It is not an exaggeration to say that pregnancy is more dangerous for Black people. Articles, data and even political task forces underscore the issue, which is formally known as the Black maternal mortality crisis.
In short, “Black women have a three to four times greater risk of dying during pregnancy and childbirth than white women, and for Indigenous women and birthing people that number is equally high, if not higher,” said Dr. Jamila Perritt, an OB-GYN in Washington, D.C., who also works in the areas of public policy and public health advocating for reproductive justice.
This crisis affects Black folks across education levels, economic levels and care levels, added Dr. Tracey Sylvester, an OB-GYN in California who works with the Association of Black Women Physicians.
Though this isn’t a new problem ― Black people have been at higher risk of dying during pregnancy or childbirth for generations ― it’s recently received more press and attention from legislators.
“It’s good that at least we’re looking at the numbers and we’re talking about the numbers … the hard part, though, is as we’ve been watching this and seeing more attention, we’ve seen those numbers get worse,” Sylvester said. “So the intention, the money, the focus, the awareness, it’s not exactly turning things around because it’s a much bigger problem.”
There is one issue that’s at the core of this crisis, doctors say.
Racism is what puts Black people at heightened risk of death during pregnancy.
“So much of the conversation in the past has really been focused on personal responsibility and individual behavior, this idea that Black women have higher rates because we are sicker or make poor decisions or whatever,” Perritt said.
“What we’ve seen in the last certainly decade, led by advocates and activists and organizers … is a shift in this conversation to really be very clear that it is not because I am Black that puts me at greater risk for morbidity and mortality during pregnancy but really the racialized experiences that I have within the health care system.”
“And so it is racism, not race, that puts me at risk,” Perritt said.
This fact is unsettling, but to any Black person, it’s likely not surprising. Black people should not be tasked with weighing the risk and rewards of pregnancy. Black people should not have to take extra steps to protect themselves in a racist health care system. And Black people should be able to get pregnant and enjoy the journey, just like many white people.
Unfortunately, as with the racist systems in this world, the burden falls on the marginalized.
Solutions and safety precautions should not fall on the shoulders of Black birthing people — it is not our responsibility. What’s more, we are not able to just “fix” the racist systems that created this problem by checking a few things off a to-do list.
But for those, like me, who look at the staggering statistics and feel consumed with anxiety and fear, it can be hard not to wonder what you can do. Ultimately and unfortunately, it is largely out of your control, but some actions and decisions are proved to help pregnancy outcomes for Black people. Here’s what they are, according to Black OB-GYNs:
Seek out a health care team you trust and can talk to about the risks of pregnancy for Black people.
“I think one of the biggest recommendations I have is to make sure that you have a health care team that you can trust,” said Dr. Erika Simpson, an OB-GYN in California.
This should be doctors who hear you, understand what you want out of your prenatal care, your delivery and your health in general, Simpson said.
Additionally, you should feel comfortable being honest with your doctors. It’s OK to directly talk about the Black maternal mortality crisis and ask how they handle the health of their Black patients.
“Get their viewpoints on the maternal health crisis, get their viewpoints on taking care of Black and brown women and how they show up for that or how that’s different for them,” Simpson said.
Their answers can help you decide if a doctor is a good fit. If they’re not, don’t be afraid to go elsewhere for your care. Sylvester stressed that it’s important that your health care team validates your fear. The fear about this crisis is real.
“Fear is a big information blocker, and I think acknowledging that and then learning how to work beyond that, like, ‘Yes, I might be on edge; it’s because I’m afraid’ or ‘I might be short with you … but I’m afraid.’ It’s important to acknowledge that it’s part of the interaction,” Sylvester said.
Physicians in this space are aware of the problem, no matter their race, Sylvester said. (Unless they’re hugely out of touch, which can happen and is definitely a red flag.)
“There is space for some open dialogue for women to say — what steps are you taking as a doctor to combat these statistics? What can I do to better help myself as a Black woman?” Sylvester noted.
It helps to be open and honest about the crisis and get insight from your doctor. And if they do act surprised or look at you like you’re overreacting, it’s best to find a new doc.
Don’t be afraid to specifically ask for a Black doctor.
Just as some people request a female primary care doctor, it’s perfectly OK to request a Black OB-GYN.
This doesn’t mean that non-Black doctors can’t be a fit for a Black pregnant person — or that all Black doctors are a good fit. But data shows that when paired with a Black doctor, Black people and Black babies have better outcomes.
“It goes back to representation matters. Racism in this country is a big powerful enemy, and so it’s really hard. I can’t fix all of that, but I can know what it’s like to be a Black woman talking to a Black woman,” Sylvester said. “I don’t have to fix all of racism to have that connection or that kind of understanding of the value of a Black family because I have a Black family.”
