Doulas, midwives and lawmakers challenge erasure of Black women in maternal health care

The Centers for Disease Control and Prevention's latest maternal mortality report found that in 2023, Black women nationally were more than three times more likely than white women to die during or after childbirth. (FatCamera/Getty Images)
Brandie Bishop-Stacker was absent from school the day her little sister was born 24 years ago. Instead, the then-10-year-old went to a Georgia hospital with her mom, rubbing her feet, getting her water, and comforting her during labor pains. She recalled her mother screaming when she initially couldn’t feel her legs after receiving an epidural. And she remembered the nurses and medical staff not offering much in the way of support.
“Nobody gave any extra support seeing that my mom was a single mom, that I was there out of school helping her that day,” said Bishop-Stacker, now a professional doula in Atlanta. “…If she needed something … that was kind of a me thing, even though, of course, there’s nursing staff and I was 10 years old.”
In the two decades since, Bishop-Stacker said she has attended the birth of hundreds of Black babies and has often seen mothers’ needs and concerns be dismissed or ignored, sometimes to the detriment of their maternal care. She was unsurprised by the latest statistics showing rising maternal deaths among U.S. Black women while rates of maternal deaths of other populations have fallen. Research shows these disparities cannot only be explained by education and income levels. And Bishop-Stacker’s experience has taught her that economic advantage does not cancel out racist attitudes in the medical care setting.
“Here in Atlanta, I have a unique vantage point of being where there are probably the most successful Black women in the United States,” said Bishop-Stacker, who is the CEO of the National Black Doulas Association. But she said Georgia is often among the top states with the worst maternal health outcomes. “Oftentimes, when we’re looking at the money part to it, we’re not taking into consideration the fact that racism is the true issue.”
Doulas are non-medical professionals trained to support people through significant health-related experiences, such as childbirth, miscarriage, abortion and death. Bishop-Stacker said her organization has around 4,000 members and trains doulas around the country on how best to advocate for parents of color.
Increased access to community-based doulas and midwives is one of several potentially effective strategies identified by medical groups and health advocates in recent years to improve Black maternal outcomes and potentially stem a persistently high and rising national Black maternal mortality rate. But in the first three months of President Donald Trump’s administration, some state lawmakers and reproductive health advocates say they’re already seeing a rollback to emerging state and federal measures designed to better understand and improve Black maternal health outcomes.
In conjunction with the annual Black Maternal Health Week campaign founded by the Black Mamas Matter Alliance, which began Friday and ends April 18, lawmakers in dozens of states are calling on their colleagues to address what they say are alarming levels of pregnancy- and childbirth-related deaths and adverse outcomes among Black women.
“When we talk about maternal health, it’s imperative that we center Black women in that conversation, and that we also respond to this maternal health crisis in a way that brings some equity in our policymaking process,” said Democratic Mississippi Rep. Zakiya Summers, who is participating in this year’s campaign coordinated by the State Innovation Exchange (SiX), Black Mamas Matter Alliance, and the National Organization of Black Elected Legislative Women. According to SiX — a progressive nonprofit that provides policy support to state legislators — participating state lawmakers are releasing resolutions or proclamations in Colorado, Georgia, Illinois, Massachusetts, Michigan, Mississippi, Nevada, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia and Wisconsin.
Summers, whose District 68 includes West Jackson, Pearl and Richland, said the Trump administration’s categorical opposition to discussions of race and identity in policy is also reflected in the Mississippi legislature, which recently banned diversity, equity and inclusion policies from public schools.

During the past legislative session, which ended this month, Summers sponsored bills to mandate cultural competency training for certain physicians, including OB-GYNs; to establish a legal framework for licensing and regulating professional midwifery and requiring insurance companies to cover midwifery services at the same rate as physician services; and to address postpartum depression that would have required screening birth mothers for depression at the time of birth. Those bills died in committees, as did her resolution for the legislature to recognize Black Maternal Health Week and to commit to policies focused on reducing Black maternal mortality and morbidity.
“Our committee was very reluctant to bring anything that had to do with African Americans, and I think that’s due to this national conversation around DEI and Republicans being unwilling to do anything that appears to have something to do with diversity, equity or inclusion,” said Summers, adding she will issue a proclamation instead.
Bishop-Stacker said the National Black Doulas Association has had to walk away from certain partnerships “due to the companies’ change in stance on DEI and the lack of funding available for states to continue with efforts to expand Medicaid to cover doula care.”
Efforts to remove race from federal and state policy are consequential to maternal health, says Jennifer Driver, senior director of reproductive rights at SiX. She said Trump’s policies broadly — mass federal job cuts, restrictions to a national family planning program, and significant cuts to reproductive health research teams within the Centers for Disease Control and Prevention — will disproportionately affect people of color who have already been disproportionately impacted by abortion bans.
But just as disconcerting for her is how the Trump administration has begun erasing Black people from history, such as the National Park Service’s recently removed reference to Black abolitionist Harriet Tubman and her efforts to resist slavery.
