Black women in the United States are three to five times more likely to die from pregnancy or postpartum issues than white women—a maternal mortality crisis that cannot be ignored. In Glamour’s Black Maternal Health series, we’re sharing these stories—and solutions.

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One week after my 32nd birthday the hot flashes began. In 2.5 seconds my body went from New York City in fall to a Thailand summer, whether it was in the middle of the night, middle of the morning, midday, mid-work break. The sweats were relentless.

Two weeks, one doctor’s appointment, and more than a hundred Google searches later, my doctor put a name to this sudden inferno: early perimenopause. A short time after that, the financial coordinator at New York University’s Fertility Clinic let me in on something. If I wanted to retrieve the good eggs I had left to increase my chances of having a baby down the line, it would cost me—cash up front—much more than I had to give.

My reproductive rights story doesn’t involve limited access to birth control or an abortion. It involves being told just two years after turning 30 that my path to motherhood could be forever thwarted, and I, a journalist with employer-sponsored insurance making just enough money at the time to cover my monthly expenses, could not afford to do anything about it.

The tears I cried over this realization are just a few in a sea of fallen tears from women. And Black women, I among them, understand that the current framework for reproductive justice must address the various ways in which systemic structures prevent women of color from achieving reproductive freedom.

“The harms that were created through white supremacy, the harms that were created through patriarchy—they came from the White House,” says Joia Crear-Perry, M.D., president of the National Birth Equity Collaborative. “So we’re saying if you created those harms from the White House, you need to undo them from the White House.”

Crear-Perry is one of several Black women pushing for the creation of a White House Office of Sexual and Reproductive Health and Well-Being (OSRHW) to be considered under the Domestic Policy Council. 

As she said to me on a video call last week, the federal government has for hundreds of years “operationalized eugenics, has operationalized believing that one race was more valuable than another.” And so her goal for this office is to ensure that women like myself have a path to motherhood and sexual well-being by disrupting the barriers that now exist due to race and class.

She’s not alone. More than 150 organizations have signed on to push for OSRHW. They include institutions whose core work focuses on a range of issues from Black breastfeeding to abortion. Collaboratively, they are urging the Biden administration to guarantee that women, in short, have access. 

“The matter of reproductive justice is so important because what we’re talking about is wanting to create some parity where everyone gets what they need, not based on their capacity to pay, or if they’re lucky enough to work at an insurer,” says Monica R. McLemore, Ph.D., an associate professor at the University of California, San Francisco. “This is a bigger discussion that takes out the polarization and elevates it to a larger discussion about what people need and deserve across their reproductive life course that will allow them to optimize who they are.”

McLemore has been working side by side with Crear-Perry to highlight the importance of equity in the larger conversation of gender policy and reproductive rights. For these Black women, it is about centering the margins, being unafraid to speak about racial injustice, and saying full-throated that ending racism includes addressing the ways in which BIPOC women are restricted in their maternal pursuits.

If you’re feeling pressured into a treatment decision or don’t quite understand what the physician is asking you to agree to, ask whether there’s an alternative course of treatment and what the risks of that course of treatment are. 

When the situation is slightly more urgent, “part of the discussion needs to be, ‘How quickly do I need to make this decision? How urgent is this? What are the risks to myself and what are the risks of the pregnancy if I need to take an hour to think about this?’” says Dr. McDonald-Mosley. 

Know that you can change doctors.

“There is no rule that says any birthing human has to remain in the care of a provider they do not feel safe with,” Hawkins says. “If the provider recommends something that makes you feel scared or unsafe, get a second opinion. You are not locked into a contract, and you are free to leave your provider at any time during your pregnancy.”

Perkins says it’s perfectly reasonable to stop seeing a provider “if you ever feel unsure or uncomfortable for any reason—whether that’s medical or even just energy or vibe related.”

Prep your delivery partner.

“If you’re in pain, going through a difficult situation, or in labor, it can be hard to advocate for yourself,” says McDonald-Mosley. This is why many people choose to hire a doula—a birth worker who can advocate for you in the delivery room. But if that’s not in your budget, or you can have only one person with you due to COVID-19 restrictions, “it’s critically important to have someone by your side, if possible, to help to advocate for you, whether that’s a trained doula, a sister or an auntie, or a partner,” McDonald-Mosley says.  

