North Carolina is currently facing a critical maternal and infant health crisis, as highlighted by the March of Dimes. Disturbingly, various indicators of the well-being of pregnant women, new mothers, and infants in the state are heading in the wrong direction.
As is often the case with historical challenges, the impact of this crisis is disproportionately borne by women. The maternal death rate in 2019 was 22 per 100,000 births. The next year, the rate per 100,000 births increased to 29 then spiked to 44 in 2021. “It's a huge jump, especially in such a short period of time,” said Keisha Bentley-Edwards, a Duke University researcher who studies health equity.
This disparity in maternal health is intricately linked with infant mortality rates. Black infants in North Carolina face a mortality rate more than twice that of white infants. In 2020, the infant mortality rate for Black babies in the state was 1.66%, significantly higher than the rate for white babies at 0.58%. In 2019, the Black infant mortality rate was 1.22%.
Surviving pregnancy for many Black mothers in North Carolina, like tennis phenom Serena Williams, becomes a harrowing experience. Countless others terminate their journey to motherhood traumatized by experiences of neglect, dismissal, and blame within the medical systems designed to support them.
These disparities for Black mothers and children are deeply rooted in oppressive and unjust systems, persisting even when accounting for factors such as education, body mass index, and socio-economic status. Dr. Elizabeth Howell, a professor and director of the Women's Health Research Institute at the Icahn School of Medicine, emphasizes the role racism plays in shaping health outcomes, challenging the notion that access to care and insurance alone can explain the disparities.
Looking back, from the 1600s to the mid-1900s, Black women in North Carolina received maternity care and birth support from Black midwives, a practice distinct from the clinical settings. The first Black midwife in America, dating back to 1619, played a vital role during enslavement, acting not just as a birth attendant but also as a spiritual healer, family counselor, breastfeeding consultant, nutritionist, postpartum doula, family planning counselor, and advocate for the community. Unfortunately, racism has led to the forgetting of many aspects of Black women's contributions to midwifery.
In the 1900s, approximately half of all U.S. births, including those in North Carolina, were attended by midwives, who were primary health care providers for Black women and often assisted white women in the South during childbirth. The Sheppard-Towner Act of 1921 systematically eliminated Black midwives from the profession, contributing to a legacy of birth injustices. The push from the American Medical Association in 1948 to standardize medicine further accelerated the decline of midwives, leading many, including Black women, to switch to physician care. By 1972, only 1% of all births in the United States were attended by midwives.
In the present day, North Carolina's Black families are increasingly turning to midwives and doulas—trained birth coaches providing physical, emotional, and educational support—contributing to improved health outcomes for both Black mothers and their babies.