Black Maternal Health Week 2026: What Birth Centers and Midwives Have to Do With Saving Black Lives

This week is Black Maternal Health Week, and in 2026, it marks a powerful milestone: the 10th anniversary of the Black Mamas Matter Alliance's week-long campaign, held this year under the theme "Rooted in Justice & Joy". Each year from April 11–17, communities across the country commit to telling the truth about what is happening to Black mothers in America, amplifying the voices of Black women who are building new systems of care and demanding the changes that make both justice and joy possible.

I'm a labor and delivery nurse, a birth center consultant, and co-founder of the March for Midwives movement. And I want to tell you what I know — from the data, from history, from my own experience, and from the families I've sat beside — about why birth centers and midwifery matter so much to this moment.

The Crisis Is Real, and It Is Racial

Let's start with the numbers. In 2024, the Centers for Disease Control and Prevention reported that the maternal mortality rate for Black women was 44.8 deaths per 100,000 live births — more than three times the rate for white women, which stood at 14.2. This gap has persisted for years and is not explained by income alone. Black women with college degrees still die at higher rates than white women without them.

Black women are nearly twice as likely to have a birth with late or no prenatal care compared to white women. Black infants have a preterm birth rate of 14.39%, compared to 9.26% for white infants. And according to the March of Dimes' most recent report, more than 2.3 million women of reproductive age live in "maternity care deserts" — counties with no hospital offering obstetric care, no birth center, and no OB clinician. In those deserts, over 150,000 babies are born annually, and data confirms that these women receive less prenatal care and experience higher rates of preterm birth.

This is the accumulated result of disinvestment, structural racism and the systematic erasure of the care models that once kept Black mothers alive.

The Story of Black Midwifery

Long before hospitals existed, Black women held the knowledge of birth. One of the earliest recorded stories of birth work is in Scripture: Shiphrah and Puah, two midwives who defied Pharaoh's order to kill all newborn Hebrew boys and chose to protect life instead (Exodus 1:15–21). The story is ancient and radical: birth workers choosing what's right regardless of the consequences.

According to historian Sharon Robinson, writing in the Journal of Nurse-Midwifery, the first Black lay midwife came to America in 1619, bringing with her a tradition of healing rooted in the African continent. As the transatlantic slave trade forced millions of African women to American shores, they brought with them ancestral knowledge of herbal medicine, hands-on birth support and holistic postpartum healing. Enslaved African midwives became the primary source of prenatal, birth and postpartum care for enslaved women and, frequently, for slaveholders' wives.

Museum exhibit at the International African American Museum honoring Black midwife Maude E. Callen, who delivered more than 800 babies in South Carolina, alongside a medical tools illustration from 1865 and profiles of Black women health leaders Modjeska Simkins and Dr. Matilda Arabelle Evans.

After Emancipation, the tradition continued. Known as "Granny Midwives," these women served both Black and white women across the rural South, attending an estimated 75% of all births through the 1940s. By the 1930s, 80% of Black births were attended by midwives. These women — like Mary Frances Hill Coley of Albany, Georgia, who delivered over 3,000 babies and was immortalized in the 1953 documentary All My Babies; like Maude Callen, who walked through swamps in South Carolina and ran a community clinic out of her home; like fourth-generation midwife Amanda Carey Carter of Virginia. These women were not simply skilled at catching babies, they were healers, counselors, nutritionists, postpartum caregivers and community anchors.

They were also erased.

The Erasure and Why It Still Matters

As obstetrics grew as a medical specialty in the early 20th century, Black midwives were systematically targeted and removed. Physicians called midwifery "a relic of barbarism" not because outcomes were worse, but because hospital births and physician-attended deliveries were more profitable. The 1921 Sheppard-Towner Act and subsequent state legislation imposed certification requirements that contributed to the decline of traditional midwifery, disproportionately impacting Black midwives. The result: less than 5% of midwives in the United States today are people of color.

This erasure is directly connected to the crisis we are in. When we removed the birth workers who were culturally embedded in Black communities, who spoke the language of their patients, who showed up at midnight by oxcart, we didn't replace them with equivalent care. We replaced them with a medical system that has consistently failed to see Black women as worthy of the same attention, dignity and resources as white women.

What a Midwife Is (and What a Doula Is)

These terms matter, and they're often confused. A midwife is a trained medical professional who provides prenatal care, attends births, can prescribe medication, and manages postpartum care for both mother and newborn. Certified Nurse-Midwives (CNMs) are also registered nurses; Certified Professional Midwives (CPMs) specialize in out-of-hospital birth. What distinguishes midwifery as a model is not just credentials, it is a philosophy. Midwives approach birth as a normal physiological event, not a medical emergency requiring intervention.

A doula is different but equally important: a non-medical birth professional who provides emotional, physical and informational support during pregnancy, labor and postpartum. Doulas cannot deliver babies or prescribe medication, but they can hold your hand, advocate with your care team, and ensure you feel seen and heard in a system that often makes Black women feel neither. Research shows that doula-assisted mothers have 25-50% lower odds of cesarean delivery and lower odds of postpartum depression or anxiety. According to the CDC, doula-assisted mothers are less likely to have a low-birthweight baby.