Educating yourself and your birth partner is really important. Research things like induction protocols, epidurals, and cesarean births to know what questions to ask and what alternative options there might be. Make sure your partner knows about anything really important to you, like having skin-to-skin contact with the baby directly after birth. While you’re in active labor, your birth partner can help advocate for you.

“I also recommend using the nurses,” adds McDonald-Mosley. “Part of their role, especially in inpatient care, is to advocate for their patients.”

Stay vigilant during the postpartum period.

Common postbirth complications include hemorrhage, blood clots, and hypertension. “People need to be looking out for things like a severe headache, having pain in your leg, difficulty breathing, and, of course, heavy bleeding,” says McDonald-Mosley. “Those are all huge warning signs.” 

“With cardiovascular disease, the postpartum period is a very high-risk period,” says Jennifer Haythe, M.D., a cardiologist and codirector of the Women’s Center for Cardiovascular Health at Columbia University in New York City. “Sometimes people forget that.” After delivery, look out for chest pressure, palpitations, shortness of breath, and swelling.

It’s also crucial to keep an eye on your mental health. Perkins experienced postpartum depression four months after her daughter’s birth, and she recommends that everyone in your household brush up on potential symptoms. “Educate your team, your partner, your mother, your nanny—whoever is helping you with the baby,” she says. Signs of postpartum depression to look out for include fatigue, a low mood, crying, low appetite, feeling more irritable than normal, and showing little or no interest in the baby.

If you are going back to the hospital with postpartum complications, bring someone with you who can help advocate for you. 

Approach your health care as a team effort—your expertise is crucial.

“Remember, a physician comes to the discussion with medical knowledge,” Perkins says, “and you come to the discussion with how your body is feeling along with your own research, so that together as a team, you can make a fully informed decision.”

Advocate. 

It bears reiterating that the onus should not be on birthing people to fight for the right to a birth that’s joyful instead of life-threatening—we need to fix the system. “Advocate for system change and holding our health systems accountable for how they’re paid, who’s leading them, and whether they are making this a priority,” says McDonald-Mosley. 

The National Birth Equity Collaborative and the Black Mamas Matter Alliance are great places to start. 

Nina Bahadur is a health and culture writer in New York City.

It doesn’t feel like an overstatement to say that news coverage about Black pregnancy emphasizes poor outcomes. This isn’t inherently bad. Black maternal mortality awareness helps inspire policy changes, targeted funding, additional training for providers, and other solutions. And this knowledge can empower individuals too. It can help Black pregnant people figure out how to advocate for themselves against a racist system, even though it can be exhausting to think about the barriers and challenges they face when giving birth and endeavoring to survive to raise their children.

Yes, Black women are three to four times more likely to die from a pregnancy-related reason than white women are, according to statistics from the Centers for Disease Control and Prevention (CDC). But how do we resist the temptation to let fear dominate our thoughts in the face of increasingly disturbing facts? Kimberly Seals Allers has launched a new podcast to help us all answer that question. Seals Allers is a health journalist and founder of IRTH, a Yelp-like app that allows Black pregnant people and their partners to review birthing centers, hospitals, and doctors. Her new podcast, Birthright, is based on the notion that we can learn as much from Black triumph as we can from Black pain.

For the uninitiated, the reasons for why Black people die from pregnancy-related causes at higher rates are multifaceted. Black pregnant people are at higher risk for cardiovascular conditions like preeclampsia and eclampsia, which are blood pressure conditions that can negatively impact pregnancy and labor outcomes. Then there’s the relentless biological stress that comes from existing as a Black person in a racist society. These factors, of course, all existed before COVID-19 came into our lives. “The pandemic only exacerbated the weaknesses in our system, and the system was already failing, particularly Black and brown women and birthing people,” says Seals Allers. “So what we’ve seen is that it’s just getting worse.”

The ways that death and despair dominate Black birth narratives help raise awareness, but it can also trigger anxieties in people who are or wish to become pregnant. “In my experience, working on the ground in the community, talking to Black and brown working people all the time, people were becoming afraid,” Seals Allers says. “People are preparing death documents to give birth. This cannot continue. We have to show that there is hope and possibility.”

