Laboring for Change: Reimagining Black Maternal Health Equity

I will always remember the day I found out I was pregnant with my first child – it was a “dream come true” moment after years of wondering if it would ever happen for me. Looking down at the two lines on the pregnancy test, I literally jumped up and down and screamed with unbridled excitement. Months later, my overwhelming joy was capsized by an undercurrent of fear, fear that I might not survive childbirth. As a maternal health researcher with a focus on improving Black maternal health, I knew the statistics all too well. Black women in the United States face disproportionately high maternal mortality rates, and every related headline and tragic story in the news reminded me of that harsh reality.

Despite my professional background or maybe because of it, I found myself haunted by the possibility that I might become another statistic. I had nightmares about it and in many ways, I began preparing for the worst. I had explicit conversations with my loved ones about what to do if I didn’t make it out of labor and delivery alive. I even rehearsed scenarios with my partner in case he needed to advocate for me if I was in distress and no one was listening. Even as my body blossomed with new life, the persistent thought, “What if?” loomed large. By the end of my pregnancy, I’d reached a morbid sense of peace with the idea that giving life to my daughter might cost me my own.

When I finally delivered my baby and we went home together, a flood of relief poured over me, but I also remember being floored and agitated by the many ways the system can fail Black mothers. It's one thing to study it, it's an entirely different thing to experience it. Now through the lens of two personal births and four client births as a doula, I have seen firsthand how fragmented and impersonal our current model can be.

Here are the facts: maternal health in the United States is a critical public health concern and a poignant example of health inequity. Continuing a decades-long trend, the maternal mortality rate for non-Hispanic Black women is nearly 3 times higher than that of non-Hispanic white women. The perinatal period—the time from pregnancy to up to a year after birth—is a critical window for early identification of preventable conditions such as cardiovascular problems and mental health disorders, which collectively account for nearly 70% of maternal deaths but remain underdiagnosed and untreated among Black women. Moreover, given that most maternal illness or death occurs after birth, there is an urgent need to prioritize postpartum care and support to prevent unnecessary deaths and reduce disparities.

In this country, routine postpartum care is insufficient, typically limited to a single clinical visit six weeks after birth, despite research advocating for earlier postpartum assessments. Additionally, Black women have lower rates of attendance at postpartum visits and are more likely to experience care-seeking delays compared to white women. For new mothers, especially Black women who are at higher risk, six weeks is a lifetime. And during that gap, new mothers can experience life-threatening emergencies. This information in mind, it’s clear that the system isn’t designed to center patient needs.

My international research has taught me that when we strategically invest in maternal health, even in the most challenging environments, lives can be saved. I’ve worked with nonprofits (e.g., Midwives for Haiti) and government organizations in Haiti, evaluating several initiatives to expand access to better quality care, including implementing mobile maternal health clinics, task shifting, and training for traditional birth workers. Despite enormous challenges, midwives and health care workers in Haiti demonstrate the power of collective action, resourcefulness, and community-based care.

The successes I’ve witnessed abroad are a reminder that when care is prioritized, even in resource-limited settings, meaningful change is possible. Yet in my own country, where resources abound, we still fall short, underscoring the urgent need for systemic transformation.

Many of the recent calls to improve Black maternal health have focused on addressing structural racism. Indeed, the stress, bias, and trauma experienced at the expense of racism have tangible physiological effects and impact clinical decision-making, all of which influence health outcomes. However, focusing solely on structural racism is not enough, especially in a system where even the most privileged women still experience poor outcomes in comparison to women in similarly industrialized nations.

If we want to improve Black maternal health outcomes, bold structural shifts are necessary at multiple levels. In addition to addressing structural racism in health care, employment, housing, and the environment, we also need:

Comprehensive, Holistic Care: Too often, new moms are sent to multiple providers in different locations for support—physicians, doulas, mental health counselors, lactation consultants, pelvic floor therapists, and so on. This is time-consuming and can feel impossible when you’re already sleep-deprived and caring for a newborn. This type of fragmentation is unsustainable. We need comprehensive, co-located care models that integrate services a new mother requires under one roof or through a streamlined digital platform. I’m currently developing an app aimed at bridging these gaps, but systemic change requires more than technology; it demands a paradigm shift.

