For many, the joys of bringing a baby into the world can feel like a dream come true — preparing a nursery, picking a name, and happily waiting to welcome a new little bundle of life into the family. Mothers may be especially gleeful about experiencing pregnancy and feeling their little one kick and grow.
But, for Black mothers, the joy can often be clouded with worry and fear that something will go wrong. While pregnancy complications can affect anyone, Black women must regularly advocate for themselves, their pain levels, and their bodily autonomy.
Rose Archer, a doctoral student in the department of sociology at Florida State University, experienced firsthand what it was like to have pregnancy-related complications. During her first pregnancy, Archer had an unplanned C-section performed by the on-call doctor. A week later she went to get her stitches removed by her primary OB-GYN, and that’s when things took a turn.
After multiple tests, Archer was told by her doctor to go straight to the hospital, her blood pressure was severely high.
“That was my first really close, intimate experience with the maternal health inequities that Black women face. I had no idea that you could have postpartum preeclampsia after you delivered until I experienced it personally,” she says. “Nobody told me, nobody warned me.”
Doctors told her she could have had a stroke, Archer says this experience was part of the reason she went back to school to research race, reproductive health inequities, and coping behavior predominately in African American communities.
Unfortunately, Archer’s experience is not uncommon. Pregnancy-related complications like preeclampsia, hypertension, postpartum hemorrhage, and gestational diabetes, also disproportionately affect Black women.
Complications are not the only thing Black women have to worry about. In February 2022, the Center for Disease Control and Prevention released a study that details the stark rate at which Black mothers are dying in childbirth, Black women are three times more likely to die during live childbirth than white women.
Why is pregnancy and delivery for Black women so high-risk and complicated? Some contributing factors point to the maternal healthcare crisis for mothers of color in the U.S.
Maternity care deserts
March of Dimes defines a maternity care desert as any county without a hospital or birth center offering obstetric care and without any obstetric providers. According to their 2020 report, more than 7 million women of childbearing age live in areas with little to no access to maternal healthcare.
Part of the reason so many of these deserts have developed is due to rural obstetric units closing their doors and the U.S. for-profit medical system, the report said.
Although March of Dimes identified thousands of areas considered maternity care deserts, Archer says there are so many more. During Archer’s second pregnancy she was living in Gadsden County, Florida, an area not identified as a maternity care desert. But Archer says there are no obstetric providers, clinics, or services in the county.
“Gadsden County is Florida’s only predominantly African American county. It’s one of the lowest socio-economic status counties and one of the poorest counties — and it’s just interesting how we’ve been invisibilized in their research and in their report,” she says.
A lack of obstetric care for pregnant women in these rural areas forces Black women and families to travel farther for prenatal care, treatment of pregnancy complications, and even delivery. Transportation, money, and access to maternal care are all barriers Archer has identified in her research.
Due to the inaccessibility of reaching an OB-GYN, many Black mothers have skipped out on prenatal care visits. In 2020, about 1 in 16 babies were born to a woman who had late to no prenatal care.
“My hope for this particular research on maternity care deserts is to help people understand how Black women and Black birthing people are making a way out of no way,” Archer says. “And how can we notice and appreciate what they are doing as a way to mitigate health inequities?”
Justina Williams, a speech therapist in Quincy, Florida, says she lives in a maternity care desert. She describes her pregnancy as being an outlier among other Black women, having access to prenatal care, transportation, and the education available to get essential care.
But maternity care deserts impact more than just pregnancy — Williams says when she needs to take her daughter to her doctor, the drive is more than 45-minutes each way.
“My daughter goes to a pediatrician in Tallahassee because we don’t have them here in our town, which is sad.”
Part of Archer’s research includes conducting a case study with Black and brown folks who are pregnant, gave birth recently, and folks who gave birth more than 30-40 years ago. She says she’s heard a lot of what she calls birth trauma.
“I’ve spoken to folks in their 70s and 80s who gave birth decades ago, who are still facing and dealing with the effects of birth trauma. From fetal demises to miscarriages to infant loss to providers who do not respect them because of their race, gender, or class,” Archer says. “A part of them are still wrestling with the fact that it could have gone another way.”
The Department of Health & Human Services 2018 report said Black infants are 2.3 more likely to die due to low-birth weight, congenital malformations, and maternal complications. But a 2020 study found that when Black newborn babies are looked after by white doctors, the babies were about three times more likely to die than when cared for by Black doctors.
