Black women experience in maternal care, including . The medical racism that Black women experience contributes to disproportionately high rates of maternal mortality. Just look at the stats: Black women are -related causes than white women according to the Centers for Disease Control and Prevention (CDC). Shockingly, the CDC also reports that of pregnancy-related deaths are preventable.

Numerous studies show that . While their roles are different, both doulas and midwives offer vital support before, during and after birth that can combat the Black maternal health crisis. Midwives are trained medical professionals who provide prenatal care, monitor physical and emotional health, and perform labor and delivery in a variety of settings including hospitals, homes and birthing centers. The midwifery model of care is holistic and client-centered, and . Doulas are advocates that ensure clients’ needs are respected, and they make active, informed decisions about care. Doulas can create birthing plans, offer techniques for pain management during labor, and provide continuous physical and emotional support. Their presence is proven to improve maternal health outcomes and .

Being paired with a birth team that is reflective of background, values and culture is important, and helps to build trust and contribute to more equitable care. For Black women, that connection can be lifesaving. Yet, and according to some estimates .

Niambi Bloom (LSW) is one of only two Black birth doulas in Colorado Springs. She first discovered this maternal care desert while searching for her own doula during her first pregnancy. She found only one Black doula based in Denver, more than an hour away. Ultimately, she chose a local doula and had what she describes as a “textbook home birth” where she was surrounded by a midwife and a doula who she felt genuinely cared about her. Bloom chose to become a birth doula to help positive birthing experiences like her own become the norm. She also wanted to give other Black women what she did not have, care from a Black doula. Bloom now helps to lead training sessions about maternal health disparities to new groups of prospective doulas. It was during one of these sessions that Bloom met a Black woman who was training to become a doula in Colorado Springs. Now, the two work together but still have not found other Black birth doulas in the area. According to Bloom, “It’s just us.”

Building a more diverse maternal care workforce is essential to providing more equitable care, and it’s a necessary component to combating Black maternal health disparities, but there are barriers that prevent both recruitment and retention of Black birth workers. Tyla Leach, a labor and delivery nurse and childbirth educator, believes a major barrier is the sheer amount of money, time and energy it costs to become trained and remain in practice. A found that almost all doulas find their work to be emotionally fulfilling, but few consider it to be financially rewarding. According to Jazmin Williams, a full spectrum doula and the Founder of , “Birth work is not a revenue-based service. It is not a revenue-based profession. We aren’t getting rich off supporting our community…But we know the necessity of having a doula that is reflective of your background, reflective of your culture that knows how to become an advocate with you… to amplify your voice rather than talk over for you.” She added, “We do provide a lot of sliding scale assistance and I’m pro bono, but we also have families of our own and that’s how we came into practice, so we really have to look at our care pricing that is also sustainable for us.”

The for their work. Most private insurance providers and Medicaid programs do not cover doula care, which often means clients can pay up to thousands of dollars out of pocket for these services. The CDC, estimates that over . Failure to include Medicaid coverage for doula care makes a vital resource to combat maternal mortality largely inaccessible for those who are most at risk. A growing number of states are pushing for Medicaid reimbursement for birth doulas to address the problem. According to , “the goal of Medicaid coverage of doula care [was] threefold, according to advocates: support people who are giving birth, provide culturally congruent care and compensate doulas fairly for their work.”

Necessary Policy Change: How They Did It

In 2022, Washington lawmakers passed to establish birth doulas as a health profession in Washington state, creating a process for state certification and thus a pathway for Medicaid reimbursement. The success of HB 1881 is as a national model for how legislators should directly involve and advocate with birth workers.

• The , a Queer, Trans, Black, Indigenous and People of Color-led (QTBIPOC) organizing group bolstered by , was instrumental in the creation of the bill and worked in lockstep with legislators to lobby for its passage. Members of the Coalition shared their perspectives to ensure the bill combats harm, addresses community concerns, and that the certification process does not shut out doulas who are already practicing.
• They were instrumental in creating a certification process that is voluntary, meaning doulas who choose not to become certified are still able to practice and support their communities.
• They also advocated for a competency-based model for certification and training that values ancestral knowledge, and differs from courses offered at large certification organizations that have historically .

Sage Maenad Kissiah-Grove, a member of the Coalition, and a birth and postpartum doula, credits HB 1881 with establishing and opening up the certification process “for people who come from all kinds of backgrounds in birth work, people who have been trained ancestrally, people who have self-trained and people who have not trained through these big organizations.” She added, â€śFor their training to be from people who look like them and who have their same experiences is huge.”

Washington State Senator T’wina Nobles, a Black woman and mother of four, worked alongside the Doulas for All Coalition to rally support for the legislation and to create a clear pathway for its passage in the State Senate. She believes that doulas “really are the leaders” in this work, and that people who are most impacted and most connected to birth work deserve their voices to be heard. Nobles sees herself as an amplifier who focuses on “allowing the experts, the doulas and midwives and folks who do the birthing work, to lead and let me know what they need.”

