Honoring the Legacy and Future of Black Birth Workers

As we reflect on the history of maternal healthcare in the United States, the enduring legacy of Black birth workers is a testament to resilience, advocacy, and empowerment across generations. During Black Maternal Health Week, it is imperative to recognize the invaluable contributions of Black birth workers in addressing the pressing issues surrounding Black maternal health. From the historical lineage of Black midwives to the present-day activism of Black doulas, Black birth workers have left a permanent mark on maternal health by supporting Black mothers and birthing people throughout their pregnancy journey. 

Black maternal health disparities remain a stark reality, with Black women experiencing higher rates of maternal mortality and adverse birth outcomes compared to their white counterparts. The Center for Disease Control (CDC) reports alarming statistics, revealing that Black women are three times more likely to die from pregnancy-related causes than white women, regardless of socioeconomic status and education levels. These numbers are even more disturbing when considering the United States overall has the highest maternal mortality among high-income nations, with the numbers increasing in previous years. The CDC also reported that more than 80% of pregnancy-related deaths were preventable. 

In combating racial disparities and high maternal mortality rates, Black birth workers play a crucial role in advocating for, providing culturally competent care, and improving the health outcomes of Black mothers, birthing people, and infants. Doulas and midwives offer continuous physical, emotional, and educational support to pregnant persons before, during, and after labor and delivery. Midwives, specifically, can have various levels of training ranging from traditional to doctoral-level certification. By providing culturally competent, individualized care, Black doulas and midwives can help mitigate the impacts of racism that are embedded within the healthcare system, including addressing the causes of pregnancy-related deaths. 

With a profound history rooted in ancestral traditions, Black birth workers honor their cultural heritage while advancing equity and justice in maternal healthcare. 

The legacy of Black birth workers in the United States traces back centuries ago to the enslaved women who served as midwives within their communities using their traditional customs and practices. Despite the brutality of slavery, these birth workers provided compassionate care not only to other enslaved pregnant persons but even to their enslavers. Post-emancipation, Black midwives, known as "Granny Midwives” in the South, continued their vital work to ensure Black families had the care and support they needed during labor and delivery. Though midwives were present in half of all births across the country in the early 1900s, the modernization of healthcare, compounded by racial and sexual prejudice, led to the drastic decline in midwife-attended births and increase in maternal mortality, especially for Black mothers. 

Today, amidst a resurgence of midwifery care, Black birth workers are reclaiming their ancestral traditions and advocating for compassionate and empowering care in their communities. By honoring their cultural heritage and traditions, Black birth workers show a commitment to nurturing their clients while advancing equity in maternal healthcare. Through their persistence, they are embodying the spirit of resilience, empowerment and advocacy of their ancestors. 

Despite the historical positive impact of Black birth workers, challenges persist in achieving equity and inclusion within the maternal healthcare workforce. Structural barriers, including limited access to education and systemic racism, hinder progress towards diversifying the healthcare workforce. The American College of Nurse-Midwives reports that almost 90% of all midwives are white. More must be done to address this disparity. 

Organizations like the Black Mamas Matter Alliance (BMMA) are leading efforts to address these disparities through training, policy advocacy and community-building initiatives. They, along with their partner organizations across the country, are advancing reproductive justice and providing education and training to those seeking to work in maternal health. 

Founded by the BMMA in 2018, Black Maternal Health Week aims to raise awareness, foster activism and amplify the voices of Black mamas, birthing people, and birth workers. Held during National Minority Health Month from April 11-17, this annual observance highlights the importance of reproductive justice and maternal health equity. President Biden’s proclamation acknowledging the week highlights its significance in raising awareness of Black maternal health disparities. 

As we honor the legacy of Black birth workers, it is essential to amplify their voices and stand in solidarity with their vision for an equitable future. By addressing disparities, fostering diversity in the healthcare workforce and advocating for policies that prioritize maternal health equity, we can honor the contributions of Black birth workers and create a world where every mother and birthing person receives dignified and respectful care. Together, let us continue to nurture generations and empower communities towards a future of health and equity for all.

Alaysia Black Hackett is the Chief Diversity and Equity Officer in the Office of the Secretary.