As the debate over women’s reproductive rights grows more intense, Tamika Cross, MD, an ob-gyn, is on the front lines of women’s healthcare in the Houston suburb of Pearland, Texas — a state at the center of the controversy. Her mission has long been to provide better care for women in underserved communities and to reduce rates of maternal mortality among Black women, and neither changes to state laws nor a pandemic have weakened her resolve.
In November 2020, Dr. Cross and her business partner, both Black women, opened Serenity Women’s Health & Med Spa in Pearland, a one-stop shop where women can get both a Pap smear and a massage in a single visit. They wanted to connect relaxation with quality medical care to help make typically tense and downright frightening gynecology visits more comfortable for women. And they specifically wanted to provide accessible, affordable, quality care to Black women who, in the South, have the lowest rates of health insurance coverage among all Black women, according to a report from the National Partnership for Women and Families, and therefore the least access to high-quality medical treatment.
“I knew that a lot of people from underrepresented groups did not have access to affordable healthcare and suffered from advanced-stage disease, sometimes unnecessarily,” says Cross, who in April 2017 received U.S. Congressional Recognition for her community outreach. “I also knew that the discomfort that many women feel when discussing health issues with their provider was a significant barrier to seeking and receiving quality medical treatment.”
Having served on several multidisciplinary hospital committees intended to address the alarming maternal morbidity rates in the country, she was also keenly aware of the many challenges that Black women face. According to the Centers for Disease Control and Prevention (CDC), Black women are three to four times more likely to die of pregnancy-related complications than white women, and most of these deaths, Cross says, are preventable. Black women are also more likely than white women to delay prenatal care because of lack of access — making them more likely to die of pregnancy-related causes than women who receive timely prenatal care.
“Lack of access to health insurance and sometimes quality medical care due to bias among medical providers is not the only issue,” she says. “Black women are not being heard, and that’s why they’re dying.”
As a Black woman, Cross has experienced discrimination firsthand, including most infamously on a Delta flight in 2016 when a flight attendant refused to let the then 28-year-old doctor help a sick passenger because she didn’t fit the standard description of what a physician looks like. The experience ultimately turned positive, however, leading Cross to pen the phrase, “I am young, Black, and female and I am exactly what a doctor looks like,” and to publish What a Doctor Looks Like. That same year, she was named one of the Top 60 Most Powerful People in Healthcare by Becker's Hospital Review.
Photo Courtesy of Melvin Cross Jr.
That experience was part of what encouraged her to push ahead with her plan to open a health center and med spa to serve her community — a dream she’d had since medical school. But securing financing to open the practice in the middle of a pandemic wasn’t her only challenge.
“It was a difficult experience. We were profiled and scrutinized heavily throughout the process,” she recalls. “I often wondered why they would expect less of me because of my age, race, and gender.”
Yet they succeeded, and the two doctors are now able to serve the community that needs them most, also hiring mostly women of color as aestheticians to bolster this effort. Helping others has helped Cross, too, who said she’s become a “better advocate for myself with my own healthcare providers. I’ve started choosing my health and my mental health as priorities. I’ve also started to show up for myself in the same way I show up for others.”
Cross discussed her experiences with Everyday Health Chief Health and Medical Editor Patrice Harris, MD, MA, FAPA, including how the health center and medical spa are serving and helping women of color, how recent abortion legislation could impact women’s health, and how Cross is mentoring youth in the hopes of bringing more minorities into medicine — which should ultimately result in better health outcomes for the minority communities they serve.
Patrice Harris: You opened Serenity Women’s Health & Med Spa in the middle of the pandemic. What sparked you to open this practice at this time? Share with us the challenges, but also the rewards that you've had in opening this new practice.
Tamika Cross: It's definitely something that I've always wanted to do. I wanted to create that safe space for women to be able to come and get that compassionate care that we all deserve. And to have in that same setting a med spa where you can indulge in self-care: get a facial, get a Pap smear, get your mammogram order all in the same space.
