2023 Equity Challenge Day 8: Vital Signs: Inequity in Black Maternal Health Care

Content Warning: Please note that today’s material has themes and examples of traumatic birth experiences and loss during childbirth, especially for Black women and babies. Please take care of yourself as you go through today’s email. If you need free and confidential support please contact the National Crisis Hotline by texting HOME to 741741 from anywhere in the United States, anytime, about any type of crisis. 

The United States is in the midst of a dire maternal and infant health crisis. Nearly every measure of the health of pregnant women, new mothers and infants living in the U.S. is going in the wrong direction, according to the March of Dimes. 

Like many historical traumas, Black women and babies are bearing the brunt of the burden. 

Approximately 1,205 women died in 2021 as a result of pregnancy or its complications, according to the Centers for Disease Control and Prevention, and Black women are three times more likely to die from pregnancy-related issues than white women. 

Maternal health discrepancies are intertwined with infant mortality: Black infants are more than twice as likely to die than white infants. Infant mortality rates in Detroit for Black babies in 2020 was 1.66% compared to .58% for white babies. In 2019, the rate of Black infant mortality was 1.22%. 

Untold numbers of Black mothers — like tennis phenom Serena Williams — will survive pregnancy, but barely. Countless others will end their journeys to motherhood traumatized by experiences of being ignored, dismissed and blamed by the medical systems and professionals put in place to help them.  

That’s because tThe disparities that exist for Black mothers and children are rooted in systems of oppression and injustice. They persist even when controlling for education, body mass index and socio-economic status. 

“Everyone always wants to say that it’s just about access to care and it’s just about insurance, but that alone doesn’t explain it,” said Dr. Elizabeth Howell, professor and director of the Women’s Health Research Institute at the Icahn School of Medicine. Howell speaks candidly about the role racism plays in health outcomes. “There’s more and more emphasis to thinking about the ways bias shapes the way we hear our patients.” 

Click here to watch Kyra’s story.

From the 1600s to mid-1900s, maternity care and birth support for Black women was provided by Black midwives. This was a far cry from the approach used in clinical settings. 

The record of the first Black midwife in America can be traced back to 1619. She provided birth support during enslavement and would do more than catch babies. She brought with her the rich African experience where the midwives transferred traditions, hope and systems and performed roles as spiritual healers, family counselors, breastfeeding consultants, nutritionists, postpartum doulas, family planning counselors and were largely advocates who provided resources and care for their communities. However, due to racism, many of the histories and legacies of Black women’s contribution to midwifery has been forgotten. 

In the 1900s, approximately 50 percent of all U.S. births were attended by midwives who were the primary health care providers to Black women and were often called on to assist white women in the South during birth. Then the Sheppard-Towner Act of 1921 happened, which systematically eliminated Black midwives from midwifery, resulting in a legacy of birth injustices. This was further aggravated by the push from the American Medical Association in 1948 to standardize medicine and eliminate lay healers. Many women — including Black women — switched their method of antenatal care from midwives to physicians, and by 1972 only 1% of all births in the United States were attended by midwives. 

Now, Black families are increasingly choosing to work with midwives and doulas — trained birth coaches that offer physical, emotional and educational support for families, either during labor or the postpartum period; or both in hospital settings, at home, and in birth centers — as it contributes to better health outcomes for Black mothers and their babies. 

Birth Detroit, a member of United Way for Southeastern Michigan’s first Racial Equity Fund cohort, will soon launch Detroit’s first free-standing birth center. Learn more about their work here.