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Birth and perinatal health disparities in communities of color are facts we know all too well. But we also know what to do to change this.

We know that midwifery care – nurtured and sustained with community birth center infrastructure – is the solution to a failing US birth care system. Midwives are healthcare professionals who provide expert care, support, and guidance during pregnancy, birth, postpartum, and throughout our reproductive lives. Birth centers are the only healthcare facilities designed to center the midwifery model of care, and access to birth centers is limited. Research shows that midwifery care improves birth outcomes, enhances the care experience, is cost effective, and reduces inequities. Yet, in the US, only 15% of birthing families have access to midwifery care.

It is estimated that 60% of US pregnancies are low-risk and could be safely supported by midwives. In countries with better birth outcomes than the US, like France, the United Kingdom, the Netherlands, and Japan, 75% of pregnancies are supported by midwives.

“Today’s lack of access to midwifery and to community birth in the U.S. is rooted in racism. At the turn of the 20th century, midwives attended the births of half of all the babies born in the US. Most Black midwives (known as ‘Grannies’ or ‘Granny-midwives’ in the South) received their training through apprenticeships. In many areas of the country, physicians working in hospitals largely displaced midwives, as women were told that hospital births were more ‘modern’ and ‘advanced.”

“National legislation played a large role in the decline of mid-wifery:
The Sheppard-Towner Act of 1921 supported prenatal and children’s health centers. The act established public health nurse supervision, training and oversight of traditional midwives, which discouraged the practice of midwifery, particularly Black midwifery. Biased views held that the midwives were too uneducated and unclean and too involved with cultural practices to provide optimal maternity care.
While midwifery practice and community standing declined among all mid-wives, Sheppard-Towner especially targeted Black midwives.”

“The effects were severe. For example, in 1920, there were 5,000 Black midwives in Georgia alone, but by 2002, the state had just 15 practicing Black midwives; and in 2020, seven percent of midwives certified by the American Midwifery Certification Board identified as Black or African American, in contrast to 16 percent of childbearing women. By the 1930s and 1940s, primarily affluent white male physicians with standardized curricula, formal credentials, authority to self-regulate, and hospital-based practice came to predominate as maternity care providers.”

“Indigenous midwives have also faced a pattern of racialized barriers to practice. Over the course of a century and in the name of ‘safety’, state and federal legislation has forced Indigenous midwives to assimilate into the predominant under-resourced and underperforming medical system. Indigenous midwives and their longstanding traditions as well as the communities they serve have been adversely affected.
Many Indigenous people now live in communities designated as workforce shortage areas.”

*Excerpts from “How Racism Undermined Midwifery”, Improving Our Maternity Care Now Through Community Birth Settings Report, 2022.

Because birth centers are based in the midwifery model of care, they lessen rates of preterm birth and low-birth weight, reduce cesarean usage, improve breastfeeding rates, lower health care system costs, and ensure families feel seen and heard and have a foundation on which to raise healthy thriving children.

Moreover, birth centers led by Black, Indigenous, people of color are:

• A key solution to reversing the perinatal health crisis by providing safe and culturally reverent care in communities of color
• A crucial part of a vibrant health care system.
• Vital infrastructure to increase access to midwifery education, training, and practice by Black, Indigenous, people of color, which strengthens the field overall.
• Community institutions that create healing for generations.

Our country’s history of racially unjust wealth distribution means people of color lack access to the capital needed to start birth centers in their communities. More than 80 percent of birth centers are for-profit entities that were started through owners’ personal savings, loans, or family gifts. (Source: American Association of Birth Centers). In 2020, when BCE began, we discovered that no data was collected regarding the number of birth centers led by people or color – so we collected the data ourselves. In 2020, an estimated 5 percent of birth centers were led by people of color. While BCE is proud to have been part of growing this proportion to 7 percent in 2024,these data make clear that the need for birth centers in communities of color far outstrips the availability.

Racial inequity is a major barrier to community birth center access. This is why BCE specifically focuses on birth centers led by (not just serving) Black, Indigenous, people of color, to address the structural inequities in access to midwifery education and access to the capital to finance birth centers. With a midwifery workforce that is 95% white, Black, Indigenous, and Person of Color-led birth centers provide vital infrastructure for the education, training, and practice for midwives and birth workers of color.

At a time when disparities in birth and perinatal care persist in communities of color, and an increasing number of perinatal clinics and labor and delivery hospitals close, access to community-based midwifery care is more important than ever. Community birth centers led by Black, Indigenous, people of color are answering this call, organizing to meet community needs for safe, high-quality, culturally-reverent prenatal, postpartum and birth care.

Our health-care system was not designed with equity at the center—in fact, it was originally designed to the full exclusion of Black, Indigenous, people of color. By contrast, community birth centers are designed to reflect the stories and dreams that the larger health system has ignored, and heal the frustrations and traumas of people and families who have not been centered in the design of health-care spaces.

Using evidence-based models of care and trained professionals, we can increase safe birth options for all our children and grandchildren. Today’s babies—and tomorrow’s generations—cannot wait.