“If you don’t record our contributions, if you deny our inherent rights … you also absolve yourself and the responsibility from addressing the significant health disparities that exist for Blacks in this country,” Driver said, noting that this year’s initiative will spotlight Black-led community efforts to improve maternal outcomes in the face of what she describes as an “erasure.”
“Black communities have done what we have always done; we have turned to one another,” she said. “We’ve turned to community practices. That’s why you see this emphasis on doulas and midwives, because we know the historical practices and how we have taken care of each other when this country continues or has failed us in the past.”
Driver herself might not be here were it not for the midwife whom she said helped deliver her mother in Alabama in the 1950s. She said her grandmother was barred from giving birth in the white hospital in Birmingham because of segregation and had all 14 of her kids with a midwife.
Vast Black maternal health disparities
The U.S. has one of the highest maternal mortality rates of any developed nation, but that is partly due to high rates among Black women and people who are nonbinary. Earlier this year the CDC released its latest maternal mortality report showing that between 2022 and 2023, maternal mortality rates went down for white women (from 19 to 14.5 deaths per 100,000 live births), Hispanic women (from 16.9 to 12.4) and Asian women (from 13.2 to 10.7) but rose for Black women (from 49.5 to 50.3), who were nationally more than three times more likely than white women to die during or after childbirth. A brand-new study from the Journal of the American Medical Association analyzing pregnancy-related deaths in the U.S. between 2018 and 2022 found the pregnancy-related death rate was 3.8 times higher among American Indian and Alaska Native women and 2.8 times higher among non-Hispanic Black women, compared with the rate among non-Hispanic white women. Other recent research has found that Black women are disproportionately impacted by rising maternal cardiac deaths and that 30% of Black women report mistreatment by medical staff during maternity care.
But in the backdrop of worsening outcomes for Black women and rising deaths attributed to abortion bans, some state governments, like in Georgia and Texas, have opted to halt or change how maternal mortality data is collected and studied. And as part of sweeping layoffs, the U.S. Department of Health and Human Services recently placed on administrative leave the entire staff overseeing the Pregnancy Risk Assessment Monitoring System, designed to better understand infant and maternal health.
Georgia disbanded its maternal mortality committee last year after ProPublica reported on deaths attributed to the state’s abortion ban. The committee has since been reconstructed, but a bill that would have directed the committee to focus specifically on why certain communities are disproportionately impacted failed to pass. Democratic state Rep. Jasmine Clark, who is sponsoring a resolution for Black Maternal Health Week, said she hears a lot from Black women in her district who say their pain concerns are dismissed by providers due to racist beliefs that Black people have a higher pain tolerance or are simply seeking out drugs.
Clark, who’s in her 40s and has two teenagers, said she has considered growing her family but is scared by the stories she regularly hears of Black women having detrimental reproductive health experiences or even being criminalized for their choices.
“It’s scary to hear these stories and not wonder in the back of your mind, ‘What if that were me?’” Clark said. “I worry that the policies that we have in place in the state where I live mean that not only do I have to worry about what happens if I were to go to term and to deliver a baby and what happens in the postpartum, but I also have to worry about what happens if things don’t go according to plan, and what happens in the process of miscarriage care and whether or not I will receive the care.”
Dr. Jamila Perritt, an OB-GYN in Washington, D.C., who specializes in complex family planning and is the CEO of the advocacy group Physicians for Reproductive Health, said more research is needed to combat the Black maternal mortality crisis.
“It’s actually dangerous for the federal government or state government or anyone to suggest that these review committees are not useful,” she said. “If we do not investigate, if we do not evaluate what is happening for folks while they’re dying … then how can we suggest that we care about pregnant people and their families?”
Perritt also advocates for more access to midwifery and doula services in Black communities led by culturally competent providers, which research has shown helps reduce rates of high-risk procedures, like cesarean sections and inductions.
That is clear for Jamarah Amani, who is a midwife and the executive director of the Southern Birth Justice Network based in Miami, whose mission is to increase the number of midwives and doulas throughout the U.S. and to integrate them in hospital systems.
She said that while she was in labor with her second child in a Georgia hospital, she was told by medical staff that “I was going to kill my baby,” if she got out of the bed to labor upright.
“I had a doula that actually physically blocked the door so that I could labor on the toilet, and then as the baby was crowning, I was like, ‘OK, call them in,’” Amani said. “I knew what my body needed, and I knew that that nurse was lying. She was a white nurse. I was a Black woman. When I tried to challenge her, ask questions, she got very defensive and even threatening. And I think, as a Black person, what we often experience is a fear of, you know, DCF [Department of Children and Families] being called … because we’re asserting our rights and that’s looked at as some form of neglect.”
Doula Brandie Bishop-Stacker said her work specializing in Black births has taught her how effective this kind of advocacy can be in improving health outcomes and especially coming from Black and brown doulas. Though she has never given birth herself, she said that when she was 18, she adopted her little sister “due to health concerns that limited my mom’s abilities and the incarceration of our fathers.”
“When you are able to have somebody who has a shared lived experience of not being seen, of not being heard of, not being valued, and they understand what those things feel like, that can help them to care for you in a way that goes a bit further, because they actually walked in your shoes,” she said.