Archer says a common theme she has found as to why Black babies die, is the limited access to healthcare resources for birthing people. When Archer asked her interviewees if they had better access to a provider during their pregnancy, do they think their baby would have survived — “nine times out of ten they say yes.”
Healthcare research often calls these situations perceived racial discrimination Archer says, but at the end of the day, it’s racism and obstetric violence.
“It’s the ordinariness of racism,” Archer says about birthing folks she’s spoken to who don’t even realize, that “disrespectful provider,” is in fact racist. “They wouldn’t even come out and name it as racism because it’s so embedded into their daily lives… it’s just a part of what you deal with as a Black person taking care.”
After spending months on her research, racial discrimination, birth trauma, and limited access to maternal healthcare are the three primary findings of Archer’s research.
What Black mothers, families can do
Something Williams noticed in her work was the number of Black women suffering strokes after delivering their babies.
“When you’re at your most vulnerable, I didn’t want to have to fight that fight. That’s why I sought out a Black OB-GYN,” she says.
With COVID-19 exacerbating everything, it is no surprise the mortality rates for Black mothers and infants increased. But Black women can seek out Black OB-GYNs as soon as they know they are pregnant.
Williams says she knows there are so many barriers in the way for Black women to get the best maternal care, like transportation, access to money, and if a family has other kids, finding something to do with them during doctor visits. But she encourages Black mothers to do their research and take advantage of the information available to them.
“Take the time to sit down and actually read the research that is given to you,” she says. “I think that’s where the willingness comes in.”
Black mothers and families can also research their health care providers, speak up, and advocate for themselves if something does not feel right, and ask for a second opinion if a treatment plan does not feel like the right fit.
How doulas support Black mothers
With the unrelenting statistics of Black mothers and infants dying, Black birthing folks are seeking out doulas, to provide emotional and physical support to them during their pregnancy and childbirth.
Data from Blue Shield of California shows how doulas have improved outcomes for Black moms and babies, with a higher percentage of full-term births, fewer cesarean sections, and lower rates of postpartum depression.
Archer works as a part-time chaplain at the hospital, oftentimes when she is called, it’s not for the happy moments it’s to support families and birthing people who are experiencing crises.
“I sat with families where the mother was going through cardiac arrest. And some families where the mothers were experiencing a pulmonary embolism — and all of these birthing folks that I sat with were minority people,” she says.
Due to the crises Archer was witnessing, she decided she needed to do more. She became a doula and later started an organization for Black and brown birthing people called Doulas for me. She partnered with other doulas who she knew and decided that they would offer care to people in their community who could not traditionally afford one. Now that Archer has returned to school, she outsources doulas but will work as one if needed.
The cost of doulas varies by state and county. Archer says she knows doulas who start out charging $300 which includes two prenatal visits, constant attention during labor, and one postpartum visit, but other doulas who charge upwards of $1,200 to $1,300.
“Doula work for me is not about profit, it’s about extending ministry in a different way,” she says.
Resources, support for Black birthing folks
- Black Mamas Matter Alliance is a national network of Black women-led and Black-led, birth and reproductive justice organizations and multi-disciplinary professionals, working across the full spectrum of maternal and reproductive health.
- National Birth Equity Collaborative is one of the nation’s leading experts and an advocate for change in the Black maternal health and infant mortality crises. The organization is focused on the sexual reproductive health and wellbeing of Black women and birthing people worldwide, NBEC creates transnational solutions that optimize Black maternal, infant, sexual, and reproductive wellbeing.
- Sista Midwife Productions is a birth advocacy organization based in New Orleans, LA. We provide education, training, and consultations for communities, birth workers, and organizations that work with childbearing families.
- Abella Women’s Center is a free pregnancy center in Quincy, Florida. They serve all of Gadsden County and the surrounding areas. The center provides compassionate medical care for pregnancy and sexual health-related services.
- Black Mothers Breastfeeding Association provides education, resources, and ongoing support to Black families and public/private agencies that service these families. The association works to reduce racial disparities in breastfeeding for Black families, on a national level.
- Black Women for Wellness is committed to healing, supporting, and educating Black women and girls through health education, empowerment, and advocacy. They have a community forum, which brings hot topics and major health and wellness issues to the forefront of public conversation.
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