Just So We’re Clear: Black Mothers Aren’t to Blame for High Infant Mortality

When famous midwife Ina May Gaskin suggested that Black mothers should make better lifestyle choices to have healthier babies, the Black birth world decided they’d had enough.
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“Black women did not cause the health disparities that plague us, but we are working hard to resolve them.”

Photo by myrrha / iStock.

Ina May Gaskin is often referred to as the “mother of modern midwifery.” But when Gaskin was asked at an April 22 birth seminar in Forth Worth, Texas, about the effects of systemic racism on high infant and maternal mortality, her response left many in the Black birthing community questioning her competence.

Her response left many in the Black birthing community questioning her competence.

“Drug overdoses, cause number three—that’s a biggie—and I presume these are illegal drugs. Not prescription drugs, but those are also going to be a problem,” said Gaskin, who then offered Black women simplistic solutions like praying and growing food to reverse mortality rates. The comments have sparked criticism from Black birth workers on social media, including a petition to boycott events that feature Gaskin.

In that moment, Gaskin did two things: She denied the reality that Black mothers are disproportionately affected by poverty, crime, and other causes of stress that undermine infant and maternal health; and she bypassed the fact that not only are Black birth workers competently serving our communities now, but they were also historically responsible for serving Black and White families in the South, delivering and raising White babies as their midwives and caretakers.

Historically, Black women provided most of the birth services in the South in the form of “Granny midwives.” These women were often past childbearing age and gained their experience through having and witnessing many births. But as with most things, institutional racism found a way to rob Black birth workers of their freedoms.

The Sheppard-Towner Act of 1921 provided matching funds to states for prenatal and children's health centers. Although the act had positive effects—like increasing funds to health care—it discouraged the practice of midwifery, particularly Black midwifery, and portrayed midwives as too uneducated and unclean to direct births. All midwives soon saw a decrease in activity, but Black midwives were especially targeted by Sheppard-Towner. Consequently, they lost their positions as birth leaders and became “birth assistants.”

The United States is the only developed nation that is headed in the wrong direction.

In 1920, there were 5,000 African American midwives in Georgia alone, but the Sheppard-Towner Act led to a gradual end to lay midwifery. By 2002, there were only 15 practicing African American midwives in the state, according to The International Center for Traditional Childbearing, a nonprofit based out of Portland, Oregon. And now, in the U.S., Black women account for fewer than 4 percent of registered members of the American College of Nurse-Midwives.

Unfortunately, maternal mortality rates are increasing and the United States is the only developed nation that is headed in the wrong direction. Regardless of socioeconomic status, Black mothers are three times more likely to die and babies are two times more likely to die than their White counterparts. A likely culprit is the stress that comes with being a Black woman (often caused by continued exposure to overt and subtle racism and misogyny). Gaskins’ insensitive comments are a strong reminder that White birth workers lack the knowledge to appropriately deal with the environmental (and economic) stressors that plague the Black community.

In addition to restoration of customs, more needs to be done to diversify the birth world, create equal access to quality health care, and establish a more supportive postpartum system for mothers. More and more birth workers of color are stepping forward and doing the work to change our infant and maternal outcomes.

One such group is Birthing Beautiful Communities, located in Cleveland.

Even Black women who receive prenatal care are losing their children at higher rates than White women.

Cleveland falls within the Rust Belt, one of the poorest regions in the nation. Four other Rust Belt cities are among the 10 highest for infant death in the United States: Milwaukee, Detroit, Indianapolis, and Columbus, Ohio. In Hough, a neighborhood of Cleveland, 22 babies die for every 1,000 born. That is more than three times the national average. Even Black women who receive prenatal care are losing their children at higher rates than White women who receive none.

That’s why BBC’s founder, Christin Farmer, was called to action. BBC describes itself as a team of community-based doulas who provide education and support to expectant mothers. Born out of a volunteer effort, Farmer’s project, founded in 2014, has brought immense resources to Hough by addressing infant mortality and maternal health disparities holistically. According to Farmer, “it’s not just about community health—it's about community wealth.”

Farmer believes those who reside in the community are best prepared to make effective change within her community. For this reason, she seeks out local residents and trains them in mental health, prenatal and postpartum care, and breastfeeding so they are equipped to serve as doulas/perinatal birth workers. This community-based doula training lasts eight weeks and is free to those from high-risk areas.

“The birth workers who we train live in the community they serve. We do that to ensure reliability,” Farmer says.

“We can do this,” she adds. “Black women are highly capable of doing this. We have been doing this. We are the pillars of our community.”

To Farmer it is clear, contrary to popular opinions like Gaskin’s, that the Black community already has the necessary tools and knowledge to assist Black mothers and babies. However, in addition to these tools, the larger birth movement also needs to support the Black community and prioritize cultural sensitivity, as the petition has called for.

Farmer stresses the importance of a holistic approach to account for the multitude of factors that affect new mothers. “It’s a trickle-down effect. If toxic stress is high because you lack access to housing or adequate education and pay to take care of your family, stress levels will increase,” she says.

Black women did not cause the health disparities that plague us.

Preterm delivery is the most frequent cause of infant mortality and Black infants are at risk for preterm birth 1.5 times more than White babies, according to the Centers for Disease Control. At BBC, this is a key area of focus, and their rate of delivering full-term babies is an astounding 98 percent; their birth workers have attended 70 births since 2014 and have had zero infant deaths, according to Farmer. She currently has 76 local mothers as clients, but she hopes to bring BBC to communities around the nation, targeting systemic disparities one location at a time.

Black women’s struggles are not based in a lack of effort, like Gaskin implied. Praying and gardening will not fix all our problems. Black women did not cause the health disparities that plague us, but we are working hard to resolve them. Perhaps Gaskin will use the experience to educate herself on the history of Black midwifery, which paved the way for her to practice. But regardless of what she does, we Black women won't be able to monitor her—because hardworking women like Farmer will be far too busy actually doing the work.