Black Doulas Are Banding Together to Beat High Infant Mortality Rates

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.

Few teenagers know precisely what they want to do with their life when they’re a high school sophomore, but Christin Farmer knew when she was 16 that she wanted to start her own birthing center. “I used to watch all of these reality shows about birth, and I was so fascinated,” says Farmer. “My favorite show was about a midwife in Texas who did home births and provided a calm environment with low lighting—it was the first time I saw birth in a different way.”

Almost 20 years later, Farmer’s nonprofit, Birthing Beautiful Communities, is preparing to break ground on a 28,000-square-foot campus that will house Ohio’s first-ever freestanding birthing center. It’s a game-changing development in Farmer’s hometown of Cleveland, where Black babies are approximately four times as likely to die before their first birthday than white babies and in a state that ranks among the top 10 states for infant mortality, according to data from the Centers for Disease Control and Prevention.

“When I started Birthing Beautiful Communities, I knew of doula collectives around the city, but hardly any of them employed women of color,” Farmer says. “Infant mortality issues are mainly occurring in Black neighborhoods, so why not more Black doulas and birth workers?”

Diversity matters.

It’s no secret that Black women face vast health disparities. In addition to being three to four times more likely to die in childbirth or due to pregnancy-related complications than white women, Black moms also face the highest infant mortality rate among all racial and ethnic groups and the highest incidence of premature birth and low birth weight (both top factors contributing to infant mortality). Black women are more likely to be uninsured and face greater financial barriers to obtaining care.

And an alarming percentage of Black women don’t have access to any type of prenatal support—10.2% of Black moms received late or no prenatal care at all in 2017, according to data from the U.S. Department of Health and Human Services Office of Minority Health.

“When you can see yourself in your doula, it’s easier to relate, connect, and open up.”

Doulas can help address the failings of the medical system. Their job is to provide emotional, physical, and educational support to moms throughout pregnancy, labor, and postpartum—and their impact on birth outcomes can be incredible. A 2013 study published in the Journal of Perinatal Education revealed that moms who work with doulas are four times less likely to have a baby with low birth weight and two times less likely to experience complications. The positive effects of doula care were greater for women who were socially disadvantaged, low-income, and/or experiencing language and cultural barriers.

But as in all things, representation matters when it comes to birth workers. Arkansas-based doula Nicolle Fletcher, owner of Nurturing Arrows Doula Coaching Services, believes that positive change for Black moms and babies starts with creating more diversity within the field. “When you can see yourself in your doula, it’s easier to relate, connect, and open up,” says Fletcher. “But the marketing in the doula and midwifery worlds is geared toward upper-middle-class white women. In order for any sort of change to happen, we need more representation.”

After getting certified in 2010, Fletcher spent five years as the only Black doula in Arkansas (which currently has the nation’s third highest infant mortality rate). Yet most of her client roster remained white; in fact, of Fletcher’s approximately 270 clients between 2009 and 2017, only 10 were Black, she says. It wasn’t until 2018, when Fletcher teamed up with other Black birth workers to form Ujima Maternity Network, that she began to attract more Black moms-to-be as clients. “That year alone I had 10 Black mothers [sign up for doula care],” she says.

Doula collectives like those run by Farmer and Fletcher are becoming more mainstream, but an estimated 40% of women still don’t know about doula care and its benefits. “A lot of women say to me, ‘Isn’t that some white, New Age, granola thing?’” says Chinyere Oparah, provost and dean of the faculty at Mills College in Oakland, California, and cofounder of Black Women Birthing Justice (BWBJ).

Bridging the infant mortality gap.

This work matters deeply. A 2019 Health Equity study found that doulas who specifically worked with low-income African American moms were able to act as much-needed advocates, due to their familiarity with institutional biases within the health care system and with how to rise above them. “Having a doula who is working for the birthing person is really key,” says Oparah. “When Black moms are being dismissed or intimidated, a doula can amplify their voice.”

Oparah says she experienced this necessity firsthand during her own pregnancy when her ob-gyn recommended a C-section. “As someone who grew up in foster care, I wanted to be able to hold my baby right away—I didn’t want to have a C-section,” she says. “I felt I wasn’t taken seriously by my ob-gyn and felt myself being undermined, and my confidence eroded. I began to believe maybe I couldn’t push out this baby, even though I was super healthy and active.”

At seven months pregnant, Oparah followed her intuition to transfer her care from her ob-gyn to a midwife, which influenced the creation of BWBJ—a culturally diverse collective of women set on righting birth injustices and transforming the Black birth experience.

Currently BWBJ is working on a doula hotline that will provide emotional support to 200 pregnant and postpartum Black women in California, as well as a community research justice project measuring the effects of COVID-19 on Black moms and birth workers. BWBJ has also been instrumental in helping further national legislation for the Black maternal health “momnibus,” which includes bills introduced in March 2020 to diversify the birth workforce and address social determinants of health that impact maternal well-being.

In Cleveland, Birthing Beautiful Communities is also making strides, having helped more than 800 families since 2014 with a 99% infant survival rate. Farmer approaches her work using a “holistic birth equity model” addressing the root causes of infant mortality, from nutrition to stress levels. Along with usual fare such as breastfeeding and newborn care classes, BBC provides everything from vegan eating guidance to mommy-and-me yoga classes to parent-empowerment support groups—all of which are offered for free. “If we don’t find a way to look at Black pregnant women as whole people, we will never solve this issue around infant mortality,” says Farmer.

Add in the rise of Black doula collectives, and it’s a powerful formula for change. As Oparah puts it, “Black workers are the mothers of this movement.”

Jen Jones Donatelli is a Cleveland-based freelance writer whose work has appeared in Redbook, Natural Health, Business Insider, Budget Travel, Robb Report, and many more. In 2015 she won a Hearst Editorial Excellence award for her infertility-focused blog, The Truth About Trying, for Redbook. 

Originally Appeared on Glamour