Midwifery Model of Care: Across the globe, midwifery care is the gold standard recommended by the World Health Organization - it’s the proven model that delivers better outcomes. This approach, which utilizes fewer interventions and prioritizes longer, more personalized interactions, is something I believe the U.S. health care system desperately needs to embrace. I’ve personally experienced the midwifery model at the Atlanta Birth Center (ABC), where I gave birth to my first daughter and currently serve on their Research Committee. Like many practices utilizing midwifery care models, ABC’s cesarean, maternal morbidity, and preterm birth rates are substantially lower than the national average. This suggests that adopting this model of care as the default may drastically improve maternal health outcomes and reduce disparities.

Training Culturally Conscious Providers: This is simple. We need mandatory medical education on addressing structural racism and maternal health disparities. Many Black women prefer, and indeed deserve, providers who understand their unique cultural and social contexts. Mandatory education on these topics must become a cornerstone of both medical school curricula and ongoing professional development. Furthermore, we cannot assume that patient-provider racial and gender congruence equals cultural competence. Yes, we need more Black women midwives, doulas, OB-GYNs, and nurses but we also need to avoid assuming that their identity ensures that they are adequately trained to care for Black women.

Easily Accessible Prevention over Treatment: Our health care system tends to kick in after emergencies arise. But imagine the lives we could save if we emphasized preventive measures like remote blood pressure monitoring—something my research has shown is feasible and acceptable among patients. Or consider how new moms would fare if home visits or mental health check-ins were routine or if postpartum care was integrated into the same visits as pediatric checkups or lactation consultations, so new moms don’t fall through the cracks. These are just a few simple interventions that expand access to care and can significantly reduce complications.

The recent wave of federal funding cuts to maternal health research and programming is not just a budgetary decision - it’s a direct attack on Black mothers and birthing people. These cuts dismantle initiatives designed to expand access to care, improve support across the continuum of care, and address racial disparities in maternal outcomes. As Black feminist scholars remind us, oppression is interconnected, Black maternal health cannot be separated from broader struggles for reproductive justice, economic security, and racial equity. The reality is that the United States, despite its wealth, prioritizes profit over people, leaving Black mothers to navigate an underfunded, fragmented, and often hostile health care system. Without adequate investment in patient centered and community-driven solutions, maternal health inequities will only deepen. But let’s be clear: this is not just a Black issue. A system that fails Black mothers fails all mothers. When we fight for Black maternal health, we are fighting for a health care system that values all birthing people, one where survival is not a privilege but a guarantee.

You don’t have to be a health care provider to support Black mothers. Here are a few simple ways you can help:

Check in Early and Often: If you know a new Black mom, reach out. Instead of asking if she needs support – offer it. Drop off a meal or send a gift card to her favorite restaurant. Offer to clean her home or watch the baby so she can rest or shower. Offer to take her toddler for a walk so she can have some quiet time with the new baby. Sometimes the simplest acts of kindness make the biggest difference. They were paramount for me, and I am ever grateful to my loved ones who showed up for me in this capacity.

Amplify Voices: Share stories, research, and organizations working to improve Black maternal health. This can be as simple as using your social media platforms to raise awareness.

Advocate for Policy Change: Support legislation that funds midwifery programs expands postpartum Medicaid coverage and mandates anti-racism training for health care providers.

Support Comprehensive Care Solutions: Donate funds to organizations (like ABC) providing comprehensive care at lower costs to new moms and consider supporting research focused on developing integrated care models that streamline postpartum support.

Black Maternal Health Week’s theme, “Healing Legacies: Strengthening Black Maternal Health Through Collective Action and Advocacy,” resonates deeply with me. Healing legacies begin when we collectively decide that the lives of Black women and birthing people are not expendable. They continue when we build systems that see mothers as whole people, not just patients on a conveyor belt. And they flourish when communities rally around new mothers with compassion, resources, and unwavering support.

I’m hopeful that through research-based interventions, open dialogue, radical policy shifts, and a renewed commitment to comprehensive care, we can finally reverse the alarming trends in Black maternal mortality.

Because motherhood should be an occasion of joy and empowerment, not terror and dread. Together, we can create systems and spaces where Black mothers no longer have to fear for their lives when giving life.

Dr. Jasmine Abrams, PhD, is a research scientist in the Yale School of Public Health’s Department of Social and Behavioral Sciences. She is also an affiliate faculty with the Maternal & Child Health Center of Excellence at the Boston University School of Public Health.