Black Women With Money Are Doing What White Men with Power Will Not

“ We are done waiting for someone else to fix what’s broken. It’s on us to save us. We are ready to take action now.”

Accompanying Elaine Welteroth’s words is a collage of smiling pictures and videos displaying any woman’s most vulnerable, intimate phase in life: her pregnancy. The Instagram reel is an announcement for Serena Williams’s and Elaine Welteroth’s new collaborative, Birthfund – a nonprofit that covers midwifery care for families of color. With Founding Funders like Kelly Rowland, Chrissy Teigan, and Ayesha Curry, Birthfund clearly articulates what healthcare and political leaders will not: financial barriers are being used to inhibit access to midwifery care, and it needs to stop. Now.

The decision to fund midwifery is a political act. Despite the US White House’s assertion that midwives have better outcomes, they face systemic barriers to practice such as hospital opposition and insufficient reimbursement from insurance. For example, Health Resources and Services Administration (HRSA) only offers grants to accredited nursing programs. This means that only programs for nurse-midwives – and not programs for homebirth midwives - are eligible for the federal funding aimed at increasing diversity within midwifery.

Currently, there are no Historically Black Colleges and Universities (HBCUs) with midwifery programs. The field of nurse-midwifery is more than 90% white.

This is by design. Nurse-midwifery came into existence in response to the Midwife Problem campaign of the 1920s. White male OB/GYNs fresh out of medical school saw the Black enslaved women who traditionally worked as midwives (known as Grand Midwives) as a threat to the budding obstetrics field. Thus, they started campaigning and lobbying legislatively for their eradication, calling them dirty and incompetent. White nurses, eager to capitalize on the usurpation of power from Black traditional midwives, created the field of nurse-midwifery. In 1921, the US federal government passed the Sheppard-Towner Act, nearly eradicating the existence of Black traditional midwives.

Today’s maternal healthcare system serves as a dark ramification of decisions past (and present). 98.4% of all US births happened in hospitals in 2017. However, as obstetricians leave the field in a post-Roe America, hospitals across the country are closing their maternal care centers. Nearly one of every three US counties do not have access to maternity care. Old state laws outlawing homebirth midwifery practices are still prevalent. In some states, pregnant people drive up to two hours for prenatal -and sometimes emergent – care.

Black women are fed up. Amidst a seemingly endless number of panels and strategy sessions geared towards addressing racial disparities, little seems to change. Most insurance policies still do not cover homebirth fees. Birth centers still face de facto laws and hospital opposition. Black women no longer see hospitals as safe places to give birth. They’re not wrong; the maternal mortality rates for Black women more than doubled from 1999 to 2019. The number of Black women who gave birth at home has more than tripled, from 823 in 2016 to 2733 in 2022.

In Serena Williams’s 2017 cover story with Vogue, she tells a story about her emergency cesarean section. She had a history of blood clots and took anticoagulant medication. However, the medication increases the risk for hemorrhaging during surgery, and she stopped taking them beforehand. The day after her c-section, she reported that she suddenly had trouble breathing. Given her history with blood clots, she knew this was a sign that she had one in her lungs. Pulmonary embolisms, or blood clots in the lungs, are a life-threatening emergency. Giving birth causes changes in blood volume and increases the risk of blood clots; maternal healthcare workers are supposed to be on high alert for any signs of shortness of breath or swelling in the leg. When Serena found her nurse, her nurse thought her pain medications were causing Serena to become confused. Serena demanded, for a second time, a CT scan and a heparin drip. When she finally got her CT scan, they found a collection of clots in her lungs.

Her self-advocacy saved her life. “Listen to Dr. Williams!” she exclaimed.

On her Birthfund Instagram reel, Serena can be seen playing tennis and doing yoga with Olympia, the daughter she fought so hard to stay alive for seven years ago. “We are tired of waiting for change,” she says. “So, we are creating the change ourselves.”

Black women with money are doing what white men with power have long refused to do – and Black maternity care is better of for it.