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Birth Equity for Black Families

Learn about birth equity, why it’s important and how to advocate for yourself during pregnancy and childbirth.


It’s Black Breastfeeding Week, so you know we’re going to dive into the topic of birth equity. That’s because breastfeeding is a racial equity issue. Black breastfeeding rates have historically been lower than white women’s, partially because of breastfeeding’s connection with systemic racism — both in its historical realities and current disparities.


To provide more support and combat these inequities, we want you to be able to understand birth equity, why it’s important, who is involved and how to receive the care you deserve. This is crucial information every Black woman needs to educate herself and make informed choices for her birth and her family.


What is Birth Equity?

The official definition of birth equity is “the assurance of the conditions of optimal births for all people, with a willingness to address racial and social inequalities in a sustained effort.” That’s a lot to take in! We like to think of it as equal shares — the same sized pieces of pie, the same amount of “birth bucks.”



Birth equity means everyone receives the same access, rights, coverage and care when giving birth, regardless of race, social standing, sexual preference or any other characteristic. Everyone deserves to be treated fairly, with dignity and respect.


As a birthing person, you are able to produce another human being. That makes you incredibly worthy. You have the right to be safe, informed and valued.


Why is Birth Equity Important for Black Mothers?

Unfortunately, it’s a reality we can’t ignore: Black moms and birthing individuals are not given equal treatment and care. We don’t receive a full or fair portion. Why? Because of prejudice and preconceived notions, biased personal beliefs and unfounded medical beliefs. For example, some doctors wrongly believe Black women have a higher pain tolerance, so when a Black woman says she is in pain, the doctor won’t respond to it the same way they would for a white woman.

These racial inequalities need to be discussed, and the root of the problem needs to be exposed. Pregnant Black women are not spoken about, taught or shown in medical books. Our experiences are not shared with the providers who care for us, yet our anatomy is the same, and our providers must meet our needs. We don’t have access to the same resources and information, which can cause us to not expect or ask for the same quality of care. Too often, this inequity leads to a difference in birth outcomes.


How does birth inequity show up in interactions? It can present in significant ways, but it also happens in small, intangible ways. Maybe your provider’s personality seems to change, or their level of support shifts. You may feel they are patronizing you or only acting like they’re affirming you. By your third trimester, perhaps you start to get pushback on what you want. Birthing people need to recognize and address these things so we can take back control for delivery day.


Key Players in Achieving Birth Equity

Many people impact birth equity, but it’s important to know that you have the power to make a difference in your pregnancy and birthing process.



As a birthing person, you set the stage for how you want health providers to interact with you. Be clear about your expectations, be proactive and have a plan that drives your appointments instead of letting them happen to you. Educate yourself so your provider can confirm what you already know. You need to be informed to ensure they’re telling you the whole truth.


You have a role in your birth outcome. This is absolutely not to put any blame or fault on anyone, but we need to recognize the role we play in birth equity. There are certain things that only you can do and information only you can know, so don’t give away your responsibility or control. Communicate what you’re feeling and resist shutting down.


Of course, doctors and nurses have important roles in creating an equitable birth experience. They must listen, be authentic, and answer questions fully. They need to do their job and provide the same level of care to everyone, no matter who they are. They have a responsibility to do no harm.


Policymakers, lawmakers and insurance providers also play a role. For better or worse, they influence who gets to be present in birthing, how nurses can interact with patients, how physicians are held accountable and more. Insurance companies can perpetuate racism against Black people. For instance, midwives aren’t always covered by insurance, but many Black women need them for the best birthing outcomes.


And finally, partners and family members can contribute to birth equity. They can validate how you feel and what you’re experiencing. They can play a clearly defined role by being actively present, participating in appointments and being invested in your outcome.


Tips for Self-Advocacy

Birth inequity can happen even if you give birth outside the hospital. For that reason, it’s essential to learn how to navigate the medical field and advocate for yourself and your child. Advocate for your rights, recognize when they aren’t upheld and speak up when you experience inequity. Here’s how to get started.


Educate yourself so you can be confident in your self-advocacy.

You are capable of understanding your body, caring for yourself and giving birth. Ask questions and use your voice. Remember, you have the right to question and the right to say no.


Build your support system.

Bring your partner or a supportive family member with you to appointments. Hire a doula for your pregnancy and birth. Working with a doula results in better birth outcomes for Black women, including a higher successful breastfeeding rate.


Keep notes.

Bring a small notebook with you and write down what the doctor or nurse is saying to hold them accountable. Repeat back what they said or ask them to repeat themselves. This gives them the opportunity to self-correct, which they often will once they know you’re keeping records. Your notes can also serve as a legally binding document.


Ask for it in writing.

Request the hospital policy or medication information in writing. Pay attention to how the doctor or nurse responds to your questions. . Know that if they change their stance, they’re not making an exception or doing a favor. It’s already a part of your care and a part of their job.


Know when to escalate.

If a provider says no to a request, you can ask them to make a note in your chart. But keep in mind that you may not want to be confrontational, especially while you remain in their care.


Birth advocacy raises birth equity — the two concepts go hand in hand. Through it all, you are a practicing patient, just like your provider is a practicing doctor. It’s a learning process, so be willing to do the work. We’re on your side.


Chicago Birthworks Collective is here to help you learn how to communicate with providers and set your own standards for birth equity. Reach out to determine which of our services would be the best fit to support you during your pregnancy.

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