“It’s not to say that other people don’t carry those values or appreciation, but we don’t have to go over all the burdens of subconscious bias and disparities when we’re coming from a very similar place,” Sylvester added.
For this reason, she said, when possible it’s important to get Black folks in the care of Black doctors to help make pregnancy and childbirth safer.
“It’s a hard one sometimes to talk about … if that’s what the data shows, I feel like we have to listen to that. We can’t be evidence-based only when it sounds good or only when it makes us all feel good,” Sylvester explained.
You can specifically ask your hospital for a Black doctor or search “Black OB-GYN” and your city to find a new doctor.
If you’re able, get a doula or midwife.
“When you ask why aren’t the numbers getting better, I also think we might not be approaching it from the right direction. We’re sort of doing the same things we always have done,” Sylvester said. “One of the things that I think could really benefit in this space is more things like birth support workers — so things like doulas and midwives who are culturally and in-tune with Black women who are going to provide care in a different avenue.”
Though the terms doula and midwife are sometimes used interchangeably, Simpson said there are big and important differences between the two.
“You have doulas, which are essentially birth support folks, and these are people that can be there for you during the birth experience — a lot of them actually will start with a birthing person during the pregnancy journey [and] help them get through the pregnancy journey,” Simpson said. Doulas are birth support people who attend births, can communicate with doctors on a pregnant person’s behalf but generally do not have medical training, Simpson noted.
“Then you have your midwives. Midwives are nurses that went for midwifery school. They deliver babies, they have medical training and you can actually see a midwife for your prenatal care if that’s what you choose,” Simpson said. “There’s been a really big push for doulas to be part of the prenatal care journey … to make sure the patient has someone that they feel like can advocate for them in the medical space where they may not be quite as comfortable.”
“Doulas and perinatal support workers who partner with pregnant folks have been shown to improve outcomes for people during their pregnancy, and peripartum and postpartum period,” Perritt added.
“[I]t is not because I am Black that puts me at greater risk for morbidity and mortality during pregnancy but really the racialized experiences that I have within the health care system.”
– Dr. Jamila Perritt
So there’s no question that these are beneficial people to partner with, but these services can be expensive, often upwards of $2,000, which makes them impossible for many people to obtain.
For those who can’t afford it but want doula support, Sylvester said there are certain programs that offer free doulas to Black people. Here are some organizations that offer free or low-cost doulas for Black pregnant people, but each has its own set of requirements and services:
It’s also worth checking with your doctor or local health systems to see if they know of any free or low-cost doula services you can sign up for.
“[Doulas are] a great additional support person who has some education who can advocate for you,” Sylvester noted.
Also, Simpson said if you want to find a Black doctor, Black or brown midwives or doulas can be great resources for finding a Black physician.
LWA/Dann Tardif via Getty Images
Consider bringing a loved one to your appointment.
“One of the things I recommend, too, to Black women nowadays is bring somebody with you to the visit,” Sylvester said.
This can be your partner, of course, or your mom, sister or best friend — whoever you think can help support you best during this journey.
As Sylvester said, fear can be an information blocker, which means you may not be fully able to listen to your doctor if you’re feeling scared. It can be helpful to have someone there to take notes or just hold your hand during stressful appointments.
Perritt added that this doesn’t have to be just one person either — “finding trusted partners, whether it is a sister or cousin or an auntie or someone ideally who was trained and doing advocacy in health care spaces, is critical.”
“So what does it look like to build a network of folks that you are in relationship with that can support you during this difficult time?” Perritt added.
And Perritt noted that this network should support you during your pregnancy, peripartum period and postpartum period — not just up until you give birth.
Remember: What you do or don’t do won’t fix this monumental problem. Racism is at fault, not you.
“A solution that I hear often is that people often tell pregnant folks: Just be sure to advocate for yourself. Well, we need to understand that medical systems in this country are designed to disempower people,” Perritt said. “So, saying that someone should be able to traverse that power dynamic or that divide all on their own is not just unreasonable, it is shortsighted and dangerous.”
This underscores the importance of engaging with experts like doulas who are trained to talk to doctors and relay information to the patient — without the birthing person having to take on that additional burden.
With the right support, Sylvester said she thinks there’s hope, whether that’s support from loved ones, medical professionals or the larger system as a whole.
“Most of these mortality events are preventable, and I think that’s important for women to know,” Sylvester said.
Though that certainly doesn’t make this an easier pill to swallow, it’s helpful to know that the reasons behind the majority of these deaths is known: Experts know what went wrong and, hopefully, through health care changes and government support, these deaths can become fewer and fewer.
