Inequality is rampant throughout the healthcare system: women of color are more likely to die of breast cancer, heart disease, and COVID-19, and more likely to report chronic, severe anxiety. There are many reasons why—gaps in biomedical research, deliberate discrimination, lack of resources, lack of empathy—all of which come to a head when a Black woman gets pregnant. Black women in the United States are three to five times more likely to die from pregnancy or postpartum issues than white women—a maternal mortality crisis that cannot be ignored. In Glamour’s Black Maternal Health series, we’re sharing these stories—and solutions.
As a Black woman in my mid-20s, the thought of getting pregnant is incredibly anxiety-inducing. Not because I don’t want to be a mother or because I lack the resources to support a child. The reason is simple: Being Black makes me much more likely to die from childbirth.
I’m not alone in experiencing these anxieties. For Black women of reproductive age, the Black maternal mortality crisis isn’t just a chilling headline; it’s a life-threatening reality. “It almost feels normalized, like something that’s not going away,” says Pamela,* a 24-year-old Ph.D. student in Florida. It’s a truth Black women have had to accept: Starting a family might look a lot different, a lot more fraught, than we envisioned.
Pregnancy expectations vs. reality
Like many women, I equated motherhood with strength and resilience when I was a child. “I always felt like my mother could do everything, and I just assumed that it was because she was a mother,” says Maria, a 24-year-old pediatric nurse in Maryland.
It was clear early on that my family expected me to have children one day. But it was more than my parents’ yearning for grandchildren—the cultural expectations in the Black community heavily promote the role of the strong Black mother, stigmatize anyone viewed as promiscuous or sexually active, and shame women who choose to get pregnant later in life.
“Everyone makes pregnancy seem like this beautiful thing that every woman should experience. But it’s life-threatening.”
Because of the emphasis around needing to give birth, teenage me was pretty committed to the idea that I’d either have a kid or be pregnant by the time I was 26, modeling my future as a parent on my own mother, who was 27 when she had me. With my 25th birthday fast approaching, I can wholeheartedly say that the idea of having a child anytime soon is laughable.
The reality of childbirth as a Black woman feels terrifying and cold compared with the romanticized picture that was painted for me when I growing up, the birth experience synonymous with the glow of new motherhood. “Honestly? I feel bamboozled,” says Pamela. “It feels like everyone makes pregnancy and birth seem like this beautiful natural thing that every woman should experience. But it’s life-threatening.”
Black women and medical mistrust
Awareness of the Black maternal mortality crisis is gaining steam—celebrities are using their platforms to speak out about Black maternal health and politicians are introducing legislation to address the many causes of the disparity. But significant work to counter it has yet to occur, and I question whether things will change enough in time to make an impact if and when I do desire to get pregnant.
“How can I expect someone to care about my health if they don’t even respect me enough to ask how my name is pronounced? It’s dehumanizing.”
My fear of pregnancy is about more than possibly dying during childbirth. The Black maternal mortality crisis is a representation of an active disinterest in the well-being of women who look like me. Racism and bias have been linked to poor health outcomes for Black women. “On top of the fact that so many things can go wrong, how will I know my concerns are taken seriously? How will I know my doctors and nurses are vigilant?” says Pamela. “I’ve seen people around me look into more holistic birthing methods, but I can’t say I would feel comfortable having a home birth.”
I’ve often experienced a feeling of dismissal by medical professionals—as have most of the Black women I’ve grown up with and spoken to about it. When I think about getting pregnant in the future, I have to factor in not only trust that I’ll be taken care of but that another living being will be taken care of too. “I recently dealt with a doctor who outright said that they refused to say my name because they thought it was too difficult to pronounce,” says Felysha, a 25-year-old graduate student in Maryland. “How can I expect someone to care about my health and the well-being of my unborn child if they don’t even respect me enough to do the bare minimum of asking how my name is pronounced? It’s all dehumanizing. I don’t think I’ll feel comfortable having children until I know I cannot only healthily support them, but also have access to medical professionals who actually care.”
Black maternal mortality and intergenerational stress
So much of the conversation around Black womanhood is around the notion of sacrificing for the greater good, even down to bringing another life into this world. It’s a catalyst for chronic stress and all the health disparities that go with it.
Intergenerational stress and trauma are experienced by BIPOC at an elevated rate, and Black women are more likely to report chronic, severe anxiety. This anxiety is heightened by the systemic lack of essential resources available to Black women and the federal defunding of organizations that provide affordable health services. “In one corner, you have society telling you, ‘You have to be a mother’ and that you’re somehow defective if you’re not,” says Felysha. “In another corner, you have politicians making parenthood all the more difficult. It’s like, ‘Hey, you need to have children and if childbirth doesn’t kill you, we’ll do everything in our power to systemically break you.’ Thinking about this alone is exhausting.”
Black women battle so many things as a result of institutionalized racism and misogynoir, much of which, it seems, we have no choice but to deal with ourselves. “Even though Black women are the victims in this situation,” says Pamela. “I feel like there’s this burden on us to know even more than our non-Black counterparts about risks of pregnancy so we can advocate for ourselves in dangerous situations.”
Deciding what role to play in the village
I firmly believe in the idea that it takes a village to raise a child. And with so many potential roles that I could play in a child’s life, I’m much more open to exploring alternative roles as opposed to birthing myself.
Many of the women I spoke with were rethinking the idea that getting pregnant was a necessary experience for creating a family. “I love the idea of adopting or fostering children. My grandparents adopted three children and fostered many others, so it’s always been something I’ve wanted to do,” says Melissa, a 27-year-old clinical researcher in Ohio. “I’ve always considered alternative avenues,” Pamela says. “I don’t think by any means it is the end of the world, and motherhood is so much more than being pregnant and physically having a baby.”
Even with the anxiety the Black maternal mortality rate gives me, it also highlights the sacrifices my own mother made when having my siblings and me. It affirms my thoughts around there being an inherent courage and strength in being a mother. That is an experience I want, but it would be irresponsible to have a child without considering the realities of the environment I would be bringing them into. And right now the climate is pretty hazardous for us both.
Whatever form becoming a parent takes for me, I know I will have to advocate for my own well-being—because if left to the current system, I might not be alive to experience the postbirth joys of parenthood.
*All names have been changed.
Chase Alston is a medical student and freelance writer in Baltimore. She is passionate about health care reform, social justice, and tacos. She is also the cocreator of Ezi Health, a platform for elevating wellness and health education.
Originally Appeared on Glamour