Black women shouldn’t have to die to give life, but too many of us do. According to the CDC, in 2021, Black maternal women died at a rate of 69.9 per 100,000 live births, nearly three times the rate for white women. The statistics are alarming when compared to maternal mortality rates in high-wealth nations like Australia, Austria, Israel, Japan, and Spain which all hovered between 2 and 3 deaths per 100,000 in 2020, according to data from the Organisation for Economic Co-operation and Development. The numbers show that the United States is pulling up the rear on maternal health in general and Black maternal health specifically.
“If you have a planned pregnancy, are always welcomed, society is happy to see you and supportive of your existence, you will live a relatively decent life; maybe not rich but you can have a good life,” Dr. Latanya Hines, MD, assistant clinical professor of obstetrics for Kaiser School of Medicine, Bernard J. Tyson and Charles R. Drew School of Medicine, tells SheKnows. “This is not true for African Americans.”
As far back as the Antebellum Period, studies have found, Black women have been stereotyped as sexually promiscuous, single mothers, poor, uneducated, and masculine. Black expectant mothers are still being othered in modern times, leading to microaggressions, implicit bias, and blatant racism before conception and during pregnancy and postpartum, the immediate period after delivery up to six months. Othering also leads to demands for change in healthcare, though the onus for large-scale change often falls on individuals, rather than the systems that we know cause harm, as Elizabeth Dawes Gaye, co-director of Black Mamas Matter, wrote in The Nation.
The most extreme case for change is the high rate of Black maternal mortality, exemplified by the 2017 postpartum death of CDC epidemiologist Dr. Shalon Irving. Far from the first Black mother to die due to complications from blood pressure, Dr. Irving’s death shined a light on the catastrophic outcomes for postpartum Black birthing people — outcomes that can occur no matter their situation in life. Dr. Irving was loved, insured, married, and working to understand how structural inequality, trauma, and violence made people sick, as NPR reported at the time. And yet she died three weeks after her daughter was born, the victim of the same structural inequality in medicine that she sought to change.
During postpartum, tennis champion Serena Williams famously self-diagnosed her second pulmonary embolism because no one would listen to her requests for medicine for her blood clots or demands for a CAT scan, as she told Elle. In Williams’ case, a nurse relented. Williams got the appropriate surgery and survived to raise her child. Yet her story is just one on a long list of wealthy, well-heeled, insured Black women who experienced birth complications.
The Black maternal mortality crisis casts a shadow on the reproductive justice movement of the last few years that is impossible to ignore. Among the tragedy and injustice, though, there is hope.
Related story
Gestational Diabetes Is Under-Diagnosed, and It’s Contributing to the Black Maternal Health Crisis
The skyrocketing deaths of Black birthing people have forced researchers to reassess antiquated biases that linger in healthcare. Those biases include the idea that if Black people had poorer health outcomes than whites, the differences must be due to inherent racial weaknesses, not disparities in economic circumstance, a notion that was explored at a 2017 Harvard symposium on slavery and public health. An entire healthcare system was built on this 18th century logic that ignored the role of segregation, educational barriers to Blacks becoming doctors, lack of access to hospitals in urban communities, and the idea that Black couples are not a family unit.
Other factors that contribute to disparities in maternal health are lack of health insurance; racial mistrust of the medical profession due to experiments that rendered Black women sterile; dismissive healthcare providers; or lack of cultural competency and compassion for this vulnerable demographic. “Living Black in America is real. Weathering in this society is real,” says Dr. Hines. Here, Dr. Hines adds her voice to the health advocates seeking to stem the tide of Black maternal morbidity by offering tips to Black birthing people considering pregnancy and those who are currently pregnant.
Know your body and health history before you conceive
Black birthing people often do not know enough about their bodies before conceiving, so Dr. Hines suggests getting their vitals checked before getting pregnant. “How is your blood sugar? Weight? Are there any heart issues? These three are the main factors that contribute to postpartum death in Black women.”
“It is worth the time and effort to make excellent plans for pregnancy,” stresses Dr. Hines. “Get your blood pressure or blood sugar under control, start prenatal vitamins three months in advance, get insurance, deal [with] anxiety and depression issues, and educate yourself about complications like deep vein thrombosis, advanced maternal age, and high blood pressure, as these can show up after giving birth.”
