Resource guide · Black U.S. experience
The forces that shaped Black reproductive health — and the people changing them.
Fannie Lou Hamer addresses Mississippi Freedom Democratic Party supporters outside the U.S. Capitol, Sept. 17, 1965 · The Associated Press
01 — Why this exists
For generations, Black communities in the U.S. have faced systemic barriers to reproductive care — from the forced reproduction and experimentation of slavery to today's maternal mortality crisis. These disparities are not incidental. Treating every patient "the same" without naming that history does more harm than good.
02 — What's inside
We created this guide to help folks move from the roots of reproductive injustice through its present forms and toward the work of repair.
Enslavement, eugenics, and the dismantling of Black midwifery.
PresentThe maternal mortality crisisWhy the gap persists, and the lives behind the numbers.
PresentModern challengesMedical racism, care deserts, environmental racism, criminalization.
NewInfant feedingBreastfeeding through disruption, survival, and reclamation.
FrameworkReproductive justiceThree rights: to have, to not have, to parent in safety.
ActionSolutions in actionModels and laws that are measurably working right now.
03 — Historical foundations
Reproductive injustice in the U.S. did not begin as an accident. It was built — deliberately, over centuries. The seam traces that through-line from the distant past to the present, where responsibility begins.
Enslaved Black women were forced to bear children and made subjects of medical experiments — including the anesthesia-free gynecological surgeries of J. Marion Sims. Bodies were exploited while people were alive and then, through grave robbing, even in death.
Thousands of Black women were sterilized under government-sanctioned programs. Look up: Fannie Lou Hamer named the practice the "Mississippi appendectomy." The abuse continued into the 1970s.
Black midwives were the primary, expert birth professionals of the South. Racist regulation labeled them "dirty" and "untrained," and the rise of hospital birth erased them — a loss we're still wrestling with today.
The same patterns surface today as bias, neglect, and criminalization. Naming where it comes from is the first step in disrupting it.
04 — The Black maternal mortality crisis
Disparity in perinatal health persists across income, education, and access to prenatal care — because its causes are tied to big system-wide things, not necessarily the choices or conditions of individual people. Black patients are more likely to have their pain dismissed, their symptoms overlooked, and their warnings ignored, even when they show up in medical spaces with clear signs of preeclampsia, hemorrhage, infection, etc.
Chronic stress from racism takes a measurable toll on the body — "weathering," coined by Dr. Arline Geronimus, that raises the risk of preterm birth and hypertension. Layered on top: higher rates of unnecessary C-sections, and restricted access to the midwifery and doula care shown to improve outcomes.
Serena Williams
Athlete
Nearly died postpartum when doctors initially dismissed her concerns about blood clots — despite her own knowledge of her medical history.
Dr. Shalon Irving
CDC epidemiologist
Studied racial health disparities for a living. Died three weeks postpartum after her warnings about complications were repeatedly dismissed.
Amber Rose Isaac
Mother, age 26
Died after months of pleading for better care amid documented medical neglect at a New York hospital.
Kira Johnson
Mother, age 39
Died of internal bleeding after a routine C-section as her husband's pleas for help went unanswered for hours. Her family founded a foundation in her name — 4KIRA4MOMS — to hold hospitals accountable.
We share these testimonies with deep respect for each of the real women and families behind them. It matters how we share our stories — and for what purposes. Each represents the painful continuation of a pattern of harm that we see continue to be shared over social media and via news outlets. A pattern of harm that funding for Black midwifery, provider accountability, and legislation like the Black Maternal Health Momnibus Act are working to end.
05 — Modern challenges
Medical racism is not just something we look back on. It is embedded right now in how care is delivered, where it is available, what the environment does to a pregnancy, and how the legal system treats Black parents.
False beliefs about "higher pain tolerance" still shape care. Nearly half of medical trainees in one study held such beliefs — leading to under-treated pain, delayed intervention, and avoidable C-sections. Dr. Dána-Ain Davis named this "obstetric racism."
See the reading →Maternity care deserts, transportation insecurity, insurance gaps, and Medicaid that too often ends 60 days postpartum — even though complications can arise for a full year — cut Black families off from continuous care.
See the reading →Segregation and disinvestment place Black families nearer pollution, lead-contaminated water, food deserts, and urban heat — each linked to preterm birth, low birth weight, and pregnancy complications. Flint has been one well-known crisis among many.
See the reading →Black pregnancy outcomes are policed — non-consensual drug testing, charges after miscarriage or stillbirth, court-ordered interventions, disproportionate CPS removal, and shackling during birth in prison. "Neglect" is often poverty, not parenting.
See the reading →06 — Infant feeding · newest section
Breastfeeding rates remain lower for Black families — not because they don't want to or lack of education, but from centuries of systemic barriers. This specific story starts from rich African traditions, through the forced wet-nursing of slavery, the formula industry's targeted marketing, to a present-day reclamation led by Black birth workers.
This history is about support that was disrupted and knowledge being reclaimed — not about anyone falling short. And formula — although there have been real issues in its marketing — isn't always the problem itself. The problem is systems that withhold support and then make parents feel ashamed for what happens next. Real feeding equity means every parent has safe, supported, well-informed choices — breastfeeding, chestfeeding, pumping, combo feeding, or formula feeding — with no shame and no pressure.
Founded in 2013, Black Breastfeeding Week centers joy, healing, and visibility, building on decades of grassroots work by organizations like ROSE and the Black Mothers' Breastfeeding Association.
07 — The reproductive justice framework
Coined in 1994 by a group of Black women and developed by SisterSong, reproductive justice expands beyond rights to the conditions that make those rights real. It rests on three inseparable claims.
Right 01
Free from coercion, forced sterilization, or barriers to fertility care — the right historically denied through eugenics and medical racism.
Right 02
Access to contraception and abortion that is safe, affordable, and free of stigma or criminalization — access that abortion bans strip first from Black and low-income communities.
Right 03
To raise children without police violence, family separation, environmental harm, or the daily fight against systemic neglect.
Reproductive justice connects to every other justice — racial, economic, climate, labor. The legal right to care means little without the means, community, and access to exercise it.
08 — Solutions in action
Across the country, Black-led models and hard-won policy are producing measurable change for reproductive justice.
Jennie Joseph's low-barrier, patient-centered model in Florida has reached near-zero maternal deaths and preterm births among the families it serves.
A Black-led midwifery clinic and birth center in Missouri whose community doula program has trained over 460 Black doulas in St. Louis.
Mandates implicit-bias and anti-racism training for all perinatal providers in the state — a national precedent.
Extended postpartum Medicaid from 60 days to a full 12 months, with more than ten states now reimbursing doula care.
A set of bills expanding Medicaid, funding Black midwifery training, investing in community-based care, and improving disparity data.
09 — Read, watch, support
A starting shelf. The full guide carries the complete, cited list.