Why Survival Is Not Enough: Black Maternal Health and Dignified Care

Before the numbers, there are names.

Before the reports, there are bodies.

Before the statistics, there are stories that live in the nervous system long after the charts are closed.

This is one of those stories.

And it is not mine alone.

The statistics on Black maternal health have been telling the same story for decades. As far back as 1985, Black women were documented as being three times more likely to die from pregnancy related causes than White women. While multiple factors are often cited to explain these disparities, the numbers alone fail to capture the lived realities behind them.

In Georgia, from 2020 to 2022, the leading causes of pregnancy related deaths included cardiovascular conditions such as cardiomyopathy, hypertensive disorders, and cerebrovascular accidents, along with COVID 19, maternal health conditions, hemorrhage, and embolism. In 2022 alone, mental health conditions became the leading cause of pregnancy related deaths. Postpartum is a period marked by intense hormonal shifts, and mental health disruptions can escalate quickly. Postpartum depression can arrive unexpectedly and with devastating force.

Many of these deaths were linked to suicide, overdose or poisoning related to substance use disorders, and other causes identified by the Maternal Mortality Review Committee. These women lost their lives while battling mental health challenges that were often unseen, untreated, or dismissed. Black women are frequently ignored or silenced when we attempt to raise concerns about our health.

In Georgia in 2021, Black women accounted for 57 percent of pregnancy related deaths despite having 41,752 births. White women, in comparison, accounted for 25 percent of deaths while having 53,685 live births. These statistics reveal more than disparity. They reveal a system that continues to fail Black women even as research and awareness increase. Without continued education, community advocacy, and representation within healthcare, these outcomes will persist.

Beyond the numbers, Black women’s lived experiences reveal truths that data alone cannot capture. What was once joked about by many Black women, the fear of having children in certain states, has become a lived reality. Pregnancy in states like Georgia, Texas, and Florida often feels less like a journey toward life and more like a negotiation for survival.

One Black woman who was pregnant during the COVID 19 pandemic described her experience as fearful rather than empowering. She feared not being heard. She feared losing her life or her baby. She feared the reality of birthing while Black. During her first pregnancy in Northern California, she received care at a small regional hospital with a comprehensive birthing team that included doctors, midwives, nutritionists, and home health nurses. She described the environment as welcoming, open, and safe.

Five years later, during her second pregnancy, she struggled to find anything comparable. She wanted a Black provider and discovered there were only two Black midwives in the entire Dallas Fort Worth metroplex. After an unsuccessful attempt with a provider within her insurance network, she eventually found a birthing center dedicated to serving Black women, though it was owned by a White woman. Despite initial hesitation, she scheduled a visit.

The owner listened to her fears and validated them, sharing her own decision to open the center after losing her best friend and witnessing the harsh maternal realities facing Black women in Texas. For a moment, the woman’s fear eased. Eleven weeks later, she experienced a prolonged coughing episode followed by light pink bleeding. Her provider suspected a pregnancy induced blood clot and sent her to the emergency room.

There, she was ignored, disrespected, and belittled. Despite her symptoms and her provider’s concerns, the emergency physician discouraged a CT scan and repeatedly referred to her husband as her boyfriend, even after being corrected. She insisted on further testing. The scan revealed a pea sized blood clot in her lungs. Her pregnancy immediately became high risk, and her dream of delivering at a birthing center was lost. This early experience set the tone for the rest of her pregnancy. Her story mirrors the experiences of countless Black women navigating pregnancy in America.

Medical dismissal and implicit bias appear when pain is minimized, symptoms are questioned, and concerns are delayed until they become emergencies. They show up when Black women are not believed the first time, when providers assume exaggeration or emotional instability instead of listening. These moments, often subtle, can have life threatening consequences.

The emotional and mental health realities Black mothers carry are not rooted in a lack of resilience, but in the quiet emotional labor they are expected to shoulder without acknowledgment. Black women become hyper vigilant in spaces meant to be safe. They carry the weight of not being believed, fear without permission to express it, postpartum isolation disguised as independence, and joy layered with grief. Intergenerational memory lives in the body. Depression and anxiety do not always look textbook. There is guilt for needing help and not receiving it, pressure to protect everyone else’s feelings, and healing that happens quietly, slowly, and often alone.

Black mothers are not resilient because they are unhurt. They are resilient because they survive pain that systems refuse to see.

Historical and generational experiences with the medical system continue to shape how Black women seek care today. Legacies of experimentation, dismissal, and harm influence guarded trust, delayed care seeking, and the need to over prepare for appointments. What is often misinterpreted as distrust is, in reality, learned self-protection.

Advocating for oneself during childbirth can feel like an act of defiance. Standing up for one’s body and voice during one of the most vulnerable moments requires strength that should never be demanded. Advocacy should not come at the cost of exhaustion, vigilance, or emotional armor.

Survival alone is not enough. Living through childbirth does not mean living without trauma. For many Black women, survival means downplaying pain to avoid stereotypes, protecting providers instead of their own bodies, being touched without consent, and being spoken over or dismissed. Dignified, affirming maternal care means being believed the first time, receiving informed and unrushed consent, having emotional safety treated as clinical care, and receiving postpartum support that does not disappear.

The responsibility to do better belongs to all of us. It requires staying informed by listening to Black women describe their pregnancies, births, and postpartum experiences. It requires rejecting survival as the benchmark of success and understanding that dignity is the standard.

Listening to Black women’s stories is not passive. It is a form of intervention and accountability. Lived experience can function as an early warning system, preventing harm before it escalates. Stories can inform training, reshape clinical practice, and ground community-based interventions. Research that treats lived experience as expertise creates pathways toward repair.

Healthcare systems must measure respect, not just outcomes, and respond to harm with repair rather than defensiveness. Providers must listen without dismissal, interrupt bias in real time, and accept correction without ego. Researchers and policymakers must center Black voices as expertise and fund community led solutions. Communities and families must protect space for truth telling and refuse silence when harm occurs.

Each of us must carry these stories with care rather than consumption and demand systems worthy of Black life.

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