The History of Black Maternal Mortality in America

Black maternal mortality did not begin with modern healthcare disparities. Its roots stretch back centuries, embedded in the earliest structures of American medicine.

Slavery and the Exploitation of Black Women’s Bodies

During slavery, Black women’s reproductive labor was economically exploited. Enslaved women were forced to bear children who would also become property. Their bodies were treated as assets, not as patients deserving care. Medical experimentation was often conducted without consent or anesthesia, reinforcing harmful myths that Black women felt less pain or were inherently stronger.

These false beliefs did not disappear with emancipation. They became embedded in medical culture.

Reconstruction, Segregation, and Unequal Access

Following the Civil War, the United States experienced rapid urbanization. Advancements in medicine — including germ theory and aseptic techniques — dramatically reduced maternal deaths overall. Hospitals increasingly replaced home births as the preferred setting for delivery.

But access to these safer environments was not equal.

Before the Civil Rights Movement, hospitals serving Black patients generally fell into three categories: segregated institutions, Black-controlled hospitals, or facilities determined by local demographics.

In 1891, Provident Hospital became the first Black-controlled hospital in the United States. The following year, the Tuskegee Institute and Nurse Training School opened, becoming the first of its kind in the South. These institutions were groundbreaking, training Black physicians and nurses while serving Black communities that were often denied care elsewhere.

Still, systemic underfunding and segregation limited access to high-quality maternal care. The racial gap in maternal outcomes was already visible more than a century ago.

The Legacy of Black Midwives

While formal institutions excluded Black families, community midwives became essential pillars of care.

One extraordinary example is Margaret Charles Smith, affectionately known as “Miss Margaret.” Practicing in rural Alabama, she delivered babies for over three decades without a single maternal death. Working with limited resources, she relied on deep community trust, skill, and attentive care.

Even after Alabama outlawed traditional midwifery in 1976, her legacy endured. Her life story, Listen to Me Good: The Life Story of an Alabama Midwife, preserves her wisdom and impact. In 2010, she was inducted into the Alabama Women’s Hall of Fame.

Her work reminds us that culturally grounded, relationship-centered care has long saved lives — even when systems failed.

History Is Not the Past — It Is the Foundation

From slavery to segregation to the decline of community midwifery, structural inequities shaped maternal healthcare in America. The disparities we see today did not emerge suddenly; they were built over generations.

Understanding this history is essential. Without acknowledging how bias, exclusion, and unequal access were woven into medical institutions, we cannot fully grasp why maternal mortality disparities persist.