So Seals Allers set out to discover the treasures tucked inside positive birth stories. “I see the work as twofold,” she says. “[It’s] not just adding this idea of possibility and hope…. It’s about learning lessons from our joy and not just pain.” 

Each Birthright episode features a Black birth story told from multiple perspectives: The pregnant person recounts their experience, but listeners also hear from the doctors, midwives, doulas, and partners who participated as well. It’s a treat to hear from the dads and partners who supported and witnessed their children being born. Throughout each episode, Seals Allers acts as both interviewer and narrator helping us contextualize each birth story so that we come away with a sense that good birth stories do happen and that certain conditions can make them more likely.

For instance, in episode two, Shenika Welch-Charles, M.D., an assistant clinical professor at the University of Texas, shares that research suggests having a Black doctor can increase positive outcomes for Black patients, but what matters most is that care teams provide a consistently high standard of care no matter what their patients look like. This call for a clear standard of care aligns with the sad fact that over 60% of pregnancy-related deaths are preventable, according to the CDC. The onus is on the health care system to provide adequate care for Black patients and other patients of color.

Ultimately, Birthright is a candid and unapologetic celebration of Black-birthing joy, but Seals Allers says that upcoming episodes will expand to examine the healing journeys of people who’ve had less than positive birth experiences. “There are positive stories we can learn from,” she says, “but we also need to learn how to heal because many of us, including myself, may not have a positive experience because of the nature of the system that we’re in.”

So if you’re well-versed in dire birth outcomes for Black pregnant people and need to remember that joy and healing are part of your birthright, spend some time with generous folks who’ve shared their stories on the podcast. Birthright (available every other Wednesday on most podcast platforms) is a stunning and heartfelt reminder that, despite the disturbing statistics, many Black people are having the safe, supportive, and joyful birth experiences we deserve.

Markle’s story gave viewers a glimpse into the lack of support she says she received from the system meant to be providing a safety net. She says she reached out to both the Firm and the H.R. department within the monarchy and to specific family members for help but did not ultimately receive it. She (sort of) joked about not being able to Uber to the hospital from the palace. But that lack of validation she experienced can be disastrous for people struggling with suicide who finally decide to reach out; as Markle pointed out during the interview, it takes an incredible amount of courage to ask for help—to then be told no is devastating.

Vissing says it’s important for others to understand the struggle in the pregnant person’s mind. “It sounds a bit extreme but the logic of it is when you feel so bad about yourself, you feel you are the worst possible person, the worst possible parent,” she says. “It’s intense shame.”

You don’t have to have a history of depression to experience these thoughts

In a 2019 study published in the Journal of Affective Disorders, researchers found that women with depression were 13 times more likely to report suicidal ideations. However, you don’t have to have preexisting depression or anxiety to have suicidal thoughts, Vissing says—a third of the women with suicidal thoughts during pregnancy in the 2019 study did not report clinically significant depressive symptoms.

Depression during pregnancy can take wildly different forms for each individual. The core element, Vissing says, is a “deep sense of hopelessness.” For some, it manifests as “intense anger, irritability, and rage.” Trauma can make matters worse, whether from intimate partner abuse, childhood events, medical abuse, or sexual abuse.

Pregnant people can also experience “intrusive thoughts,” meaning passing thoughts such as “What would happen if I killed myself?” that don’t necessarily signify intent or major mental health disorders. “Intrusive thoughts are very common in pregnancy. It can be very scary and uncomfortable,” Vissing says, encouraging those with potential mental health disorders and those with fleeting intrusive thoughts alike to pursue help. “There’s no reason not to—there’s no issue too small.” Therapists can help with strategies and education surrounding intrusive thoughts to train people to recognize them and address them quickly.

A broken system for women of color struggling with mental health in pregnancy

Mental health conditions are one of the leading causes of maternal death during the postpartum period. Pregnant non-Hispanic Black women are more than three times more likely to die due to pregnancy complications than white or Hispanic women, the CDC reports, disparities that Vissing calls “staggering and deeply concerning.”

“It’s easy for me to say, ‘Reach out to your provider,’ but they know the system is not supporting them,” Vissing says. “We can’t put it all on the individual and see it as an individual’s responsibility. Pregnant moms are really angry and frustrated and have good reasons to be.”

