Joy Is Our Birthright: Striving for Black Maternal Health Equity

The Black body deserves joy. It deserves to feel peace, and to breathe easy. This is especially true for the bodies of Black mothers and birthing people who face disparities before, during, and after pregnancy.

According to the Centers for Disease Control and Prevention (CDC), Black women are three times more likely than white women to die due to childbirth or pregnancy-related complications in the United States.

Although many factors contribute to these disparities, systemic racism and implicit bias are the main underlying causes.

“Black women and Black birthing people need support to improve maternal health. They can’t do it alone,” says Monique Rainford, an OB-GYN and the author of “Pregnant While Black: Advancing Justice for Maternal Health in America.”

“It is not their fault. It is not because they aren’t doing the right things. It is way bigger than them,” she says.

Unjust laws and policies have restricted the rights of Black mothers for centuries. Understanding how this has affected the lives of Black families over time can offer insight into the disparities we see today.

“[Black women] didn’t start the problem,” says Rainford. “They inherited a problem that started way before them.”

During slavery, the Black body was exploited and subjected to forced labor and gross mistreatment. Laws and policies were created so that Black women didn’t have autonomy over their own bodies.

Enslavers relied on a Black woman’s ability to reproduce to increase the population of the enslaved. And in many cases, after giving birth Black women were taken away from their children to breastfeed and care for their white enslaver’s babies.

According to a 2023 paper, the legacy of slavery exists today in the form of structural racism. The impact of structural racism shows up in nonmedical factors that can have a direct impact on your health, also known as social determinants of health (SDOH).

The following examples of social determinants are suggested to increase the chances of maternal health disparities:

• unequal access to quality healthcare
• food and water insecurity
• experiences of racism
• discrimination
• exposure to air pollution

Chronic exposure to such disparities, interpersonally or vicariously, can cause overwhelming feelings and stress that can be difficult to cope with. In turn, this may trigger your body’s fight, flight, or freeze response in an effort to protect you from perceived life threatening situations.

For example, a negative perception of public safety and exposure to violence can impair the health of pregnant people and their infants.

Studies indicate that anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes.

Stress and long-term trauma can increase your risk of developing chronic conditions and illnesses that are common in the Black community, such as high blood pressure and diabetes. If you’re unable to receive quality maternal care, this can further increase your risk.

“All birthing people need the resources, opportunities, and support that enable them to protect their human rights to health and life,” says Angela Doyinsola Aina, MPH, co-founder and executive director of the Black Mamas Matter Alliance (BMMA).

For years, Black women have been seen as resilient and able to withstand anything. The labels we receive from society are deeply rooted in white supremacy and stem from the perceived value placed on our bodies during slavery.

Our true strength is found in safety. And we deserve the right to be “angry” when our voices go unheard and our feelings are pushed to the side.

Gaining knowledge and understanding can help you make informed decisions for yourself and your family. It can also help you create healthy boundaries so other people can learn how to provide safe spaces for you.

Exercising your bodily autonomy

It’s your right to decide what you want to do with your body. Whether you’re planning for pregnancy, adoption, surrogacy, abortion, or not to have any children, your choice is valid.

If you’re considering birth control, weigh the pros and cons to determine which option will best support your needs.

“When discussing contraception, it’s important to first identify personal needs and wants, and then work to find the method that best aligns with those. Don’t just go with the option that’s most popular or was presented first,” says Dr. Charis Chambers, OB-GYN.

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Building a safe environment starts in the body

“When we are taught that our bodies belong to us, our role in our health and thereby our responsibility to our health is clarified,” says Chambers.

“We are then empowered to learn about our bodies in a way that prepares us to make decisions with authority, when needed.”

Experiencing unwanted thoughts or feelings can cause your body to react in an attempt to bring you a sense of safety. Even if there isn’t an actual life threatening event occurring in the present moment, how you feel is valid.

Consider taking the time to listen to your body without judgment. You can do this by:

• observing your surroundings
• being aware of how your surroundings affect your thoughts
• noticing how those thoughts affect you physically and emotionally

If you’re comfortable, you can develop a sense of safety by carefully witnessing your thoughts and feelings. It may take time, but practicing mindful awareness can assist you in advocating for yourself.

Consider the following practice to help you relax and bring awareness to your current needs:

Centering yourself in the present moment

You can do this practice sitting down or standing up. It takes 5 to 10 minutes. Consider using a blanket or pillow to support your body, as needed.

When you’re ready and feel safe, close your eyes or soften your gaze as you let your eyelids relax. Then:

1. Take 3 deep breaths in through your mouth and out of your nose. If possible, try to deepen your breath each time you inhale, focusing on sending your breath to your stomach as though you’re filling up a balloon.
2. Release your breath and let your breathing return to its natural state.
3. Take a moment to observe the points of your body making contact with the floor. If you’d like, gently rock back and forth if you’re sitting, or wiggle your toes if you’re standing, to get a better sense of your body.
4. When you’re ready, return to stillness and notice your natural breath for about 5 minutes. You may notice your breath is rapid or shallow. Try not to judge your observations; just notice.
5. If you begin to experience uncomfortable sensations or thoughts, try to shift your focus to your natural breathing pattern. You can also bring a hand to the areas of your body where you sense discomfort to acknowledge your observations.
6. Feel free to release this practice if you become too overwhelmed.
7. When you’re ready to close this practice, inhale deeply through your nose and exhale through your mouth 3 times.
8. Slowly bring yourself back into the present moment by wiggling your fingers and toes and blinking your eyes open.

