Confronting Disparities in Black Maternal Health

In 2019, I gave birth to my first child. As a first-time mother, I was anxious and afraid, but I was also excited and very well prepared. By the time I arrived at my hospital's labor and delivery unit that morning, all illusions of a natural birth had vanished. As many women can attest, the pain of childbirth is as universal as it is staggering. So, I was surprised when, in between mind-bending contractions, an L&D nurse leaned over me and said, without any kindness in her voice, "If you don't quiet down, we won't give you an epidural." I was stunned, but I was also in pain and afraid. As a graduate student researching the Rhetoric of Race, I knew the concepts, the arguments, and the statistics to explain what I was experiencing. I knew that I was less likely to be believed or treated well because of the color of my skin. But I also knew that I needed the hospital's help, and that was not the moment to stand and fight. I did my best to be quiet.

My experience and others like it are the reason why Uchenna Jones does the work she does. Uno, as she is known to her colleagues, has been a registered nurse for 14 years, a certified doula, a nurse consultant, a doula trainer, and a published author.  She is also the Community Impact Director of Health at United Way of Dane County in Madison, WI. I spoke with Uno about the challenges to Black maternal and infant health and the work United Way does  to protect them.  

While my son was born healthy, too many Black women and their babies do not survive the birthing process. According to the Centers for Disease Control and Prevention, Black women in the U.S. are 2.6 times more likely to die while giving birth than White women. It’s not because they are unhealthy or face inherent physical challenges. It’s because they are Black — and therefore don't receive the same level of attention and care. Infants of Black women have the highest mortality rate in the United States. 

Medical professionals, community members and Black women around the country are tackling this crisis. United Way Worldwide is actively engaged, as part of our global impact work to ensure that everyone has an opportunity to thrive. And we’ve been working with Deloitte, a longtime global corporate partner, and the Deloitte Health Equity Institute to pilot community-based solutions to advance health equity. 

In late 2023, United Way Worldwide brought together experts for a series of action-oriented conversations around challenges and scalable solutions to protect Black mothers and babies. It was part of the Doorways to Health for Mothers of Color project, a 2021 collaboration between United Way Worldwide and Deloitte Health Equity Institute. Panels included United Way of Greater Atlanta, United Way of Metropolitan Dallas, United Way of Dane County, and United Way for Greater Austin, with local partners and experts like Uno, and other powerhouses in the birthing world. 

The sessions zeroed in on the most critical issues surrounding Black maternal health disparities, and how those issues could be levers to bigger solutions. “We’re exploring how closing gaps in disparities for Black maternal health can help ensure that everyone has the opportunity to live a healthy life,” said United Way Worldwide’s Director of Health, Myeta Moon. The sessions offered insight from experts in Black maternal health, examined facets of the crisis like access to care and implicit bias, and identified opportunities for change like engaging communities and centering the voices of Black women. The takeaways will be part of a larger strategy that United Way and the Deloitte Health Equity Institute are co-creating to scale community-based solutions around the country. 

The Doorways to Health for Mothers of Color initiative is central to United Way’s global work at the intersection of health, financial security and education. Innovating at the community level, and bringing a diverse array of experts (included those with lived experience) to share those learnings — with an eye to scaled solutions — is part of how United Way is tackling health equity.  

The threat to Black maternal health is multifaceted, but Uno identifies three areas of special concern: 

• Improving medical education on the topic. According to Uno, medical professionals “are not told the truth about how their profession has been formed. Every doctor thinks they are entering a noble profession, but if they understood how doctors perfected certain aspects of care, they would handle the bodies that have been mistreated with more care."  
• Acknowledging the vital role midwifes play in intervening in health disparities for Black women. Data shows a troubling disconnect: in countries where midwives are still the primary attendances at birth, maternal mortality rates are dramatically lower than in countries like the U.S., where midwives are too often shut out and maternal mortality rates continue to climb. 
  • And that underscores another gap: there aren’t enough midwives. While shortages of maternity care have reached critical levels in the U.S., midwives only attend around 10% of births, research shows, and only 8% of midwives in practice in the U.S. are midwives of color. “There are more and more BIPOC women having what they call free birth, meaning nobody is there with them,” Uno says. “That's scary for us." The dearth of safe, comfortable care options is exacerbating the risk to maternal health. 
• Addressing the problematic intersection between trust in the medical system and a lack of cultural awareness. A majority of Black adults have had at least one negative experience with a health care provider, according to a 2022 study. And young Black women are particularly likely to report a harmful interaction during routine health care. That can translate to "either a lack of or too much trust in bedside conversations,” Uno said. “(So) many Black birthing people I've cared for … knew that something was wrong, but they kept going with the plan, or they didn't have the courage to speak up." At the same time, a lack of health care providers’ situational awareness and cultural competency in birthing hospitals too often undermines the care women of color receive.  

Community-Based Solutions 
Of course, there is no silver-bullet answer. But there are encouraging approaches underway, and a growing commitment within United Way’s network to implement promising strategies at the local level to address disparities in maternal health care.  

• United Way of Greater Atlanta has taken a research-based approach, assessing current systems for unequal treatment and their impact — and then providing culturally sensitive education on postpartum warning signs. In the community, United Way is investing in Black moms and babies with its Baby Born Healthy initiative, home visitation and doula services.  
• In Texas, United Way of Metropolitan Dallas has taken a slightly different approach, partnering with Abide Women's Health Services, a Black-led nonprofit that offers culturally-informed prenatal and postnatal care. United Way and Abide offer an easy access clinic, childbirth education, lactation support, resources and referrals.  

United Way Worldwide envisions these kinds of strategies being replicated in communities around the country, and continues to work with the Deloitte Health Equity Institute on bigger, bolder solutions to the crisis of Black maternal health in America. Across the world, we continue to bring diverse people, with a wide range of experiences and skills, together to shift the odds for women of color and their children.  

Just ask Uno. Like most everyone who works at United Way around the world, she believes change starts with communities. United Way brings people together across divides to identify gaps and to struggle together on how best to bridge those divides. In Madison, Uno sees that effort of mobilization people is creating solutions that can help create healthier communities, and healthier people.  

She’s optimistic, and she sees solutions on the horizon. As we talked, I found myself wishing that she — or someone like her — had been with me the day my son was born. What would she have done? Smiling, she says "As a doula, my role is to help you manage your feelings, so I wouldn't have addressed the nurse. I would have asked you how those words made you feel." Then, smiling, she continued, "as a nurse, I would have asked her if that was hospital policy. I would have asked to see that policy. I would have kept you safe." 

We know that maternal health is an important marker in the health of a community. When moms are healthy and children thrive, the community thrives. 

Join us — reach out to your local United Way to find out how you can make a difference in women’s health and healthy children where you live.