A lot of women don't like going to the gynecologist; they don't like going in for their annuals or their Pap smears. It is an invasive exam. I thought about this in residency — actually medical school — that this would bring more people into the doctor if it's not set up like your typical clinic, [if] it was very relaxing. We have aromatherapy in the office … and other services [like] massages, to prioritize your wellness and your self-care, which is important.
It was our goal to open it that year regardless of the pandemic; the pandemic really highlighted more of a need for this. And patients were really looking for physicians of color, and my partner and I were both that. They were looking for a place where they could get all those different services in one place. And we were in somewhat of a recession-proof field. People are still having babies, and we were like, "Let's take this leap of faith."
As far as challenges, it was extremely challenging when it came to banks, loans, and things of that nature. Nobody wants to fund a start-up private practice with two young physicians in the middle of a pandemic when other offices were closing their doors. So it was difficult to find somebody that truly believed in our business plan, our model, and somebody who really trusted us. But we were able to find that and secure a place. And we navigated past those obstacles together and we were able to open within six months.
PH: Congratulations on that, and the perseverance that I'm sure it took to get through. What comments have you received from your patients about the place and the fact that you are incorporating self-care? And it's a serene setting. What have you heard from patients?
TC: Our patients love coming to the office. And that was the whole point: We want you to come. We want you to feel empowered. If you have a question, you shouldn't be embarrassed. You shouldn't feel ashamed if you are having infertility issues. If you're having some type of vaginal issue, you should be able to feel comfortable to come to the doctor and to have a doctor that's going to assess the issue and to treat it.
Our patients love that it's literally two separate hallways. So you come in, it's the same waiting room, but one hallway is the clinic and one hallway is the med spa. So while patients are waiting for their appointments, sometimes they're like, “Okay, well, after this, I'm gonna sign up for a facial and a massage and get a hot stone.” We really love that aspect. I also had a patient tell me one time recently — and this was specifically a Black woman — “We always feel the need to keep going, to work hard, because that's how we're taught. And although hard work is important, sometimes we forget that we have to treat ourselves and that we deserve luxury, too, and the same aesthetic treatments that anybody else is able to get.” It's not something only rich people can enjoy. It's not something that only white women can enjoy. All of us deserve it and all of us need it, especially from a mental health aspect. Like we all need it, especially during this pandemic.
PH: I applaud you for continuing to elevate issues around bias. And I appreciate and applaud your passion to reduce maternal morbidity and mortality, especially among Black women who we know die and have birth complications three to four times more than white women. And that's true even when you account for those who have privilege, who have health insurance, who have had access to prenatal care. Can you home in on that a little bit more and tell us about the work you've done to help to reduce maternal mortality and morbidity?
TC: I think the first thing is just starting the conversation and recognizing that bias exists in all of us. And when it does exist, really understanding the impact that it can have on how we treat our patients. And realizing the different barriers and the systemic issues that are impacting our African American women that are leading to this alarming statistic. So really, it's [about] trying to change some of those things. I think the biggest thing is [to have] more of us people of color, specifically Black women, in those leadership positions, sitting on those task forces, sitting on those different panels that are making decisions at the hospital.
Photo Courtesy of Chelsea Richardson
And also, it's important to get more [minority] kids involved in pipeline programs, to be able to get them to go into these medical fields. Because at the end of the day, that's what makes a difference as well. Studies came out in the past couple of years that show that [African American] patients who are cared for by African American physicians actually fare better. And it's because it's eliminating some of that racial bias that we know occurs. Which is one of the major factors when it comes to the maternal morbidity and mortality crisis that's occurring here in America. Those are a few of the things that I've definitely tried to talk about and make everyone aware that these issues exist, because some people are blind to it. And by identifying that these issues exist, moving forward, how do we fix [them]? It's not something that changes overnight. So coming up with different strategies and plans to really get to the root of the issue [is important].
PH: You mentioned systemic issues, and I think that's critically important to amplify. We need to look at the larger systems when we’re talking about these unacceptable health inequities when it comes to maternal mortality and morbidity.
