This week marks the 10th anniversary of Black Maternal Health Week, an annual campaign held April 11 through 17 by the Black Mamas Matter Alliance under the theme “Rooted in Justice & Joy.” The observance arrives as the data remains deeply troubling. In 2023, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births — significantly higher than the rates for white women at 14.5, Hispanic women at 12.4, and Asian women at 10.7, according to the Centers for Disease Control and Prevention. That gap, researchers and advocates say, is not a matter of biology. It is a matter of history, policy, and a healthcare system that has long failed Black mothers.

“America’s ongoing Black maternal health crisis is a national tragedy that goes largely unnoticed in our society,” said Dr. Jamila K. Taylor, President and CEO of the Institute for Women’s Policy Research. “The shameful truth is that ongoing structural racism plays a central role in the deaths of these Black women. Biases within the medical profession still shape the care Black women receive — or don’t receive — during pregnancy, often with tragic consequences.”

The crisis is not simply about what is happening in delivery rooms today. It is rooted in decisions made more than a century ago. In 19th-century America, interracial midwifery was the primary form of prenatal care. Black women, many of them formerly enslaved, were pillars of their communities — traveling to homes, maintaining social networks, and providing care that blended generations of traditional healing knowledge. In the Southern states, Black midwives, sometimes called “granny” midwives, attended up to 75% of births until the 1940s.

That era came to an abrupt and deliberate end. In the 20th century, as hospitals and physicians gained authority and prestige, male physicians launched racist and misogynistic smear campaigns to delegitimize the midwifery profession, portraying Black midwives as incompetent and untrustworthy and branding their methods as unscientific. These early decades of the century witnessed high rates of maternal and infant mortality — yet obstetricians and public health reformers blamed midwives, despite evidence from several research studies showing that midwife-attended births actually accounted for fewer maternal deaths than those attended by general practitioners, who were typically poorly trained in obstetrical techniques. By the mid-1900s, all lay midwives, including Black granny midwives, were systematically ousted until there were none left at all.

The consequences of that erasure are still being measured today.

A Shortage With Deep Roots

More than 60% of doulas and 90% of midwives are white in 2024, even as Black women continue to face the country’s most severe maternal mortality rates. Demand for out-of-hospital birth among Black women has grown by nearly 30% since the COVID-19 pandemic, yet there are only four midwives per 1,000 births in the United States. 

A 2025 paper published in the Journal of Obstetric, Gynecologic & Neonatal Nursing asked the question directly: if Black midwives can improve birthing outcomes for Black women, and if the racial disparity in maternal health outcomes must be eliminated, why are there not more Black midwives in the birthing space? According to researchers, the lack of available Black midwives can be attributed to barriers including legal restrictions, limited recognition within the Westernized healthcare system, insufficient funding, lack of mentorship, and a lack of midwifery programs at historically Black colleges and universities. 

The research supporting midwifery-centered care is clear. Midwifery care has been shown to reduce preterm births and cesarean delivery rates and improve breastfeeding outcomes, particularly among Black mothers. Doulas, similarly, provide invaluable emotional and physical support during pregnancy and childbirth, helping to mitigate racial biases and foster trust in the healthcare system. States with higher integration of midwives have better maternal and birth outcomes, including lower cesarean rates, higher rates of spontaneous vaginal births, and lower preterm births — and yet states with high proportions of Black births have among the lowest integration of midwives. 

Access is also a geographic problem. According to the March of Dimes’ most recent report, more than 2.3 million women of reproductive age live in “maternity care deserts” — counties with no hospital offering obstetric care, no birth center, and no OB clinician. In those deserts, over 150,000 babies are born annually, and data confirms that women in these areas receive less prenatal care and experience higher rates of preterm birth. Black women are nearly twice as likely to have a birth with late or no prenatal care compared to white women, and Black infants have a preterm birth rate of 14.39%, compared to 9.26% for white infants.

Federal and state agencies have been urged to provide and promote training and scholarship funding to increase the number of Black and BIPOC midwives, OB-GYNs, and family practice providers. State licensing and certifying boards have also been called upon to require proficiency testing in cultural competence and bias recognition before issuing or renewing licenses for obstetric providers. Those recommendations, from the Policy Center for Maternal Mental Health and others, face an uncertain political environment. In 2024, the CDC committed to a five-year, $118 million investment in maternal mortality review committees, but budget cuts and mass firings of hundreds of agency workers have raised concerns about the implementation of that investment.

For advocates, the path forward requires both urgency and historical honesty — acknowledging not only what is broken in the current system but what was deliberately dismantled in the last one. Today, Black doulas and midwives are reclaiming a space from which they were historically excluded while addressing a maternal health crisis within their communities, offering holistic and personalized care focused on advocacy and education. Their work, researchers and organizers say, represents not a new approach to birth justice, but the restoration of one that was taken away.