The solution starts with better support for pregnant people. Vissing challenges pregnant people’s friends, family, and neighbors to go there when it comes to asking the tough questions about mental health during pregnancy. It could be a lifesaving conversation at a time when everyone else, including ob-gyns, may be focusing more on the baby’s health and development, she explains. Don’t be afraid that you could “plant the idea” or make it worse, a serious barrier to these conversations, she says. “We need to get over that. The opposite is true.” If you’re not sure how to broach the topic, Vissing suggests saying something like: “I know this is heavy stuff, but it’s important and I really care.”

Medication like antidepressants and talk therapy can be powerful long-term tools for pregnant people who are struggling. But if you are having suicidal thoughts, call the national suicide hotline or tell a health care provider to get immediate help. If you aren’t comfortable with your provider or need help finding a new one, Motherfigure offers a database of providers that specialize in maternal mental health among other resources for pregnant people.

“The good news is this is treatable and preventable,” Vissing says. “We can reach those people and give them hope and connect with them—it is through the connections with others that they will come out of that state.”

Many of us expect to recognize the “perfect time” to have a baby. The reality is that timing may never come. But in this life-altering year, how does one even consider bringing in a new life?

My fiancé Pat and I planned it, using ovulation test strips to know when would be the optimal time. But when it came down to taking the pregnancy test, I was uneasy. I told Pat, “I don’t think you left the stick in the urine long enough.” Then he showed me the result. 

But in that moment of unspeakable joy, I realized there is no perfect time, no foolproof season. In a year marked by fear, I remained grounded in the notion that our foremothers had children, intentionally or not, under far worse conditions than those we face today. It doesn’t matter whether you are 40 or 20—the world doesn’t adjust to your life; the career doesn’t stop for you. You have to decide this is what you want.

Naively, I imagined that pregnancy was a baby shower followed by the arrival of your glorious blessing. But, I have to be honest, it’s not a smooth ride. Pregnancy is hard. I remember calling and confronting my girlfriends—“Ladies, why didn’t you tell me the truth?” Or maybe they had, and I’d just chosen to hear the laughter. This idea that it would be all the wonderful things that I feel most people eulogize felt elusive. Pregnancy is many things for sure—a joy, a privilege, even a calling. But it’s also full of side effects that few utter a word about until you’re in the thick of it. (To the superwomen out there reading this and thinking, Really? Pregnancy was a piece of cake for me! For you, I have no wisdom—only applause.) 

For many of us, the experience goes far beyond the usual morning sickness and back pain symptoms. And for some women, like me, there are more serious complications. Sixteen weeks into my pregnancy, I was diagnosed with an “incompetent cervix.” During pregnancy, as the body prepares to give birth, the cervix begins to dilate or open from the pressure. And if one has an insufficient or short cervix, it can open too soon, leaving the risk for premature birth or a pregnancy loss. According to the American Pregnancy Association, 1 in every 100 pregnant women will experience an incompetent cervix, but that didn’t give me much comfort. 

Especially during this year, the diagnosis was a recipe for self-inflicted judgments and negativity. At times I felt like, no matter how hard I tried (eating right, meditation, prayer, reading), I was already failing as a mother.

As an Afro-Latina, I understood the complications of pregnancy that disproportionately affect us. Black women in America are three to four times more likely to die of pregnancy-related complications than white women. At 40 years old I carry that pain myself, and I carry the pain of my sisters. I said to myself, “You know what, Amirah, you’ve already learned this lesson, and the lesson is—call the damn doctor.” All these little buzzes in our ears are self-destructive; many of us are not used to standing up for ourselves, asking for what we need, and saying what we want. I felt blessed to have a female African American ob-gyn. She gave me comfort, knowing I had a woman aware of these issues in my corner. That’s why representation matters.

I was asked if I wanted to get a cervical cerclage, a surgery that places stitches in the cervix to hold it closed. But the procedure doesn’t come without risks of its own. The placenta could be punctured. I could get an infection. The thought was terrifying. My mental health was being seriously challenged. Still, the choice was mine. How was I supposed to know what was best? I was told because it was my first pregnancy, there was no way of knowing how to advise.