The history of Black midwifery
This exhibition asks why Black families have to be so careful, so early. The full answer runs through four hundred years of American law, medicine, and policy, and we will get to all of it.
But we are going to start somewhere narrower, with one profession.
For most of American history, Black midwives delivered the babies of the South. They carried knowledge brought from West and Central Africa and refined across generations, and they attended births for Black and white families alike, in places where no physician would go and no hospital would admit a Black patient. In some counties they attended the majority of all births. They were, in the plainest sense, the reproductive health system.
They are almost entirely gone now, and their disappearance was not a natural retirement.
The story of what happened to them contains everything this exhibition is about. Expertise held by Black women. A profession organized to displace it. Public health language used to do the displacing. A vacuum where care used to be. And, decades later, a generation working to rebuild what was dismantled.
Six eras, one thread. Walk it first, and the rest of the exhibition will be recognizable when you get there.
Exhibit — Timeline
Six eras, from West African birth traditions through the grand midwives of the rural South to the movement rebuilding the profession now.
01Pre-1600s
African midwives as community healers and spiritual guides
Before the transatlantic slave trade, midwifery across West African cultures was a respected profession. Midwives were healers, medical professionals, and spiritual leaders who blended herbal medicine, massage, and prayer with birth assistance. Birth was a communal event — midwives oversaw labor, postpartum recovery, fertility care, and child spacing.
Knowledge passed down through oral tradition and through apprenticeship with elder midwives. When African people were kidnapped and enslaved, they carried that knowledge to the Americas — and kept the tradition alive under brutal conditions.
021600s–1800s
The backbone of reproductive healthcare
Under American slavery, Black midwives were central to both enslaved and free communities. Enslaved midwives delivered Black and white babies alike — white households in the rural South relied on their expertise. They were birth attendants, healers, and community protectors, drawing on African herbal medicine and generational knowledge.
They helped enslaved women survive forced reproduction, exploited to grow the enslaved labor force. Some provided abortions as acts of resistance — refusing the forced birth of children into slavery.
Enslaved as a midwife, she won her freedom in court, practiced midwifery in Los Angeles, and used her wealth as a landowner and philanthropist to open care for Black families.
Notable figure
Bridget "Biddy" Mason · 1818–1891
Enslaved as a midwife, she won her freedom in court, practiced midwifery in Los Angeles, and used her wealth as a landowner and philanthropist to open care for Black families.
Portrait of Biddy Mason, ca. 1870s · Wikimedia Commons · Public domain
031870s–1920s
Under attack by the medical establishment
After Emancipation, midwifery remained essential to newly freed communities with little access to white hospitals. By 1900, nearly half of all U.S. births were attended by midwives, with Black midwives dominating the rural South.
Then the medical profession moved to discredit and eliminate them. The 1910 Flexner Report shut down most Black medical schools, cutting Black physicians out of obstetrics. The 1921 Sheppard-Towner Act, framed as public-health reform, drove the criminalization of traditional midwifery. The AMA and white obstetricians cast midwives as "dirty" and "uneducated" — despite birth outcomes that bettered many hospitals.
A legendary Alabama midwife who delivered more than 3,500 babies without losing a single mother.
041930s–1950s
The forced decline, and the rise of white midwifery
As the medical industry restricted and criminalized Black midwifery, white midwives reclaimed the profession under an institutional model. Restrictive licensing pushed many Black midwives out of practice, and hospital birth became the norm. Nurse-midwifery resurged through white-led medical programs.
Meanwhile, hospital segregation meant Black patients were mistreated in the very institutions that had banned Black midwives from practicing independently.
051960s–1980s
Midwifery and reproductive justice
As Black midwives were being erased, Black women organized to reclaim midwifery as a matter of reproductive justice. The 1965 passage of Medicare and Medicaid pushed births further into hospitals. In the 1970s, the Black Panther Party and Young Lords built community birth-justice programs addressing Black infant mortality. By 1977, the "Grand Midwives" of the South were beginning to be formally recognized.
An Alabama midwife whose memoir, Motherwit, recorded the wisdom and the hardship of Black midwifery.