The two roles are complementary. The midwife manages the medicine. The doula holds the mother.

The Evidence for Birth Centers

Here is where the evidence gets genuinely exciting, because we have federal government data proving that a different model of care produces dramatically better outcomes for Black women and low-income families.

The Strong Start for Mothers and Newborns Initiative (2012–2017) was a five-year, multi-site study sponsored by the Centers for Medicare and Medicaid Innovation that enrolled over 8,800 Medicaid-insured pregnant people in birth centers. The results, compared to matched women receiving typical Medicaid care, were striking:

• Birth center infants were 26% less likely to be born preterm (6.3% vs. 8.5%)

• Birth center infants were 20% less likely to have a low birth weight (5.9% vs. 7.4%)

• The cesarean rate was 40% lower at birth centers (17.5% vs. 29.0%)

• Childbirth costs were 21% lower ($6,527 vs. $8,286)

And critically: there were no differences by race for cesarean birth rates or breastfeeding at birth centers. The birth center model does not just improve outcomes, it closes the racial gap. A 2022 follow-up analysis found that Strong Start Medicaid beneficiaries achieved outcomes equivalent to privately insured patients, erasing the poverty-outcome gap as well.

Despite this evidence, there are only about 400 freestanding birth centers across 40 states in the entire country, with fewer than 1% of U.S. births occurring in them. Less than 5% of those birth centers are led by people of color.

March for Midwives

When I couldn't find a birth center near me, I started asking why. And the deeper I looked, the more I understood that we are not just dealing with a gap in knowledge, we are dealing with a gap in political will, funding and infrastructure. That is what March for Midwives is about: mobilizing communities to demand birth centers, to fight for Medicaid reimbursement parity for midwives, to push for licensure reform so CPMs can practice in all 50 states and to ensure that the communities who need this model most are the ones leading it.

The midwives and doulas who show up for Black families today are standing on the shoulders of Shiphrah and Puah, of Mary Frances Hill Coley, of Maude Callen. Their work is not alternative, it is ancient and evidence-based and overdue for reinvestment.

What Communities Can Do Right Now for Black Maternal Health

The question that frames this week, "What would we have communities do?," is not rhetorical. Here are concrete actions:

1. Demand access and ask the hard questions: Is there a birth center in your county? If not, why not? Bring this question to your local health department, your elected officials. Check the National Birth Center Directory for a center near you.

2. Support Black-led birth work: Donate to the Birth Center Equity Fund. Hire Black midwives and doulas. Fund HBCU midwifery training programs. Donate to the Birth Center Collective Equity & Excellence Fund that provides targeted operational support to birth centers that are under-resourced, underfunded or serving communities facing systemic barriers.

3. Push for policy: Medicaid must reimburse birth centers equitably. Doulas must be reimbursed by Medicaid in all states. Midwives must be licensed in all 50 states. Implicit bias training must be required for all maternal health providers.

4. Share birth stories: The granny midwives knew that community knowledge is protective. Tell your story. Normalize birth center births and midwifery care in your networks. Use March for Midwives to share your story far and wide.

5. Vote and testify: When legislators like Senator Halpern introduce maternal health data bills and proclamations honoring doulas, show up. That legislative work is vital.

Rooted in Justice & Joy

The women who carried birth knowledge through the Middle Passage knew that birth is more than just an event, it's an event that changes you physically, emotionally, mentally and spiritually. The Granny Midwives who walked through mud and delivered babies by lamplight knew that. Every Black midwife and doula working today knows that.

We are Rooted in Justice & Joy because joy is not a reward for surviving injustice. Joy is itself an act of resistance. And the movement to bring birth centers and midwifery care to Black communities is rooted in both: the justice of demanding what the evidence shows we deserve, and the joy of bringing our babies into the world surrounded by people who honor our lives.

Black Maternal Health Week is not one week a year. It is a year-round commitment. It is every labor and delivery nurse who advocates for her patient. Every advocate who fights to bring this model to communities that need it. Every midwife who shows up, and every mother who finally has someone in that room who sees her.

Key References

• Centers for Disease Control and Prevention, National Center for Health Statistics. (2026, March). Final 2024 Maternal Mortality Data.

• Dubay, L., et al. (2020). Improving Birth Outcomes and Lowering Costs for Women on Medicaid: Impacts of Strong Start for Mothers and Newborns. Health Affairs.

• March of Dimes. (2024). Nowhere to Go: Maternity Care Deserts Across the U.S.

• Ulrich, S., et al. (2022). Scaling the Strong Start Birth Centers: Promoting Equitable Maternity Outcomes. American Journal of Public Health.

• Jolles, D., et al. (2022). Strong Start Innovation: Equitable Outcomes Across Public and Privately Insured Clients Receiving Birth Center Care. Journal of Midwifery & Women's Health.

• Kozhimannil, K.B., et al. (2022). Doula care across the maternity care continuum and impact on maternal health. eClinicalMedicine.

• Robinson, S.A. (1984). A historical development of midwifery in the Black community. Journal of Nurse-Midwifery.

• Smithsonian National Museum of African American History and Culture. (2023). The Historical Significance of Doulas and Midwives.