April 11-17th is Black Maternal Health Week, and this year’s theme emphasizes the power of Black-led perinatal, maternal, and reproductive health organizations to drive systemic change and foster community healing. To further that mission, Motherly spoke to Dr. Ndidiamaka Amutah-Onukagha, the Julia A. Okoro Professor of Black Maternal Health at Tufts University School of Medicine, where she also serves as the Assistant Dean for Diversity, Equity, and Inclusion. She is the founder and director of the Center for Black Maternal Health and Reproductive Justice, one of the first research centers of its kind in the U.S. A nationally recognized scholar and advocate, her work focuses on eliminating racial disparities in maternal health through research, education, policy change, and community-driven solutions. She is also a proud Black mother working to ensure that every birthing person is seen, heard, and survives.
As told to Liz Tenety
When people ask why Black mothers and babies are dying at higher rates, I want to be really clear: this isn’t just about poverty or education or where you live. It’s about racism—systemic, embedded racism that exists in both the public health system and the OB/GYN field.
These systems overlap, and both are deeply flawed.
In medical education, students are taught things—sometimes explicitly, sometimes implicitly—that are completely false and racist. That Black people have thicker skin. That we feel less pain. That we’re biologically different. I teach in the School of Medicine, and we are actively working to dismantle these stereotypes. But they’re still there.
Related: What Black mothers-to-be need to know before giving birth
Even the tools providers use have baked-in bias. Until recently, there was a VBAC algorithm—used to decide whether someone who had a previous C-section could have a vaginal birth—and it lowered your score just for being Black or Brown. That meant doctors were telling patients, “I’m sorry, you can’t deliver vaginally,” not because of their body, but because of their race.
No one should be denied the ability to labor vaginally because of their race.
These kinds of biases don’t always look dramatic. Sometimes it’s a delay. “Let’s just wait and see” when someone is clearly hemorrhaging. Bleeding through pads. Passing blood clots the size of golf balls. These are life-threatening emergencies.
We don’t have the luxury of delay in labor and delivery. Every minute counts. Birth is a litmus test—of your body, of the hospital, of the system. And what we see, over and over, is that Black birthing people are not prioritized.
There is nothing biologically different about Black bodies. What’s different is how we are seen—and how we are not seen.
“We’re retraining the system from the inside.”
This is why I love teaching medical students. They’re still open. There’s a curiosity there, a real desire to help. People who’ve been practicing for 10, 20, 30 years—who’ve seen a lot of trauma—can be harder to reach. But we work with both.
For students, we created an anti-racism curriculum. It’s a series of case studies, workshops, and scenarios where we ask: what happens when racism shows up in clinical care, and what do you do about it? We talk about what it’s like to be a provider of color—having “Dr.” on your coat and still being mistaken for someone there to take out the trash. That’s a real experience, every day.
We also have an anti-racism task force. We have infrastructure to support students while they’re with us.
Once they graduate, we continue the work inside hospitals. We’re developing maternal safety bundles—clinical tools that save lives when implemented properly. They’re built by the Alliance for Innovation on Maternal Health. We’re working with Massachusetts hospitals to roll out:
A racial equity bundle
A maternal hemorrhage bundle
A maternal hypertension bundle
All built to make it easier for providers to respond to the needs of Black women and babies and save more lives.
We train OBs, nurses, fellows, residents—entire teams. But to make this sustainable, we also need leadership buy-in. Otherwise, it’s just another one-off training. That’s why we’re also expanding to health centers and federally qualified health centers (FQHCs), because OBs in those spaces are still delivering at hospitals. We want to saturate the whole system.
The bigger picture? We are actively dismantling the racist training that shaped so many providers—and replacing it with something better. Something humane. Something equitable.
We ask: How do you reframe how you see your patients? What assumptions do you need to unlearn?
Because ultimately, everyone wants the same outcome: that both the mother and baby go home healthy. Together.
For Black mothers
I want to say to any Black mother reading this: I’m also a Black mother. I’ve experienced the system.