061990s–Today
The Black midwifery renaissance
Black midwives, doulas, and reproductive-justice advocates are reclaiming midwifery as a life-saving intervention for Black families. Black-led birth centers and training programs revived the profession in the 1990s. In 2000, Jennie Joseph developed The JJ Way®, a patient-centered model that sharply reduced Black maternal mortality within her organization's outcomes.
The Black Mamas Matter Alliance emerged in 2018. The 2020 pandemic drove demand for home birth. In 2021, Congress introduced the Black Maternal Health Momnibus Act. Yet of the 400-plus birth centers across the country in 2024, only about 20 are owned or led by Black, Indigenous, or people-of-color midwives.
The scale of it
What a century of exclusion took.
The renaissance is real — and so is the ground it has to recover. Two numbers hold the loss.
The first tells you who used to attend Black births, and who attends them now. The second tells you who is left in the profession. Neither one is the whole story on its own, but put them next to each other and the shape of what happened is hard to miss.
Exhibit — Data
Who attended Black births
Share of Black births attended by a midwife. In the 1930s, midwives — overwhelmingly Black grand midwives — attended roughly four in five Black births. Ninety years of licensing laws, hospital campaigns, and outright exclusion cut that to fewer than one in ten.
That first number is about access — who was in the room when a baby was born. This one is about the workforce itself, and who remains in it after the century that emptied it.
Exhibit — Data
Who the midwives are now
8.7%
of certified midwives today are Black or African American — the workforce best positioned to close the Black maternal-mortality gap is one of the least diverse in health care.
- Midwives of color — 17.4%
- White — 82.6%
That is one profession, and it is also the whole pattern in miniature.
Knowledge existed. It worked. It was displaced by an organized effort that used the language of safety and standards rather than the language of race. The people who lost their livelihoods were blamed for being unfit. What replaced them produced worse outcomes for the families they had served. And the loss was recorded as progress.
That sequence repeats across every domain you are about to walk through. Housing. Schooling. Law. Wealth. Medicine.
So we are going to go back to the beginning — further back than 1900, further back than the grand midwives — and take the whole thing apart in order.
This is one thread pulled from the cloth. Now we go back and look at how the cloth was woven.
Sources 23 entries
Books & articles
- Roberts, Dorothy. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. Vintage Books, 1997.
- Ross, Loretta J., et al. Radical Reproductive Justice: Foundations, Theory, Practice, Critique. Feminist Press, 2017.
- Davis, Angela. Women, Race, & Class. Vintage, 1983.
- Smith, Margaret Charles. Listen to Me Good: The Life Story of an Alabama Midwife. Ohio State University Press, 1996.
- Logan, Onnie Lee. Motherwit: An Alabama Midwife’s Story. Dutton, 1989.
- Monroe, Shafia. The Role of the African American Midwife in the United States. ICTC, 2002.
- Time. “The History That Explains Today’s Shortage of Black Midwives.” 29 February 2024.
Historical & medical research
- Washington, Harriet A. Medical Apartheid. Doubleday, 2006.
- Centers for Disease Control and Prevention. Racial and Ethnic Disparities in Pregnancy-Related Deaths.
- Flexner, Abraham. Medical Education in the United States and Canada. Carnegie Foundation, 1910.
- Sheppard-Towner Maternity and Infancy Act, 1921. U.S. Congressional Record.
- National Black Midwives Alliance.
Documentaries & podcasts
- NPR / The New York Times. 1619: How the Bad Blood Started. 2019.
- ProPublica. “Nothing Protects Black Women from Dying in Pregnancy and Childbirth.” 2017.
- Death by Delivery. Dir. Nelufar Hedayat, Fusion TV, 2017.
- The American Experience: The Midwife. PBS, 1999.
- NATAL: A Docuseries About Having a Baby While Black. Martina Abrahams Ilunga and Gabrielle Horton, 2020.
Organizations & reports
- Black Mamas Matter Alliance.
- Commonsense Childbirth School of Midwifery.
- International Center for Traditional Childbearing.
- National Association to Advance Black Birth.
- Evidence-Based Birth: Racism + Maternal Health.
- American College of Nurse-Midwives: History of Midwifery in the U.S.