Reclaiming Black Maternal Health: A Retrospective and a Look Forward
By: Ashley Williams
If you’re a Black woman, you’re probably very familiar with Malcolm X’s 1962 speech– the one where he says, “the most unprotected person in America is the Black woman. The most neglected person in America is the Black woman.” 63 years later and those words still ring true.
Black women are worthy of all the good things life has to offer. We deserve protection, we deserve care, but you wouldn't know it if you looked at the alarming maternal mortality rates that remain stagnant. Maternal deaths for White, Asian, and Hispanic-American women, however, have
decreased substantially. Across the United States, pregnancy-related mortality rates are over three times higher for Black women. In New York state, those rates are five times higher and in New York City, nine times higher.
I'm Sick and Tired of Being Sick and Tired – Dec. 20, 1964
Hamer delivered this speech with Malcolm X at a rally at the Williams Institutional CME Church, Harlem, New York, that was organized to support the Mississippi Freedom Democratic Party's Congressional Challenge.
In the words of Fannie Lou Hamer:
We are sick and tired of being sick and tired.
A LOOK BACK
The health and well-being of Black women have never been a true priority in America, except during enslavement, when our survival was necessary to sustain capitalism and forced labor. Enslaved Black women, exploited for reproductive labor to grow the enslaved population, were often cared for by fellow enslaved midwives. These women brought with them generations of wisdom, skill, and ancestral knowledge, tending to one another as they had long before they were stolen from their homelands. After slavery ended, those midwives, who became known as “granny midwives,” cared for Black and White women in parts of the rural South where hospitals were not accessible. In 1918, in Mississippi, Black midwives attended 87.9% of all Black births. Though there had been shifts in obstetrics and gynecology, and physicians began replacing midwives in the north, mothers in the south still relied heavily on the work of midwives. In 1940, Black midwives still attended 75% of all births in the southeast.
The Flexner Report, funded by the AMA and Carnegie Foundation, led to the closure of five out of seven Black medical schools in the early 1900s. As a result, the number of Black physicians sharply declined, while the number of white physicians grew. Today, Black doctors remain underrepresented, with most trained at the two surviving historically Black medical schools: Meharry Medical College and Howard University.
High maternal and infant mortality rates in the early 20th century were used to diminish the work of traditional midwives. Rather than address the poor training of physicians, midwives became scapegoats, with Black women and other women of color often being labeled as dangerous. Though studies proved otherwise, showing that births in the presence of a midwife actually had lower mortality rates, there was a decline in midwifery among the Black community. Many factors led to this decline— none of them accidental, but rather the result of systemic efforts through racist policies, educational exclusion, and discrediting campaigns. A prime example is the 1910 Flexner Report, which recommended hospital deliveries and the eradication of midwifery, reflecting a broader agenda that has since been critiqued for its racist, sexist, and classist underpinnings.
The move to hospital births eventually led to the increased use of medical interventions like inductions, cesarean sections, and epidurals, to name a few.
Something once seen as one of the most natural events became an increasingly risky medical procedure. The response to the rise of these interventions was the homebirth movement that coincided with the “Our Bodies, Ourselves” movement and the corresponding 1970 publication, created and written by White women to push ideas like women as informed health consumers, health consumers having the right to know about medical controversies and the ineffectiveness of a pathology/disease approach to normal life events like giving birth. As mothers began giving birth in their homes again, doulas began to support them emotionally and act as advocates to help them avoid procedures that could lead to a cesarean. A decade after the homebirth movement, though not recognized as healthcare workers, doulas became extremely popular, and in 1992, Doulas of North America (DONA) was born. The organization was the first of its kind to both train and certify doulas.
Though doulas became popular, it is important to note that barriers to certification existed, and still persist today, for Black women, as well as barriers to effective care when most organizations base their trainings on White upper-class women. These barriers also exist for midwives, including: application policies rooted in racism, high application fees (thousands of dollars), and core competencies that are based on racist obstetrical education.
Today, though most births occur in the hospital, there has been a resurgence in homebirths. Black women, who fear giving birth in a space wrought with racism and bias, are flocking to the traditional practice of homebirths. According to the CDC, overall, homebirths rose 12% from 2020 to 2021. From 2019 to 2020, there was a 22% increase. For Black women, that increase was 21% from 2020 to 2021 and 36% from 2019 to 2020.
Why are Black women returning to homebirths, midwives and doulas?
(Aside from the glaringly obvious)
Historically, the Black community has had a distrust of the healthcare system, and for good reason— cue the Tuskegee Syphilis Study and Henrietta Lacks.
Black pregnant women believe that they are not valued by medical providers in the way White women are.
Black women with high incomes are at the same risk of dying as the poorest of White women.
How can we address the maternal mortality crisis?
We include the people involved. Though there are many layers to that answer, it is really that simple. Empowering Black birthing people to take an active role in their care goes a long way. Per a 2023 peer-reviewed commentary published in Health Education & Behavior (HEB), community-centered approaches show promise, and recommendations include:
Using Black community-based doulas(CBDs). In Syracuse, NY, Black CBDs utilize the Reproductive Justice (RJ) framework when working with expectant mothers.
For researchers, incorporate qualitative data, as well as quantitative data, to get the whole story.
Listen to Black birthing people. Providers have been unsuccessful in listening to the needs of the very people they are caring for.
Understanding your rights. The Black Birthing Bill of Rights is a resource for every Black person that engages in maternity and perinatal care.
Form advisory boards and partnerships with community members and doulas who work in the community.
Other recommendations to address the maternal mortality crisis for Black birthing people include race-concordant care, where providers share the same background as their patients, or care where their birthing teams are diverse and include individuals who have been trained in institutions that have prioritized anti-racist curricula.
At KIMBRITIVE, we're rooted in Reproductive Justice. To birth in safety is a right, and to live beyond that moment is a necessity. Black women and birthing people deserve to hold their babies, to watch them grow, and to thrive alongside the futures they create.
Are you a Black birthing person looking for support? Check out these resources:
New york:
Ancient Song Doula Services (and New Jersey)
Bx (Re)Birth (The Bronx)
Maryam (The Bronx)
The Bridge (Tristate)
California:
WASHINGTON:
Disclaimer: This blog is for informational purposes only and is not a substitute for personalized medical advice. If you have questions about your pregnancy, birth options, or maternal health, please reach out to a healthcare professional who can support your journey.
Ashley Williams is a Brooklyn-based writer and editor. Her interests include exploring health, wellness and beauty through the lens of Black women. In the last nine years she has gathered a wealth of experience in communications and social media management in the nonprofit sector, academia and most recently healthtech. Ashley earned a Bachelor's degree in Health & Exercise Science from Syracuse University and a Master’s degree in Publishing from Pace University.