While the United States has made strides in improving maternal care, disparities in access to quality health care persist, particularly for Black women.

Studies show Black women are three times more likely to die from a pregnancy-related cause than white women.

Jennie Joseph, a midwife and head of the Commonsense Childbirth Institute in Florida, said one of the biggest challenges Black mothers face in the state is access to care, largely due to economic and structural barriers.

"The astronomical cost of the care is prohibitive," Joseph pointed out. "It could be tens of thousands of dollars before you're done trying to pay for maternity. We believe those are the reasons for these physiological outcomes like low-birthweight babies, premature babies and mothers who are unhealthy."

Joseph's organization, supported by the Robert Wood Johnson Foundation, centers on community-based maternal care, training midwives and doulas to offer culturally sensitive support to Black mothers throughout pregnancy, birth and postpartum. She highlighted the urgent need for philanthropic funding to bridge the gaps left by traditional health care systems, which are often hindered by bureaucratic red tape.

Brandi Collins-Calhoun, movement engagement manager for the National Committee for Responsible Philanthropy, said the traditional health care system often undervalues the role of doulas and midwives, which are crucial in providing care which resonates with Black mothers.

"While midwives are just getting their foot in the door, doulas are right behind them," Collins-Calhoun observed. "Lactation consultants are behind doulas."

Doulas and midwives have played essential roles in communities of color for generations but Collins-Calhoun said the medical industry has primarily pushed them aside. Collins-Calhoun and Joseph contended the philanthropic sector has a critical role in funding programs providing affordable training and mentorship for these professionals. The programs are vital to addressing the disparities Black mothers face, not just in breastfeeding but in overall maternal and infant health outcomes.

Known as one of the oldest African American communities in the state, Royal, Fla. was founded in 1865 by freed slaves who received land through the "40 Acres and a Mule" promise.

Today, residents and descendants are fighting to protect their community from development threats, particularly an extension of the Florida Turnpike that could devastate their homes and churches.

Beverly Steele is a lifelong resident and founder of Young Performing Artists Incorporated, a nonprofit spearheading the initiative to protect Royal.

"All routes were proposed to come right through Royal, and it would have not just interrupted the community. It would have really destroyed the community. This center would have been out there. Two churches closed here. They would have been out, and most of the home in the community would have been out," she explained.

Royal's residents are pursuing historic preservation to protect against these threats, including nominating Royal as a historic district on the National Register of Historic Places, administered by the National Park Service. The Florida State Historic Preservation Officer has submitted Royal's nomination twice, but the National Park Service returned it both times due to insufficient justification of Royal's historic boundaries and other issues noted by Young Performing Artists.

Preserving Royal's history and land is just as important to the younger generation, who has learned about the importance of land ownership.

"We always had a place that we called our own. I knew nothing about renting 'cause the land was always ours, the homes were ours," she continued. "So, it gave me a sense of pride, because I can say I am a landowner."

Suncara Jackson, a descendant of Royal's founders, is working to engage younger community members through social media and grassroots efforts.

As the community rallies to preserve its history and fend off encroaching development with the help of such groups as the Southern Poverty Law Center, Steele remains committed to Royal's future and says it's not just a Florida issue; it's a national issue since Black people were freed in this country.

"Since 1865, since the end of the Civil War until today, we are true living examples of what that life was like and is like and would have been like for most. That's what we are," she said.


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Rates of breastfeeding in the U.S. have more than doubled since the mid-2000s but advocates pointed out racial inequities during Black Breastfeeding Week.

Initiating breastfeeding after birth has short- and long-term health benefits for babies and their mothers but rates of initiation vary widely by race, with rates for Black infants trailing others.

Janiya Mitnaul Williams, director of the lactation training program at North Carolina A&T State University, trains lactation consultants and has a term for when a new Black mother has someone in the room with shared lived experience: "The mirror-mirror effect."

"It's like one less thing that they have to explain when a person who looks like them steps into the room to help them with breastfeeding their baby," Williams pointed out.

According to the Centers for Disease Control and Prevention, breastfeeding was initiated for nearly 85% of white infants born in North Carolina in 2019, compared to only about 70% of Black infants; rates similar to national data.

Another barrier is what qualifies someone as a "medical professional." A doula, for example, provides support and advocacy for birthing parents, often early-on in pregnancy.

Brandi Collins-Calhoun, movement engagement manager for the National Committee for Responsible Philanthropy, said a lack of strict medical training means doulas and their peers are undervalued in traditional medical settings.

"While midwives are just getting their foot in the door, doulas are right behind them," Collins-Calhoun observed. "Lactation consultants are behind doulas."

Doulas and midwives have played important roles in communities of color for generations but Collins-Calhoun said they have been largely pushed aside by the medical industry.

Providing affordable training and mentorship are ways to help revive the practices.

Jamilla Walker, a certified nurse-midwife at Cone Health Hospital, said she hopes to see acceptance not just of these roles in the birthing space but also broader forms of community support.

"Birthing people deserve to have their people around them," Walker emphasized.

A bill headed to the State Senate floor this week would require California to start tracking discrimination in health care.

Assembly Bill 3161 asks the state Department of Public Health to collect self-reported patient demographics from complaints at hospitals and long-term care facilities.

Shaleta Smith, a patient from Corona, said she feels bias played a role in her treatment when she faced a life-threatening hemorrhage after childbirth at an Orange County hospital in 2007.

"The emergency room doctor basically told the nurse, 'We need her out of here. I want to discharge her.' She looked at me and she said, 'I'm scared for you.' And I said 'I'm scared for myself,'" Smith recounted. "Luckily, I was able to stay. And if I would have gone home, I would have bled to death. I wouldn't be here today."

The bill would also require hospital patient safety plans to specify methods to address racism and discrimination in health care, including procedures for staff to anonymously report instances of racial bias.

Raena Granberry, director of maternal and reproductive health for the California Black Women's Health Project, said she has heard of cases where patients felt staff ignored them or discounted their level of pain.

"Hearing a father come in and say, 'We've asked the doctors for seven hours to intervene,' and she laid there for seven hours and bled to death," Granberry recalled. "It is a pain that ripples through the community. It's crippling to our collective well-being to continue to experience these types of things."

Hospitals maintain they offer the same high level of care for all patients, regardless of race.

Onyemma Obiekea, policy director for the Black Women for Wellness Action Project, said the data, when broken down by race, will tell a different story.

"It's really important as well for patient safety plans to actually consider the role that some of our biases play in the quality of care that patients receive," Obiekea urged. "Particularly when they are people of color."


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