The Dangerous Gaps In Black Maternal Care

Motherhood is hard for everyone. It stretches you, reshapes you, and asks more of you than you thought you had to give. But for Black mothers, there is an added layer that is rarely named in the glossy images of celebration. Anti-Black racism weaves itself into the experience, introducing a level of stress that touches everything. From how you move through pregnancy, to how you are treated in healthcare spaces, to whether you and your baby make it through safely. Being alive becomes the win.

Many Black mothers know that joy and fear can live in the same body. That while you are preparing to bring life into the world, you are also navigating a system that has not always protected you.

For me, and for so many of the women I speak to through the Black Women’s Institute for Health, pregnancy is not just a medical experience. It is emotional, political and deeply personal. It is shaped by how we are seen, how we are heard, and, too often, how we are dismissed.

We recently completed the first national survey on Black women’s health in Canada, called Voices Unheard. What we found was both affirming and deeply unsettling. While most Black women reported having access to care, the majority also shared that they did not feel heard, and many felt dismissed. And sometimes, that dismissal is not subtle.“I felt like I wasn’t being listened to when I said something was wrong,” one participant shared. Another reflected the long-term impact of that experience, saying, “I delay going to the doctor because I don’t trust that I will be taken seriously.”  That tension does not disappear during pregnancy. If anything, it becomes sharper. Because pregnancy requires trust. It requires surrender. It asks you to place your body, your baby, your future, into someone else’s hands.

What happens when that trust feels fragile?

“Chronic stress from persistent anti-Black racism results in ‘weathering’ and development of chronic medical conditions like hypertension and diabetes. In pregnancy, this can increase the risk of pre-eclampsia, preterm births, low birth weight, mental illness and maternal morbidity,” says Dr. Modupe Tunde Byass, obstetrician-gynecologist and maternal health expert. “Being in a psychologically and emotionally safe environment reduces the stress, provides support and creates maternal joy, which is unquantifiable.”

There is growing research that shows what many Black women already know in their bodies: stress is not just emotional, it is physiological. The constant negotiation of being understood, believed, and taken seriously can shape how we move through care. It can shape how our bodies respond. It can shape outcomes.

But Black mothers are not passive in this. We adapt. We prepare. We advocate, even when we are tired.

We come into appointments with questions written down, sometimes rehearsed in our heads. We bring partners, friends, doulas, and anyone who can help hold the weight of being heard. We research, we cross-check, and we learn the language of the system so we can navigate it more safely.

The move toward midwives

And increasingly, many are turning toward care models that feel more aligned, more human, more rooted in relationship. For many Black families, midwifery care has become one of those spaces.

There is something powerful about being known by the person supporting your pregnancy. About not having to explain yourself from the beginning at every appointment. About being seen as a whole person, not just a chart, not just a risk category.

Althea Jones, Registered Midwife and Founder of Ancestral Hands Midwives, sees this shift clearly.“Right now, Black-led models are often treated as pilot projects or ‘nice to have’ additions, rather than essential components of the healthcare system,” she explains. “If we know these models improve trust, experience, and outcomes, then they should be funded and integrated accordingly.” Her work sits at the intersection of care and community, and she is clear about why families are seeking something different.

“When I started Ancestral Hands, I was responding to community needs that are not always validated in formal systems,” she says. “That disconnect can make you question whether you need to shrink your vision or translate it into something more acceptable. My experience has been the opposite. The clarity of your purpose is your strength.”What she describes is not just a preference for midwifery. It is a response to a gap in trust, time and Black women being seen.

Midwives often provide longer appointments, continuity of care, and a relational approach that centres emotional safety alongside physical health. For Black mothers, that can mean the difference between feeling like you are surviving your pregnancy and actually experiencing moments of peace within it. This isn’t specific to alternative types of care. This is needed in traditional care settings as well.

The support Black mothers deserve

“Supportive care means having more time during prenatal visits to address concerns, share stories. This would be a dream come true for healthcare providers; unfortunately, the healthcare system is not built to support this model of care,” says Dr. Tunde Byass. “Having race concordant providers help, however, this is not always possible; therefore, high-quality non-race concordant care rooted in mutual respect, non-judgmental, anti racist care can achieve safety, ensure equitable care and the feeling of being heard.”

But Jones is also clear that this work cannot survive on passion alone. “This work requires more than passion; it requires infrastructure, partnerships, and a clear articulation of your model and impact,” she says. “You cannot transform what you refuse to resource.” And that is where the conversation must shift because the burden cannot remain on Black mothers to navigate around gaps in care. The system itself must evolve.

What can families do right now within a system that still has gaps?

• Start with your voice. Your questions are valid. Your concerns are valid. If something does not feel right, you are allowed to say so.
• Build your circle early. Whether that is a midwife, a doula, a supportive physician, or a trusted friend, do not walk this journey alone if you can help it.
• Ask direct questions in your appointments. What are my options? What are the risks? What happens if we wait? What happens if we act now? You deserve clarity.
• Pay attention to how you feel in the room. Not just physically, but emotionally. Do you feel rushed? Do you feel heard? Do you feel respected? Those things matter more than we have been taught to believe.
• And perhaps most importantly, know that if something feels off, you are allowed to seek a second opinion. That is not disloyal. That is care.

What needs to change?

There is also a broader truth we cannot ignore. The burden should not be on Black mothers to navigate around gaps in the system. The system must change, and the people involved must be accountable to the women they serve.

Because when Black women are safe, heard and cared for with intention, entire families benefit. Children enter the world held, not just by their parents, but by systems that honour their lives from the very beginning.

Until then, Black mothers will continue to do what we have always done.

We will find each other.

We will share knowledge.

We will build care where it does not exist.

And in doing so, we are not just surviving pregnancy. We are reshaping what care can look like for the generations coming after us.