This year, Nobles plans to introduce legislation that builds on the success of HB 1881 with Senate Bill 6172, which will allow birth doulas up to $4500 in Medicaid reimbursement rate, the highest in the country.

What’s Next?

Federal Way Birth Center celebrated its grand opening in November. For Faisa Farole, it is just the beginning. She envisions a future in which FWBC will serve as a community hub and provide support beyond childbirth. â€śI want the center to be not just a place where we are providing mentorship to aspiring Black midwives, but also a place where the community can come and get lactation education and childbirth education,” said Farole.

She added, “I want it to be something that the community is using, and not a place where the doors are closed.” She also sees the center working in collaboration with nonprofit organizations who support BIPOC (Black, Indigenous and People of Color) communities, and she already has spoken with the about teaching in the space.

Farole is also the founder and executive director of (GPS), a nonprofit that provides free community-based doula services for Black, immigrant and refugee families. She also has trained more than 100 doulas who combined speak more than 17 different languages. She sees her own nonprofit working closely with the center, and offering GPS clients the option to give birth at the center if they choose. Farole is optimistic about the future of her center, as well as other initiatives that will help more Black women “answer the call” and provide vital support for their communities.

Jazmin Williams was fortunate to be on a Black birth team with a Black birthing person, Black midwife, Black doula and a Black pediatrician. “It’s rare to have an entirely Black birth team…It’s an incredible experience and one that I’m thankful for,” said Williams. “It fills my heart to know that is possible, and that we can do that.”

All Black women deserve a birthing experience where they feel respected, their choices are honored, and their lives are protected. There is beauty, joy and strength in birth, and those experiences should be the norm. What is happening in Washington is cause for celebration and hope. We can support Black birth workers and center them in legislative advocacy. We can build a more diverse maternal care workforce and ensure doulas and midwives are paid living wages. We can save the lives of Black women and create safe, healthy birthing experiences that are rooted in empowerment instead of trauma.

The Federal Way Birth Center is the first Black owned freestanding birth center in Washington state. It is the first of its kind, but hopefully it will not be the last.

So in 2017, Winrow — a Johns Hopkins-trained pediatric neuropsychologist, PADI master scuba diver, and associate member of the Women’s Diving Hall of Fame and the American Academy of Underwater Sciences — helped launch the . The Maryland-based program, now expanding across the country, uses the world of water to break down cultural barriers in teaching Black girls as young as age 9 the possibilities of a life immersed in science, technology, engineering and math. And a life surrounded by water.

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“I was curious why there weren’t a lot of Black females in the marine sciences, and doing my research, it came down to a cultural narrative and the big thing with young Black women was getting their hair wet,” she says. “That, coupled with a misunderstanding that marine science means you are going to be around water and the cultural segregation with Blacks and swimming, it is really multi-layered about Black girls seeing themselves in those spaces. I looked at [Black Girls Dive] as an opportunity to cultivate that STEM identity so they can see themselves in that space and dispel the myths that Black girls aren’t supposed to be swimming or shouldn’t get their hair wet.”

Starting in elementary school, the foundation’s free afterschool Streams Program takes students who don’t know how to dive — or even how to swim — and turns them into certified divers by the end of their first year, starting in pools and then progressing to open water. The program follows the students through college, gaining complexity every year as mentors and instructors teach STEM skills that cover marine science, robotics, biology and geography.

“Expectations increase, difficulty levels increase, cognitive loads increase,” Winrow says. “We are skill building and providing that mentorship.” Through the program, students come to understand the physics of diving, are taught to code so they can operate underwater drones for photography and learn about geographic information system mapping while tagging sharks for tracking.

Students are also exposed to various cultures around the globe. As part of its annual “capstone” final exam, the Streams Programs brings students to locations around the world where they can integrate culture with STEM. Immediately before the pandemic, for example, participants traveled to Andros Island in the Bahamas and spent a week immersed in the culture and economy while diving the region’s marine caverns. They also studied water chemistry and reef biodiversity. Other groups of students have traveled to Egypt to dive in the Red Sea, gaining a first-hand understanding of how one of the saltiest bodies of water on Earth changes the way a diver prepares. To make that trip, students had to study Arabic and then took part in a Bedouin dinner.

For someone who was always passionate about the ocean, Violet Smith, now a senior at Oakland Mills High School in Columbia, Maryland, used the program to see if marine science was something she wanted to pursue, all while allowing her to become a certified scuba diver.

“Through this incredible program, I have been able to narrow down my interest and have decided I want to major in marine science and cartography in college,” Smith says. “One highlight of my time in this program so far was getting to scuba dive in the Georgia Aquarium with their whale sharks. We were fortunate enough to be able to spend the night at the aquarium and get a behind-the-scenes tour of the facility. It was fascinating to see how the aquarium functioned, and getting to be on the other side of the aquarium glass was an amazing experience I’ll never forget.”

Founded in Owings Mills, Maryland, the grant-funded Black Girls Dive Foundation has expanded to New Jersey and Atlanta and expects to add chapters in Seattle and San Diego next year. Currently, about 75 girls participate, screened through a rigorous application process that tests whether the program is a good fit for them. Students need recommendations from educators and must show a personality that can handle the dangers of diving.