Contact a community agency
Community agencies often partner with insurance companies to reduce disparities in healthcare by providing free or low-cost services to birthing members. In Riverside, California, Dr. Shené Bowie-Hussy, DrPH, MPH, doula and vice president of health strategies at Riverside Community Health Foundation, understands that “based on our history, culture, comfort level, and experience, we need community support.” Many Black people have lived multi-generationally, but as young people move away to forge their own paths, grandmas and aunties are no longer accessible to offer wisdom. A village of advocacy is necessary for all pregnant people, so community agencies fill in this gap when we’re far from our families.
Geography also plays a role in the type of support mothers can expect to receive. “In the west, there are not enough community-based health systems dedicated to Black health in general. The birth experience is supposed to be amazing. Things happen but how can we still make birth amazing for Black women?” asks Dr. Bowie-Hussy.
At RCHF, doulas are free for those who receive Medi-Cal, California’s version of welfare. “Unfortunately, we lose the families in the middle who do not qualify for Medi-Cal and cannot afford $1,100 to $2,500 in doulas services for one birth,” she laments. In New York, nonclinical organizations called Neighborhood Action Centers help birthing people find advocates from the community and other services.
Expand your birth team
“A doula is an advocate, an educator, emotional support system,” Ashely Claxton, a doula who lives and works in Atlanta, tells SheKnows. “Having a doula to walk hand in hand with your family can make all the difference. We help the family make informed decisions.” She added that, per studies, Black birthing people are at higher risk for C-section births and believes that “doulas are sometimes able to answer questions and educate, freeing up the provider from an overwhelming amount of calls and messages. Having a doula is the in-between with provider and mom.”
Unfortunately, doulas are not cheap, averaging $40-$60 per hour, which quickly adds up for middle income families. At SUNY Downstate in Brooklyn, New York, doulas and midwifery are integrated into treatment for pregnant people at no additional cost. California has a similar program owing to the state’s Black Maternal Health Momnibus Act, passed in October 2021, which guarantees rights to birthing and high-quality maternal care through postpartum for one year for BIPOC birthing people. (A national version of the Momnibus Bill was reintroduced to Congress in 2023.)
An expanded birth team is crucial for Black maternal health, so hire a doula or a midwife if you can and ask your partner to attend all appointments. In the joy and fear of pregnancy, it is reassuring to know that someone is keeping a log of what the expectant mother needs.
Lean on your team during pregnancy
Black birthing people need to use their bench. We’re often caught in the trap of being everything to everyone, but pregnancy is the time to allow yourself to be taken care of. “Let someone else advocate for you,” says Claxton. Black women typically soldier through pain or substandard care, but if your ob-gyn is not meeting your needs, change doctors. This is a special time and we deserve a compassionate, knowledgeable, engaged physician, not someone checking a box.
As mentioned earlier, a doula serves as an advocate and so can a partner, best friend, or relative. Allow them to translate information in a way that encourages a positive relationship with you and a busy doctor.
Advocate for yourself and find support during postpartum
Postpartum support often means the difference between life and death for Black mothers. During this time (and throughout pregnancy), communicate exactly how you feel and do not be afraid to contradict doctors. You are an expert on your body and your aches, pains, shortness of breath, and excessive bleeding deserve attention. Be aware that while the hospital may discharge you 48 hours after giving birth, asking for home health services is reasonable, as unexpected complications may arise at any time up to one year.
For Black birthing people in need of postpartum support, local in-person and virtual therapy groups are great places to start. In Houston, Texas, the Shades of Blue Project supports Black birthing people before, during, and after pregnancy. They offer services in Spanish and help moms suffering infant loss. Podcasts like Therapy for Black Girls provide another layer of assistance for postpartum moms, and of course, doulas, providers and friends may know of community agencies or therapists you might like.
As Black moms are at increased risk for postpartum depression and anxiety, the American College of Obstetrics and Gynecology (ACOG) recommends that culturally relevant mood and emotional well-being screenings occur during the comprehensive postpartum visit. Ask the ob-gyn for this assessment, if it isn’t offered. If you or a birthing person close to you experiences mental health issues, tell somebody immediately. The faster symptoms like guilt or isolation or excessive crying are identified, the sooner health professionals can intervene to support mom and baby.
Black maternal health does not have to remain in crisis. Utilizing the above steps, acknowledging the role of stress and racism, and actively engaging during prenatal and postpartum appointments can save lives. Systemic change remains necessary and a pivotal focus point, but in the meantime, Black birthing people are still getting pregnant, having babies, and growing their families, and knowing how to protect and advocate for ourselves in these situations can make all the difference. Black birthing people have a right to live, love, and raise their bundle of joy while fully present and healthy, and Black maternity should be the amazing experience it was meant to be.