America Has A Black Maternal Health Problem

The week leading up to Shalon Irving’s death in 2017 had a familiar blueprint.

She’d given birth three weeks prior and received a C-section, but now the incision was swollen along with her legs. Her blood pressure spiked to terrifying levels. Irving, an epidemiologist at the Centers for Disease Control, sought care multiple times, and, in every instance, doctors assured her that her symptoms were typical and sent her home. On January 28, Irving collapsed in her home, dying from complications of high blood pressure.

Maternal health outcomes for Black women have not improved in the six years since Irving’s passing. In 2021, Black women experienced 69.9 deaths per 100,000 live births—nearly three times the rate for white women—based on the most recent data from the CDC, a significant jump from the previous years. Preeclampsia and eclampsia, two blood pressure disorders, are the primary cause of death.

This brutal reality is due to lacking maternal care and the racism present in American medical establishments. Black women like me are more likely to receive C-sections, a procedure unpreferred by many medical providers due to an increased risk of postpartum complications, and experience a higher rate of stillbirths. Our pain is dismissed or ignored by clinicians, a common occurrence that received significant news coverage following the near-fatal birthing experience of tennis icon Serena Williams in 2018 and the death of Irving.

These are the quintessential narratives of adverse Black maternal health in America, and there are no demographic factors that protect us. No amount of money, education, health insurance coverage, or access to supposed high-quality medical care prevents it. Such a disparate reality is why some Black people who can become pregnant are choosing to be child-free.

“Coupled with the fact that any potential child of mine would be at an economic disadvantage from the onset of their existence because of their skin color alone, I must contend with statistics that tell me I am three times more likely to die during pregnancy or childbirth than white women,” explains writer Kwentoria A. Williams in a piece for Essence Magazine. “Because of the color of my skin, there exists a barrage of biases that contribute to the likelihood of me either dying and never being able to raise this figment-of-my-imagination child or my health being at grave risk throughout and after my pregnancy.”

Her reasoning is not far from those whose stories will be featured throughout this project, beginning with Phoebe Gavin.

Gavin, a career and leadership coach with over a decade of media experience, decided not to have children based on several factors, as many Black people who can become pregnant do. The biggest were adverse reproductive and maternal health outcomes—a reality several women in her family navigated—and the pervasive idea that once a woman becomes a wife and, hopefully, soon after a mother, her life is no longer hers. The latter may seem as if it’s unrelated to the former, but if you look at it historically, it’s not.

Gavin’s narrative is the first installment in a series centering the voices of Black people who can become pregnant but choose not to due to fear of maternal mortality, systemic racism, police violence, or other societal ills that disproportionately affect Black Americans.

Here’s Gavin’s story, in her own words, lightly edited for length and clarity.

“It doesn't matter how much money you make; it doesn't even really matter what background you're coming from. Childbirth is a high-risk thing for a body to do. It’s even more high risk when you are a Black woman.”

I grew up low-income in South Florida with both my parents at home. I observed that raising my brother and I took over my mom's life. As I grew up and learned more about my parents' dynamic and why things were the way it was, it was very much driven by their interpretation of Christianity. From that perspective, my mom always told me growing up to “Live your life for you for as long as you can because once you get married, your life is your husband's. And once you have kids, your life is your kids’.” Even as a kid, that sounded terrible. So I was like, ‘Okay, well, I guess I just won't get married or have kids.’

As I came to understand that as an extension of her interpretation of Christianity and how she and my dad crafted their marriage dynamic, it pulled me away from the idea of having children and Christianity. I didn't want to subscribe to a religious tradition that required me to give my life to my husband or kids. That was further reinforced by my clarity about my sexual orientation. I’m pansexual, and until I gave myself permission to step away from their religious tradition, I had in my brain, ‘Well, I'm just going to like ladies and go to hell.’ (laughs).