As students progress in the program, Winrow says, they come to understand how to use their skills and interests. Mentors from both the dive and STEM parts of the program help the students explore career pathways. “They may not go into ocean science,” she says. “They may go into a STEM-adjacent career.”

“There are cultural barriers as part of that systemic barrier that I think was precluding Black women to enter the [STEM] space or young Black girls to see them in that space,” she says. Winrow wants to teach new “habits of mind, creating the opportunity to dispel the myths that Black girls aren’t supposed to be swimming or shouldn’t get their hair wet, dispelling all of that through education.”

Conducted by , “Our Power, Our Legacy,” , was commissioned by to identify what priorities Black women identify as critical for future economic success after the .

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“I want to turn and ask Black mothers, what do they need, and how can we better engage them more authentically in co-architecting solutions?” said Gabrielle Wyatt, who founded the Highland Project in 2020. About 89 percent of Black mothers surveyed say reaching educational goals is a key measure of success; while 85 percent say improving K-12 education is the top priority.

The report’s sample is geographically representative, with 27 percent of respondents having children under 18; 32 percent holding a higher education degree; and 38 percent married or partnered.

The findings will inform programming for The Highland Project’s and advocacy plans for their local partners, including the education-focused in Indianapolis. Wyatt, Newark Schools’ former chief of strategy, created the nonprofit Highland Project as a coalition of Black women leaders aimed at closing the racial wealth gap via systems-level change.

Wyatt told ĂŰĚŇÓ°ĘÓ that The Highland Project’s mission was born out of a belief that wealth provides opportunity — to things like home ownership and rainy day funds — yet economic solutions alone cannot solve the racial wealth gap.

“I think about — our lives and our bodies to be protected and need to be thriving. We need access to incredible health care,” said Wyatt. “We need access to great and nutritious foods. We need access to a community policing model… We also need access to great and incredible schools. When we say wealth, we need to be thinking about pulling multiple policy levers in order to get there.”

Here are three of the survey’s key findings and their implications for education policy:

1. Black women worry about children’s education more than anything else

Fifty-nine percent of Black women say the issue most frequently on their mind — more concerning than retirement savings, healthcare costs, and losing their job — is whether their child or the children around them are “getting a good enough education.”

Quality education for the younger generation was the most frequently cited worry among .

The ability to afford higher education is a top concern for 47 percent, as well. College access and affordability is of greater concern for single Black women across age groups — 55 percent fear that they won’t be able to afford higher education for themselves or a family member.

. One year after graduating from 4-year institutions, Black women owe an average of $8,000 more than their white peers, likely due to compounding factors: generational wealth and a family’s ability to contribute to college costs, access to employment and wage gaps.

“What we have seen and what we have heard, as a culture, is that college is supposed to be the thing that closes the wealth gap for us, with our white peers, and what we’re seeing now is the opposite happening,” Wyatt said. “We’re in an urgent state of affairs in terms of addressing the student debt crisis, and continuing to kick the can on this, via the extension of loan payment relief, isn’t going to get us there.”

The report recommends eliminating student debt, calling it a “crippling barrier to wealth building.”

2. Lack of educational opportunities is a top barrier to economic success for Black women

About 21 percent of Black women cite lack of educational opportunities as a key hurdle to economic success, and more than a quarter of Black women with college degrees believe so. Racial discrimination and lack of job opportunities were the other most frequently chosen hurdles.

The barriers align with the reports’ central finding of what priorities Black women want leaders to focus on: voting rights, racial discrimination, and access to quality education.

Wyatt told ĂŰĚŇÓ°ĘÓ that the lack of diversity in educational leadership may be part of why Black women aren’t accessing more educational opportunities. Nationally, of the public school population are Black students yet are Black teachers and about three percent of superintendents are Black women.

To promote academic and social opportunities, education advocates and suggest strengthening the teacher and leadership pipeline to better represent students.

“The federal dollars that are at play right now offer huge opportunities for districts to help improve teacher diversity in particular, from recruiting and hiring, to setting up mentorship programs to encourage students of color to become teachers,” Wyatt said.

3. Black women say the ability to pursue educational goals is a key measure of overall success

An overwhelming majority of Black women define success in ways that affect their quality of life beyond financial means. Eighty-five percent say that pursuing educational goals is one key way they look at success.

Educational opportunity and attainment is more important to Black womens’ perceived success than a high-paying job (82 percent), owning a home or raising kids (81 percent).

For Wyatt, these findings are another indicator that leaders must look to education policy to ameliorate racial inequities, particularly as more data is released from pandemic-era learning.

“We know that and we know that students are learning at different rates,” said Wyatt, “and for me that means that we differentiated solutions that are rooted deeply in community voice, deeply in evidence and deeply with equity and justice as our Northstar.”

Other notable findings

• 83 percent say college needs to be made more affordable
• 88 percent say they will likely vote during midterm elections
• 78 percent say quality day care needs to be made more affordable