Black birthing people in the U.S. are three to four times more likely than their white counterparts to die from pregnancy-related complications — and 80% of those deaths are preventable. We have the research. We have the data. We even have the solution.
Studies confirm that doula support reduces the risk of cesarean delivery by 47% and preterm birth by 29% — and midwifery-led care cuts cesarean rates by nearly 40% with similarly lower preterm birth rates. People with doula support are also 46% more likely to attend a postpartum checkup. And yet, only 6% of U.S. births involve a doula, and access to midwifery care varies drastically by state — with the most restrictive states consistently reporting the worst outcomes. High out-of-pocket costs and lack of insurance coverage have limited access to both almost exclusively to those who can afford to pay. As of 2024, only 14 states and Washington, DC provide Medicaid coverage for doula services.
This is not a knowledge gap. It’s a political one. And Black women have been closing it for a long time.
The Midwife Who Protected Midwives
In the 1940s, Black midwives — often called “granny midwives” — were considered experts in birth work and attended up to 75% of births in the Southeastern United States. But when states began regulating and restricting midwifery practice, a combination of laws, educational restrictions, and campaigns against the profession threatened to dismantle their practice entirely.
Mamie Odessa Hale stepped up to make sure that didn’t happen. Trained at the Tuskegee School of Nurse-Midwifery — one of the few programs in the country that accepted Black women — Hale became a midwife consultant for the Arkansas Department of Health. From 1945 to 1950, she worked to certify Black lay midwives, using innovative methods like songs, films, and mannequins to make training accessible to women who were largely elderly and illiterate, and who had been practicing for decades.
She didn’t replace the granny midwives. She made sure they could keep going. By 1948, her efforts led to the establishment of maternal-child health clinics in eleven counties, with more than 2,500 women receiving maternity care.
Carrying the Flag
birthFUND exists because the gap between knowing the problem and solving it costs lives. Founded in 2024 by journalist and editor Elaine Welteroth — alongside Serena Williams and a coalition of cultural leaders — birthFUND covers out-of-pocket costs of midwifery care for Black women and women of color who can’t afford it. In just a year and a half, the fund has supported more than 260 families and welcomed 138 births. Welteroth launched it after her own midwife saved her life — and after years of documenting a crisis that the system keeps refusing to fix. birthFUND isn’t waiting for policy to catch up. It’s meeting families where they are, right now.
The Los Angeles County African American Infant and Maternal Mortality (AAIMM) Initiative is doing the county-level work that national policy has yet to deliver. Launched in 2018 as a countywide coalition led by the LA Department of Public Health in partnership with First 5 LA, AAIMM was built on a foundational truth: the root cause of birth disparities for Black families is the stress of living under racism — and its compounding effects on the body. Their doula program has provided free, culturally congruent doula support to Black and African American pregnant people across LA County, prioritizing the communities where Black infant mortality rates are highest. They aren’t waiting for the system to catch up. They’re rebuilding it from the inside.
The Work is Far from Done
Mamie Hale didn’t wait for the system to fix itself. She built something better inside it — with the tools she had, in the counties she could reach, for the women who had no one else.
Eighty years later, the tools have changed. The urgency hasn’t. Today, only about 11% of U.S. births are attended by a midwife — and less than 5% of the midwifery workforce are people of color. Only 2% of births occur outside of a hospital setting. In countries like Sweden, France, and Japan, midwives attend close to 75% of births. The same forces that pushed granny midwives out are still shaping who gets care — and who doesn’t.
birthFUND and the AAIMM Initiative are doing what Mamie did — building inside the gaps, reaching the families the system has left behind, and refusing to wait for permission.Every mother and birthing person deserves care rooted in dignity, skill, and community. That was true in 1945. It is true today. And we will keep building until it’s the standard — not the exception.
Take Action:
- Find a doula — The AAIMM Initiative connects Black and African American families in LA County with free, culturally congruent doula support. Learn more at blackinfantsandfamilies.org
- Follow and amplify — Support the organizations carrying this work forward: @birthfund and @blackinfantsandfamiliesla
- Expand Medicaid doula coverage — Only 14 states cover doula services through Medicaid. Tell your rep that needs to change. Find your rep at house.gov or senate.gov
