Birth Justice Resources

Racism in the U.S. maternal health care system

Historically, structural racism has abounded in the foundation of the gynecological profession, which was built on nonconsensual experimentation on enslaved Black women and sterilization campaigns and medical experimentation on Black, Native, and Latina women.

For centuries, pregnancy-related care in the United States was the purview of midwives, particularly Black midwives and Indigenous birth workers. However, in the early- to mid-20th century, physicians used racist and misogynist attacks to paint Black “granny midwives” as unclean and uneducated these campaigns were used to shift control of birth from community-based and traditionally trained women of color into the power of the white-male-dominated medical profession.

This was also accompanied by legislation, including the 1921 Sheppard-Towner Act, that targeted Black midwives and created regulatory barriers for education and licensure that effectively pushed out out-of-hospital midwives and those without institutionalized training. By 1975, less than 1 percent of births took place with a midwife outside of a hospital.

Discrimination is deeply rooted in the health care system, and particularly in the medicalized birth system—the prevailing system of pregnancy-related care in the United States in which medical intervention in pregnancy and birth is the norm, and birth is seen as a medical procedure that takes place in clinical and hospital settings by physicians.

Black and Indigenous birthing people, experience bias and mistreatment in maternity care; have their pain and autonomy ignored; and are stripped of their traditional communal birthing knowledge. Structural racism, as well as homophobia and transphobia, embedded in systems such as housing, employment, and education, act as social determinants of health: conditions that affect people’s health and quality of life in a given environment.

The facts on maternal morbility and mortality.

  • Each year in the United States, about 700 people die during pregnancy or in the year after (CDC).
  • Another 50,000 women each year experience severe pregnancy complications that can cause serious consequences for a woman’s health (CDC).
  • Black women are three times more likely to die from a pregnancy-related cause than White women.

Every pregnancy-related death is tragic, especially because two in three of them are preventable. Recognizing the warning signs and providing timely treatment and quality care can prevent many pregnancy-related deaths.

Disparity in maternal health care: What you need to know

Multiple factors contribute to disparities in maternal health care, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias. Social determinants of health have historically prevented many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.

  • 1 Talk to a healthcare provider if anything doesn’t feel right or is concerning.
  • 2 Know and seek immediate care if experiencing an urgent maternal warning signs, including severe headache, extreme swelling of hands or face, trouble breathing, heavy vaginal bleeding or discharge, overwhelming tiredness, and more. These symptoms could indicate a potentially life-threatening complication.
  • 3 Document and share pregnancy history during each medical care visit for up to one year after delivery.Maintain ongoing healthcare and social support systems before, during, and after pregnancy.

Birth Justice Resources

Black Women Birthing Justice

Health Connect One

Jenny Joseph’s Commonsense Childbirth: The JJ Way

Easy Access Clinic Model

March of Dimes Fact Sheet “Racial and Ethnic Disparities in Birth Outcomes

National Association to Advance Black Birth (formerly the International Center for Traditional

National Black Equity Coalition

Othering & Belonging Institute at UC Berkeley: Diversity and Health Disparities (formerly the Haas Institute)

Invisible Visits: Black Middle-Class Women in the American Healthcare System. Tina Sacks, Oxford UP, 2019 Interview “Why Black Women Dread the Doctor’s Office

SisterSong Reproductive Justice Framework

The Perinatal Revolution

Dismantling Racism

Showing Up for Racial Justice

Capital District Chapter Facebook | Email

Birthing Justice: Black Women, Pregnancy, and Childbirth. Ed by Julia Chinyere Oparah and Alicia Bonaparte. Routledge, 2016.

Battling Over Birth: Black Women & the Maternal Health Care Crisis in California. Ed by Julia Chinyere Oparah, et al. Praeclarus Press, 2017.

Resources about Understanding & Addressing Racism by Debbie Irving.

Waking Up White by Dayna Bowen Matthew, Elephant Room Press, 2014.

Just Medicine: A Cure for Racial Inequality in American Health Care, by Dorothy E. Roberts, NYU Press, 2015

Fatal Intervention: How Science, Politics, and Big Business Re-create Race in the Twenty-First Century. The New Press, 2012

Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. Vintage, 1999

Between the World and Me, by Ta-Nehisi Coates, Random House, 2015.

Peggy McIntosh. “White Privilege: Unpacking the Invisible Knapsack”. Peace and Freedom Magazine, July/August, 1989, pp. 10-12. Learn more

What to do if you or someone you love experiences Birth Injustice?

  • 1 Spread the word and write a review. Like a modern day Green Book. Once, the Green Book was used to tell BIPOC where they were safe to go. It’s important to tell your story and advocate for your truth!
  • 2 Use the Irth app. It’s an online review of birth providers and facilities. If our stories are not heard change can not be made…. let’s be the change needed!


  • Leave a review for prenatal visits, hospital births, postpartum visits and for your baby’s pediatric appointments until the first birthday. Fathers and birthing partners are welcome to leave reviews too in their special track.
  • Search reviews and filter by race, income, gender or sexual orientation. See overall ratings and answers to questions, such as: Do you think your race or ethnicity impacted your care? Did the doctors and nurses answer your questions or respect your wishes?
  • See reviews from doulas, experienced birth support professionals, who attend multiple births at hospitals.