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Black women and birthing people need safe environments where they feel heard and cared for. But recent research has found that many Women of Color experience mistreatment when receiving maternal care.

A 2019 survey of more than 2,100 participants suggests that Women of Color are twice as likely as white women to report that a healthcare professional:

• ignored them
• refused their request for help
• failed to respond to requests for help in a reasonable amount of time

“Empowering Black women with clear information about their health status, risk factors, and various options for disease prevention and management could help to mitigate a system that often dismisses their care concerns as incorrect or undereducated,” says Aina.

Consider the following solutions to help address the disparities Black women currently face in maternal health:

1. Increase access to quality healthcare

According to March of Dimes, 62% of U.S. maternity care deserts — counties with limited to no access to quality maternal care — are in rural areas, where many women lack insurance coverage.

And according to 2020 research, 55% of Black women receive continuous coverage from preconception to the postpartum period, compared with 75% of white women. This decreases their chances of receiving appropriate preventive, prenatal, and postpartum care.

“In women’s health, that often means that preventive care is forfeited, and urgent and emergent care becomes the standard. This is harmful and dangerous, especially as it relates to access to contraception,” says Chambers.

More U.S. states can help Black women navigate mental health care and reduce maternal mortality by approving legislation to extend Medicaid for up to 1 year postpartum.

In addition, policy changes are needed to increase coverage during preconception to address adverse health conditions before pregnancy.

2. Invest in community resources

“When it comes to Black Mamas and birthing people, maternal and reproductive health care services and programs must always be informed by the birth justice and human rights frameworks.

“For this very reason, BMMA has continually highlighted and centered culturally congruent practices, with a focus on Black midwifery care and full-spectrum Black-led Doula care, as sound, evidence-based solutions, among other interventions,” Aina explains.

Rainford suggests measuring the effectiveness of the support that’s being provided to Black women. She expresses the importance of providing increased investment into the services and programs that prove to be effective.

For example, if a community health center offers breastfeeding education to Black mothers, it may help to conduct a survey before and after classes. This can help measure whether the knowledge provided improved their outcomes or experiences when breastfeeding.

3. Continuous support from birthworkers and healthcare professionals

Receiving continuous support from healthcare professionals, such as OB-GYNs and midwives, and those who are trained to provide care, such as doulas, can improve outcomes for Black mothers.

“Doula and midwifery care support during pregnancy, birth, and the postpartum period reduces rates of cesarean deliveries, prematurity and illness in newborns, and the likelihood of postpartum depression,” says Aina.

“When we center the person giving birth and their experience over pride and personal agendas, we will be better positioned to create the supportive and safe spaces that black women deserve,” adds Chambers.

But midwives, OB-GYNs, and doulas can’t do this work alone. Creating these safe spaces relies on the support of all healthcare professionals, including changes to policies and systems.

“We just don’t have enough of a pull, even among all of us, to create the change that’s needed. It’s bigger than all of us,” says Rainford.

4. Offer unbiased education services

Due to implicit bias, many healthcare professionals may have preconceived notions regarding the care needed for Black women.

Research from 2023 suggests that centering anti-racist and anti-colonial practices that value community knowledge and practices can improve research and clinical practices specific to Black maternal health.

Effective communication can also help Black women become aware of the care that’s being provided, and to allow them to express bodily autonomy when they feel unsafe.

For example, a healthcare professional can request consent before adjusting their patient’s body to a different position.

“It’s our responsibility, as obstetricians and caregivers, to explain why we suggest what we suggest,” says Rainford.

“Prioritizing patient autonomy and education improves healthcare outcomes by allowing patients to fully partner with their medical practitioners. It is only when partnership is balanced and mutually respectful that true collaboration occurs,” adds Chambers.

5. Provide space for Black women to tell their stories

There are a lot of resources and statistics that highlight the mistreatment and injustice that many Black women face in maternal care.

But it’s also important to provide platforms that encourage positive experiences to be shared.

Platforms should also allow Black women to safely express how their right to bodily autonomy improved outcomes before and after birth.

By sharing your story , others can gain knowledge on what to expect during the prenatal and perinatal periods.

The value of knowledge

“When my daughter woke up in the middle of the night and I breastfed her and she kept crying, the knowledge let me know she would be OK. I was scared, I was worried. But the knowledge kept me going. I knew she had enough wet diapers and if she had enough stools.

“It’s the knowledge that keeps you going sometimes in the middle of the night when you feel like there’s nobody else but you.

“If you don’t have that knowledge you may feel lost, but it is our job as obstetricians and healthcare providers to ensure you know where to turn to get your questions answered,” Rainford shares.