Why are so many Black women’s birthing experiences traumatic? How is the myth of the “strong Black woman” hurting Black pregnant women? Why does stigma around breastfeeding and postpartum depression exist? Why do things have to reach a crisis point before someone offers a solution? During Black Maternal Health Week, these are some of the questions that advocates are posing as they work toward solutions every day.

The Black Mamas Matter Alliance formed in 2013 to address the obstacles that Southern Black women face in accessing maternal health care, leading to poor maternal health outcomes and persistent racial disparities. This is what led to the creation of Black Maternal Health Week, which takes place every year from April 11-17. The week is intended to deepen the conversation around Black maternal health, amplify community-driven solutions, center Black mamas, and provide a platform for Black-led organizations focused on maternal health, birth, and reproductive justice.

The most alarming statistics surrounding maternal health have endured for decades: Black women experience the highest maternal mortality rates, meaning deaths caused or aggravated by pregnancy. In Louisiana, which has the highest rate in the country, 59% of Black maternal deaths were preventable. It is equally dangerous for Black women to give birth in Georgia, which has the second highest maternal mortality rate in the U.S. Broadly, 40% of deaths from pregnancy-related complications were preventable through improved quality of medical care. 

Birth workers and community advocates who spoke to Prism said they began to focus on maternal health not just out of care and concern for their communities, but because of their own maternal health experiences. For Kristin Mejia, founder of Nashville, Tennessee’s Homeland Heart Birth & Wellness Collective, it was the unpleasantness of her pregnancy and the realization that her uneventful birthing experience was rare. For Kay Matthews, founder of Houston, Texas’ Shades of Blue Project, it was the postpartum depression she experienced after giving birth to her daughter, who was stillborn.

‘What the hell is happening to Black women who give birth?’

Mejia never wanted to have children. As her friends became mothers, she saw the toll that it took and she decided it wasn’t for her. But then in 2014 she got pregnant while on birth control, and it was “devastating,” she said. At the time, she identified as “very, very pro-life,” so accessing abortion care wasn’t something she would allow herself to do.

“The day I found out I was pregnant, I had just sent out a bunch of applications for grad school. I spent weeks crying,” Mejia said. “What made it worse was that my pregnancy with my son was horrific. I found out I was pregnant at five weeks and basically from six weeks to week 36, I was sick. I had motion sickness, standing up sickness, sitting down sickness, work sickness, middle of the night sickness. I was just sick all the time. I wanted it to be over, not to hold my baby, but because I didn’t want a body inside of my body anymore.”

But giving birth was an “overwhelmingly enjoyable” experience. Mejia had insurance and researched doctors before handpicking hers. She credits her mom, who is a doctor, with helping her to feel empowered to make these decisions. In retrospect, Mejia said, she realized her experience was privileged.

After returning from the hospital and settling into her new life with her newborn, Mejia joined a number of parenting Facebook pages. She says she can still vividly remember scrolling through her feed and seeing posts about “birth assault,” the “hidden epidemic” of “obstetric violence.” This was 2014, a few years before there would be a spate of reporting on the subject, most of which was focused on white women. She also joined a Black women’s breastfeeding support group on Facebook. While she had no issues breastfeeding her son, the Facebook group made Meija realize the ease with which she fed her baby was rare. It wasn’t that lactation counselors weren’t doing their jobs, it was that Black women weren’t even being offered this support.

“I’d read all of this stuff online and just think, ‘What the hell is happening to Black women who give birth?’ I realized how lucky my experience was,” Mejia said.

Black women have the lowest breastfeeding initiation rates (about 64%) and the shortest breastfeeding duration (roughly 6.5 weeks) of all ethnic groups, TheWashington Post reported, and according to the Centers for Disease Control and Prevention, Black women struggle to breastfeed successfully because they return earlier to work, receive less information about breastfeeding from their health care providers, and have less access to professional support.

‘This is my heart work’

Mejia’s journey as a birthworker started with exBreastYourself, a small business she formed that provided pop-up tents at public events where moms can breastfeed, and that advocates for breastfeeding women who’ve been thrown out of public places. Mejia became a doula in part because of support from her obstetrician, with whom she developed a strong relationship. One day when her son was six months old, Mejia dropped him off at the babysitter. As she drove to work, she thought about veering into oncoming traffic. She called her obstetrician in a panic, not knowing who else to turn to. That’s how she learned that she was experiencing postpartum depression.