Dr. Cross, we are seeing several states pass legislation that not only restricts a woman's ability to have available to her all the options — specifically options regarding pregnancy termination and abortion — but also in some cases, criminalizes physicians for offering evidence-based care that is legal. You live in Texas, and we've seen the laws in Texas. Can you say a little bit about the impact on women who are marginalized and minoritized and frankly have fewer resources?
TC: It definitely impacts women with fewer resources at a disproportionate rate because they're essentially banning abortion — they're not calling it that, but essentially that's what it is, because by the time [women] come to the doctor, there's a heartbeat. Women without resources don't have the ability to travel to another state to be able to have the procedure performed like women [who have] a multitude of resources. So it definitely disproportionately affects women of color and women from a lower socioeconomic status. And I think it's atrocious. I think it's horrible.
And then criminalizing physicians for providing the care that we are trained to provide, where we can't even recommend that they go to a certain clinic. We can't make that recommendation or assist in any kind of way or else we can be fined. They also incentivize people to report physicians or report transportation or anything [that assists] these women in getting termination procedures performed. I think that the climate that this has created is horrible, because now what we're going to continue seeing is women, out of desperation, making choices to have procedures performed by people who are not physicians or from clinics that are not healthcare clinics — back alley procedures, if you will. And that's going to increase the septic abortions and all the different complications that could result, affecting their future fertility when they are ready to have children. So it's a big deal. It's a big deal here in Texas.
PH: Thank you for weighing in on that. You've written two books, Overcoming Challenges and What a Doctor Looks Like. I interviewed you back in 2016, and I believe [your Delta flight experience] led to this powerful quote that I've always loved: “I am young, Black, and female and I am exactly what a doctor looks like.” Tell me more about that again. And how do you think we've evolved — if we have — from 2016 until now?
TC: So going back to bias and stereotypes a little bit, when someone says, “The doctor's coming in,” I think a lot of patients have made up in their minds what they expect that doctor to look like. And a lot of times, it's not me, it's not you. Right? So at the end of the day, it was just saying that regardless of age, gender, ethnicity, sexual orientation, religion, we come in all different shapes and sizes, and there is no prototype of what a doctor looks like. If I come and introduce myself as Dr. Cross, that's exactly what I am. And so that's kind of what sparked that quote.
As far as us evolving since that time, I do think we have made some strides in the right direction. I definitely do. I've seen the conversation continue. I've seen lots of different programs come about within different companies, different diversity trainings. I do think people are more aware of [bias and stereotypes] and people are speaking up about it.
That wasn't my first time facing that type of discrimination. A lot of times we kind of shrug it off and become somewhat desensitized to it and move on. Time magazine created an article where they highlighted different doctors or healthcare professionals who’d had similar experiences. And [then] more people started coming out about similar experiences. And so I think that's kind of what it gave light to: to be able to talk about it, to be able to change, to be able to try to fix the issues. So I do think we've made strides in the right direction, but I think we still have quite a ways to go.
PH: Well, Dr. Cross, I can say it's been an honor to speak with you again. Thank you for everything you've done to promote women's health in communities of color. Is there anything you'd like to say about your hopes for your work, this new practice, this new venture, or medicine in general going forward? What do we all need to do? And I say “all” purposefully to make health and healthcare more equitable and accessible for all.
TC: As far as future work and plans to move in that direction, I recently actually started a nonprofit called What a Doctor Looks Like, and what I plan to do with that is start a lot of different mentorship programs, scholarships, and things of that nature to be able to get more minorities — and pulling our youth from different inner-city areas and underserved communities to be able to get [them] to the medical fields and in the STEM fields.
And really when it comes to mentorship, it's a lifelong experience. Being able to foster those relationships and to carry our youth from first grade all the way into matriculating into medical school and further, I think is really, really important. So that's something that I'm focusing a lot of time and attention to. I definitely would encourage everyone to get involved with different local nonprofits or different programs that are doing that, because that's what we all deserve: that equitable healthcare. And the only way we're going to see change is if we're all working together to be able to provide that for the entire community.