Before I stepped away from their way of thinking, I had resigned myself to the idea that their worldview was the only worldview and that how they saw marriage, children, and being queer was the only truth. But I still felt this cultural pressure that I had to have kids, but maybe I could still have my own life. And maybe if I married a nice guy who approaches marriage differently than my dad did, if they parent differently, then it doesn't have to take over my life. It wasn't until I got married that I had observed and absorbed enough alternative narratives of women crafting different paths for themselves that I realized, ‘Oh, you can just not do that! You can just not.’

This was all reinforced by the medical history on both sides of my family. My mom had C-sections and severe preeclampsia with my brother and me. Going back a generation, her mom had C-sections with three of her children. My dad's mother, who had 20 children, died of cervical cancer. I don't know the circumstances around how she had all her kids or whether I shouldn’t assume that not all of them were vaginal births, but she ultimately died of cervical cancer. So all that, and I have to give my life to my husband and my life to my kids? And I also might die? All of that is just so terrifying. Once I realized that not having children was a choice I could make, it was easy to say this is not something I'm willing to do.

The few times I went to a doctor, I realize now, in hindsight, that I was being gaslit by my clinicians. During my first marriage, I would talk about how scary childbirth is, and you can split yourself, poop on yourself, and get stabbed in the back with a needle—all these things have to happen to your body that are terrible. And that’s if it goes well! It could very much not go well. My ex-husband rightly said, ‘Well, you've been doing a bunch of googling, but you haven't actually talked to a doctor. We should just go to a doctor, and you can ask about these things.’

I was very explicit when I went into the doctor’s office. I shared what happened to my family members, that I know Black women are treated differently in the medical system, and that I’m really afraid. I wanted to understand how much of my family’s medical history could indicate that I am high risk in terms of my ability to have children healthily and how much of it is possibly google hysteria.

Both women doctors that I spoke to—one was a South Asian woman, and the other was a white woman—said that my family’s medical issues were a result of the times. It was the 1980s, the 70s, the 60s, the 50s. It was a very different time in our understanding of medical knowledge and birthing anatomy, and those sorts of things don't happen as they did back then. They said that based on my medical history, there's no reason to think I would be a high-risk person having birth. There was not really an acknowledgment of the fact that Black women are dying. And I know it’s happening. So what do you mean there isn't a risk when this is happening?

Unfortunately, my ex-husband and I came to very different conclusions about how we wanted children to show up in our lives. He very much wanted children, and I very much did not. This was a contributing factor to the end of my marriage. We went back and forth on this for years. I tried to negotiate it. I offered surrogacy and adoption as alternatives to me carrying a pregnancy—and those were not alternatives he was open to in any way. Having a partner who was unsupportive of my body and autonomy got me to a place where it didn’t seem like the relationship was going to work. It wasn’t just the medical professionals gaslighting me; it was also my husband. All of his efforts went toward trying to make me do something I didn’t want to do with my body.

The conversations with my husband and the doctors made me think that I was being neurotic and that I need to just get over this. But I still wanted to talk with moms about their experiences giving birth and being parents. I thought maybe that would make me feel better. I went full-on nerd on this. I interviewed 20 women in my general network who were willing to talk explicitly with me about their pregnancy, childbirth, and parenting experiences.

This didn’t make me feel better at all. These were women from all sorts of backgrounds and income levels. And it doesn't matter how much money you make; it doesn't even really matter what background you're coming from. Childbirth is a high-risk thing for a body to do. It’s even more high risk when you are a Black woman.

Two other things clinched it for me in terms of realizing that I am not crazy. Another family member needed an emergency hysterectomy after childbirth because she did not stop bleeding. She and I are close in age and have very similar backgrounds, even though we have very different economic situations. Then when Serena Williams, with all her money and prestige, couldn’t get clinicians to listen to her when she felt like something bad was happening. As an upper-middle-class Black woman, I will be less able to receive proper care if that happens.

It was further clear that the medical risk was far too high.