“I had the support of my husband and my mom and I still felt like I was drowning. That’s why there is a hole in my heart for women who [are] postpartum, especially if they don’t have any support. There’s no way to plan for it or to know how hard it will be,” Mejia said.

Mejia was able to get the care she needed while also taking a job as her obstetrician’s nanny, which introduced Mejia to some of the birthwork that was happening in their area, eventually setting the stage for her to become a breastfeeding peer counselor and a doula. But it wasn’t until 2017 when she was pregnant with her daughter that she formed Homeland Heart Birth & Wellness Collective, partly because she didn’t know of any other Black doulas in the Nashville area. Three years later, Mejia has brought together a small but mighty cohort that offers community-based doula training. Homeland Heart Birth & Wellness Collective is also piloting a program that will provide 50 Nashville families with a complete birth team, including a birth doula, postpartum doula, and breastfeeding peer counselor. The service is free to local families and the doulas are unpaid volunteers. The funding for the program comes entirely from community members and partners.

“It’s not until a person has a miserable birthing experience that people say, ‘Why didn’t you get a doula?’ It’s not until someone is drowning in postpartum depression that people say, ‘Why didn’t you get a postpartum doula?’ You’ve heard it takes a village? It really takes a village to help someone have a baby and a lot of times people don’t even know the resources they could have because no one told them they existed,” Mejia said. “This is my heart work. I don’t give a fuck if someone can pay me. I just want to help Black women survive and I want to see the community thrive.”

‘We need to talk about mental health’

Kay Mathews similarly has a deep and abiding love for her Houston community, and the certified Community Health Worker has invested tremendous resources to ensure that Black women in particular have what they need to navigate motherhood. Mathews’ BabyCakes & Brunch program provides diapers, wipes, and formula to moms in need. The program also has a community days schedule that includes mini group sessions about maternal mental health. Her organization, Shades of Blue, focuses exclusively on maternal mental health awareness. It is healing work for Mathews, who came into the field after the loss of her child.

“I delivered my daughter stillborn and that was obviously not the outcome I was hoping for. Afterwards, I experienced postpartum depression, but everyone kept telling me it was grief. The main focus was on the loss; not on me,” Mathews said. “I knew something was wrong.”

Nationally, postpartum depression affects 1 in 7 mothers and medical guidelines recommend counseling for all women experiencing postpartum depression. But what if postpartum depression doesn’t get diagnosed in the first place? This is the situation facing many Black women, who are several times more likely to suffer from postpartum mental illness but less likely to get diagnosed or receive treatment, NPR reported. The consequences of untreated postpartum depression can be deadly. A report from nine maternal mortality review committees in the United States found that mental health problems, ranging from depression to substance dependency or trauma, went unidentified in many cases and were a contributing factor in pregnancy-related deaths. Deaths of new mothers by suicide have also been reported.

Because Mathews’ birth story included a loss, and because she was a Black woman seeking help, she largely felt invisible in groups intended to address postpartum depression. So she decided to create something herself, something that was inclusive and operated from the understanding that everyone’s birth story is different.

“Stigma exists because a lot of the time, white women are only offered resources or only seen as struggling with postpartum depression and are given the space to talk about it. I decided to be at the front of this organization because by existing as a Black woman who has experienced this and by telling my story, I’m already combating stigma,” Mathews said.

If she could offer any advice to people working in maternal health, Mathews said it would be not to minimize and dismiss the mental health issues experienced by Black women after they’ve given birth. The “strong Black woman” myth has done “incredible harm,” Shades of Blue’s founder said. This Black Maternal Health Week, she wants to uplift mental health and let Black women know that weeks of anxiety and depression after giving birth aren’t a “normal part” of the process.

“When we talk about Black maternal health, we need to be talking about mental health. It needs to be at the top of the list. If we only address what is happening to Black women and not what Black women feel about what is happening to them, we are not involving the woman in what is happening to her,” Mathews said. “We cannot fight the battle for Black women instead of with Black women. Black women do experience mental health complications and forcing them to struggle in silence is deadly.”

Tina Vásquez is the editor-at-large at Prism. She covers gender justice, workers' rights, and immigration. Follow her on Twitter @TheTinaVasquez.