There’s no amount of education, no amount of insurance, or money that’s going to buffer you from a racist encounter in healthcare. But there are tools we can use when we go to deliver, or when we choose where to get our care.
We are consumers—we are the customer base of healthcare. If you’re not being treated well, you find a new clinician. You document it. Every hospital has a Patient Safety Board, a patient safety phone number. You use it.
You can switch providers even the week before you deliver. If it doesn’t feel right in your spirit, you find somebody else.
I also believe in taking people with you—partners, friends, whoever your support is. Ask: Are you hearing what I’m hearing? Are we asking the right questions?
There’s a vigilance to this process. Black and Brown women don’t get the luxury of walking in and assuming we’ll get the quality care we deserve. We have to be strategic and clear about what we need.
The third thing I say: you need a doula or a midwife on your care team. Doulas are trained birthing professionals. I’ve had three doulas for my three births. If I have ten more kids, I’ll have ten more doulas. They are part of the team. They are in the room. They are watching how you’re being treated, watching your blood pressure, rubbing your back, and providing comfort. They’re amazing.
A lot of states now reimburse doulas. Here in Massachusetts, we worked hard to make that happen. My center helped pass the Momnibus bill in August 2024, which got doulas registered as MassHealth providers and eligible for equitable wages.
Every state has doulas. There’s a doula registry. There’s DONA International. There’s the National Black Doula Association. If you can’t find a doula, look for a midwife—either a CPM for home or birth center, or a CNM if you’re delivering in a hospital.
Those are the three things I tell people:
- Go in with support.
- If you feel mistreatment—document it, report it, and find someone new.
- Have a doula or midwife on your team.
You are the expert of your own body
I remember being pregnant when the Lost Mothers ProPublica series came out. It rocked me to my core. I’ve had friends die from complications—as teenagers and as adults—who should still be here raising their kids. We lost them because they didn’t get the care they deserved.
Giving birth in the U.S. is dangerous for Black and Brown women. Our international rankings are terrible. Last I checked, we were 50th globally. It’s not getting better. But there are good providers out there. Our job is to find them.
We don’t get to walk into just any hospital. We have to be informed. That’s why tools like the Irth App— a Yelp-like platform for hospital and provider reviews—are so important.
To any mom reading this: Congratulations. Pregnancy is beautiful. I wish I was pregnant every day. I’ve had three beautiful pregnancies. I love the process—the ultrasounds, everything.
Trust your instincts. You’ll know when you’re getting the care you deserve. And you’ll know when you’re not.
Lean into your network—your family, your church, your sorority, your community. Ask: Where did you deliver? Did you have a doula? What was it like?
Whether it’s your first baby or your fifth, there’s always more to learn. Motherhood is not a destination—it’s a journey. You keep going. You keep learning. You be very clear about what you need to be healthy and safe in that space.
What allies can do
I think allies are incredible.
Whenever we host events—like our conference last weekend—we get people saying, “We love this work. How can we support?” And I always say: use your allyship to make noise.
That might mean helping us fundraise. All of this work costs money. I run a research lab with 35 students—future lawyers, nurses, social workers. These students are doing groundbreaking work in Black maternal health. They’re entering grad programs with a reproductive justice framework already built in.
I want to keep them in this field. But to do that, I have to pay them. Stipending those students each semester costs $75,000. That money goes directly to supporting the next generation.
So use your allyship to help raise those funds. Call your friends. Call in favors. Make the connections. Because this is a maternal health crisis. And we need everyone at the table.
This can’t just fall on the backs of Black and Brown women. It can’t only be the responsibility of people inside the medical system. There’s also a place in this movement for our allies.
Sometimes it’s about the message—but often, it’s also about the messenger. And when those two are in alignment, change happens.
We need that support. We need that allyship. That camaraderie. That motherhood. That sisterhood.There’s an understanding that we’re in this together. And the crisis is big enough that every single one of us has a role to play.
Related: 6 ways Black mothers can prioritize their mental health