay Matthews was running a successful catering business when she lost the daughter she’d named Troya eight months and three weeks into pregnancy.

Matthews hadn’t felt well — she’d been sluggish and tired — for several days, but her doctor told her not to worry. Not long afterward, she woke up realizing something was terribly wrong. She passed out after calling 911. When she woke up, she was in the emergency room.

None of the medical staffers would talk to her, she said. She had no idea what was happening, no one was answering her questions, and she started having a panic attack.

“It kind of felt like I was watching myself lose everything,” she recalled. She said the nurse seemed annoyed with her questions and demeanor and gave her a sedative. “When I woke up, I did not have a baby.”

Matthews recalled one staffer insinuating that she and her partner couldn’t afford to pay the bill, even though she was a financially stable business owner, and he had a well-paying job as a truck driver.

She said hospital staffers showed minimal compassion after she lost Troya. They seemed to dismiss her grief, she said. It was the first time she could remember feeling as if she was treated callously because she is Black.

“There was no respect at all, like zero respect or compassion,” said Matthews, who has since founded the Shades of Blue Project, a Houston nonprofit focused on improving maternal mental health, primarily for Black patients.

To help combat these high mortality rates in Harris County, Robinson created a maternal child and health office and launched a home-visit pilot program to connect prenatal and postpartum patients with resources such as housing assistance, medical care and social services. Limited access to healthy food and recreational activities are barriers to healthy pregnancy outcomes. Studies have also shown a connection between evictions and infant mortality.

For Hill, not having insurance was also likely a factor. While pregnant, Hill said, she had had just a single visit at a community health center before her miscarriage. She was working multiple jobs as a college student and did not have employer-provided medical coverage. She was not yet approved for Medicaid, the state-federal program for people with low incomes or disabilities.

Texas has the nation’s highest uninsured rate, with nearly 5 million Texans — or 20% of those younger than 65 — lacking coverage, said Anne Dunkelberg, a senior fellow with Every Texan, a nonprofit research and advocacy institute focused on equity in public policy. While non-Hispanic Black Texans have a slightly better rate — 17% — than that overall state level, it’s still higher than the 12% rate for non-Hispanic white Texans, according to census data. Health experts fear that many more people are losing insurance coverage as COVID-19 pandemic protections end for Medicaid.

Without full coverage, those who are pregnant may avoid seeking care, meaning they skip being seen in the critical first trimester, said Fatimah Lalani, medical director at Houston’s Hope Clinic.

Texas had the lowest percentage of mothers receiving early prenatal care in the nation in 2020, according to the state’s 2021 Healthy Texas Mothers and Babies Databook, and non-Hispanic Black moms and babies were less likely to receive first-trimester care than other racial and ethnic groups. Babies born without prenatal care were three times as likely to have a low birth weight and five times as likely to die as those whose mothers had care.

Hill’s twins, though premature, are now preschoolers. “I believe God — and the high-risk doctor — saved my twins,” she says.(Brandon Thibodeaux/KFF Health News)

If Hill’s miscarriage reflects how the system failed her, the birth of her twins two years later demonstrates how appropriate support has the potential to change outcomes.

With Medicaid coverage from the beginning of her second pregnancy, Hill saw a high-risk pregnancy specialist. Diagnosed early with what’s called an incompetent cervix, Hill was consistently seen, monitored and treated. She also was put on bed rest for her entire pregnancy.

She had an emergency cesarean section at 34 weeks, and both babies spent two weeks in neonatal intensive care. Today, her premature twins are 3 years old.

“I believe God — and the high-risk doctor — saved my twins,” she said.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF. It has been published with permission.

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澎湃新闻主笔沈彬连日来，伴随着更多事实的披露，“两人三座”一事的讨论已远远超出个案范畴，更多具有重思规则的意义。随着当事人母亲接受采访介绍了更多内情，舆论讨论也从“花钱能不能多占座”转向另一个议题：当家长无力贴身护送，铁路该如何保障未成年人的单独出行？据当事人的澄清，两个未成年女孩趁着暑假来到上海和父母团聚，返乡时，因为母亲实在请不出假，无法陪着坐27个小时的火车返乡；而按照铁路购票规则，儿童票不能独立下单，必须绑定成人票购买；如果先一起买，再退掉成人票，仅保留儿童票，铁路方面却提示，此时列车员有权要求孩子下车——此路不通。同时，考虑两个未成年女孩独自乘车的安全因素，避免她俩身旁坐了陌生男性，妈妈最终选择买下第三张成人席位，“浪费”一张车票，同时也保证两个孩子有宽裕的空间。回头看，两个女孩占三个座位并不完全是放零食，而是妈妈的一片苦心：自己请不出假陪护，孩子要返乡开学；单独买儿童票，铁路规则又不允许；索性多买了一张票。对这个新闻，公众的关注点也从所谓“金钱和效率”之争，转向了更加贴地气的未成年人出行的民生痛点。

二 | 被浪费的236元的成人票，并不是臆想中的“有钱就任性”，而是妈妈在既有规则之下的无奈之举。

三 | 相较于铁路部门回应中“席位使用权”“合同相对性”等法言法语的专业阐释，“候鸟孩子”返乡途中陪护缺位的现实困境，才是更值得直视的民生痛点。“两人占三座”不是多花钱享受舒适和特权，而是普通打工人面对制度缝隙时的无奈变通。14岁以下未成年人无法单独购买火车票，可并非所有家长都有条件陪同孩子踏上旅程。尤其对于亲子分居两地、仅靠寒暑假短暂团聚的“候鸟儿童”，独自乘火车往返几乎是许多家庭的常态。航空领域早已建立成熟的无成人陪伴儿童服务体系，家长无法随行时，可以提前申请托管，实现从送机、机中照料到到站核验接领人的全流程闭环管理。

四 | 铁路系统能否参照这套成熟思路，推出相适配的未成年人陪伴托管服务？当然，普速列车站点多、人员流动性大，乘务员配置有限，很难直接照搬航空一对一托管的模式，但不妨借鉴其制度内核，探索属于铁路版的“小候鸟”陪伴机制。发现问题、讨论问题是解决问题的第一步和第二步，办法总比困难多。

五 | 可以考虑设立可预约的未成年人重点关照通道，完善独自乘车未成年人登记制度，明确送站、在途关照、到站交接的流程，设置合理的服务机制甚至适度收费的专项陪护选项，厘清权责边界，把散落在民间的“土办法”纳入规范化的制度框架之内，补上未成年人独自长途出行的民生短板。公共交通的公平，不只有防止“花钱就能多占资源”，也包含对特殊处境群体的制度关照。三张火车票的背后，是千万个务工家庭的现实困境、“候鸟家庭”的不得已。制度理应补上缺口，让孩子漫长的返乡旅途，不必靠家长花钱买一张空座位来换取安全感。这起事件也提醒我们：公共讨论与其执着于“公平正义”的抽象演绎和交锋，不如回归事实、倾听当事人的真实诉求。“两人三座”不是金钱与公平之争，而是铁路出行民生痛点的具象化。

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