Perspectives From Leaders in the Black Community on the Black Maternal Health Crisis: A Qualitative Landscape Analysis

Introduction: In response to disproportionately high rates of maternal mortality and morbidity, many Black people in the United States have sought alternative birthing options outside of hospitals, including home births and community birth centers. Leaders in Black perinatal health care are increasingly advocating for investments in systems that better support people who are pregnant and opt to give birth outside the hospital setting. Despite the disproportionate burden of maternal death and morbidity within Black communities, few studies have examined community-driven responses to this crisis. Methods: This qualitative study was conducted between January and October of 2023 to explore how the Black community was responding to the maternal health crisis. It consisted of structured and unstructured conversations with 57 experts, leaders, artists, and practitioners who were deeply knowledgeable about community approaches and an observation of one midwife who was Black and caring for 2 clients who were Black and postpartum in their homes. Thematic analysis of the interviews was conducted. Results: Participants perceived that the overemphasis on the negative mortality and morbidity statistics on people who are Black and birthing in the media, without a concomitant attention to the solutions, is harmful to that community and discourages childbearing. They described significant yet often ignored positive contributions of women who are Black and identified Black community midwifery as an important yet underresourced strategy. Direct observation of community midwifery care illustrated dominant themes of spirituality, support, and rest. Discussion: These findings suggest that Black community midwifery is an important model of care that offers protective factors during the postpartum period, a time when people who are Black and birthing are most vulnerable to death and disease. Further investments and study into Black community midwifery are warranted to better understand perinatal crisis solutions.