History of Black Midwives & Racial Disparities in Maternal Healthcare

In 2021, reports indicated that only 7 percent of certified midwives in the United States identified as Black or African American, while 86 percent identified as white. It's tempting to overlook these figures, attributing the lack of Black women in the field to personal choice or disinterest. However, the reality is far more complex and troubling.

OCTOBER 5, 2023: MIDWIFE ADVOCACY DAY MASSACHUSETTS BAYSTATEBIRTH ORG

To understand why these statistics are concerning, we must look back into the history of midwifery in America. Before the midwives known today, there were Granny midwives, and before them were Mammies The mammy caricature is often depicted with bright red cheeks and lips, her exuberant grin gleaming with pride in her job and love for her masters. She was crafted to depict Black women as content, perhaps even happy, with their lives as slaves. This stereotype was aimed to reassure white people, especially women, that the violence they committed against their black counterparts was not in fact terrible.

It could not be, because they were happy In truth, Mammies were far from content Often separated from their own children, they nursed the children of their enslavers, cared for them as their own, and managed the household for the white women they were forced to serve.

Black women were treated as commodities, subjected to beatings, breeding, and exploitation. The perception of Black people as akin to animals, resilient to pain, was evident in the treatment of Black slaves during and after pregnancies

Compared to the care given to white mothers, enslaved women received little prenatal or postnatal attention. Although they were fed more and made to work in the fields less, the stress of being treated as an animal did not allow for pregnancy to be a joyful experience It was not uncommon for these women to endure childbirth or miscarriage only to return to the fields the next day. Their pain was untreated and considered to be nonexistent.

Even after the abolition of slavery, Black midwives, formerly Mammies, remained integral to healthcare and maternity care, particularly in the South. However, as medical science progressed and hospital access expanded, healthcare professionals advocated for hospital births attended by doctors and nurse-midwives, leading to a decline in midwife supported births.

Despite attending up to 75% of births until the 1940s, Black midwives found themselves excluded from the profession they had long dominated. A path that was once one of their only callings, was now almost exclusive to white women who actively excluded black women from their schools, which made it impossible for them to get the certifications needed to practice the midwifery that they had taken part in for generations.

“One oft he darkest moments in US history was the systematic eradication of the African American midwife from her community, resulting in a legacy of birth injustices.”

Shafia Munroe

With the decline of Black midwives, Black women increasingly relied on white doctors and nurses who often viewed them as similar to animals. White women were prioritized in hospitals, leaving Black women to fend for themselves. Now that black mothers and children could not be used for the benefit of white people, their survival was less important, and treated as such.

Over time, midwifery dwindled, with even white midwives becoming scarce Maternal mortality rates declined with medical advancements, but Black women remained disproportionately affected. Today, pregnancy-related mortality rates in black women are 2-3 times higher than those of white women, and the explanation has not changed from previous years. We have better medicine, better facilities, safer methods, and black women are still dying. They don’t care, so they don’t act

A 2016 study revealed that healthcare professionals consistently distrust Black patients seeking medical assistance. Forty-seven percent of physicians are more likely to underestimate the pain of Black patients compared to white patients, resulting in inadequate treatment and diagnoses The enduring stereotype of the strong Black woman, rooted in the treatment of slaves, continues to affect Black Women in their efforts to seek help for modern issues that are more easily solved for their white counterparts.

Recent research indicates that African American women are more likely than white women to experience persistent feelings of sadness, hopelessness, and worthlessness, yet only a small fraction seek help The expectation of enduring pain silently, embodying the superwoman schema, continues to writhe within us.

In recent years, midwives and doulas have emerged as alternatives for those seeking different or additional maternity care options. While this trend is promising, the barriers that have prevented Black women from entering the field since the 1940s persist in 2024 With a lack of trust in medical professionals due to ongoing neglect and a scarcity of Black professionals where we could use them the most, black women are left to squander and care for themselves.

Change is overdue.

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