How Black Women Can Advocate for Themselves During Pregnancy

"For too long, our healthcare system has placed a lower value on Black people's bodies and pain, and Black women, in particular, have been affected by such biases," says Raegan McDonald-Mosley, M.D., CEO of Power to Decide, an organization that works to close racial and socioeconomic disparity gaps around teen and unplanned pregnancy, based in Washington, D.C.

These disparities don’t just apply to pregnancy, either. McDonald-Mosley continues, "Black women are more likely to have hysterectomies and experience more major and minor postoperative complications than white women.”

The question of why this is the case, or why the healthcare community has failed to do more to protect Black women, lingers heavy on the air—call it a pregnant pause.

“What’s more important than the stats is how we will remedy this colossal disparity,” says Janelle R. Bolden, M.D., chief of maternal-fetal medicine and diagnostic ultrasound at Northwestern Medicine in Chicago. “There are strategies that need to be implemented, from the individual all the way to large policy and institutional changes,” she says.

5 Ways Black Mothers Can Advocate for Themselves

Until big changes occur and the healthcare system is held accountable, the most at-risk pregnant people can find ways to protect themselves. Here are five ways you can be your own advocate during your pregnancy.

1. Do Your Research

"It's important to educate yourself as much as possible about quality prenatal care," McDonald-Mosley says. Bolden agrees, pointing out that "there are many reputable online sources and books available to start this process.” Professional organizations like the Society for Maternal-Fetal Medicine and the American College of Obstetrics and Gynecologists offer accessible, patient-focused information on their websites.

You should also ask questions of people in your life who have been pregnant. "Find like-minded individuals through an online community, such as Facebook or Twitter, or seek out people in your neighborhood," Bolden says. This will help you prepare questions to ask at your visits to your doctor or other healthcare professionals.

"If possible, take a birthing class to learn about the basics of labor," McDonald-Mosley says. Gathering knowledge about the postpartum period is also vital. Because it can be overwhelming, never hesitate to ask questions, particularly if you experience mental health symptoms like sadness, irritability, or persistent worry or agitation, which could be signs of depression or anxiety.

Unaddressed mental health symptoms are also extremely stressful. Increased levels of chronic stress have been linked to adverse birth outcomes, so caring for your mental health is important for both your and your baby.

2. Know Your Health History and Your Family’s

Having a complete picture of the health issues prevalent in your family is an important part of your pregnancy journey, and speaking up about them can help ensure that you’re given the genetic tests you need. According to the Centers for Disease Control and Prevention, if your family has a history of genetic disease, developmental disability, birth abnormality, or newborn screening disorder, your baby may be at higher risk.

Start by speaking with your parents and other family members about your family’s medical information, and then share this information with your doctor. It’s helpful to discuss the family history of both biological parents, when possible.

Women of color have higher rates of hypertension (high blood pressure) and diabetes, both of which increase the risk of adverse pregnancy outcomes and preterm labor. If you have a preexisting condition, it’s important to seek regular medical care as early as possible—ideally, even before you become pregnant—to manage or even improve your condition.

3. Take Notes

Writing down the questions and concerns you have before your doctor’s appointment is essential, and so is taking notes while there. This is especially helpful if you’re feeling anxious, or when attending an appointment alone. That way, you’ll better remember all the things you wanted to mention and your doctor’s responses and instructions.

Also, if your doctor’s office has a patient portal, make sure to sign up so you can send questions as they arise, and so that you have access to records of your test results and prescriptions.

4. Speak Up

"Due to a history of oppression and racism, especially regarding healthcare, some women don't feel comfortable bringing their concerns to their doctor," Bolden says. "This can lead to a delay in care or avoidance altogether until something is gravely wrong.”

Fighting centuries-old beliefs can be daunting. According to a 2021 report, systemic biases routinely result in healthcare professionals underestimating, and undertreating, pain in female patients.

This bias also exists when the patient is Black. The results of a 2016 study suggest that a significant number of white people, including about half of the medical students and residents surveyed, hold false beliefs that there are biological differences between Black and white people. One such false belief involved the response to pain—namely, that Black people have a higher pain threshold than white people—leading to undertreatment for pain in Black patients.

These differences in quality of care persist even when there are no issues with insurance or socioeconomic status. One example is Serena Williams’ childbirth, in which she experienced disparities in care because her pain symptoms were not initially acknowledged by her medical team.

"Biases can come into play when Black women try to communicate their symptoms, including pain," McDonald-Mosley says. "You should question the treatment you receive and change your doctor if your needs are not being met.” You know yourself best: Always trust your gut.

5. Use Recommendations to Find a Practitioner You Trust

“You can find culturally competent healthcare professionals by word of mouth or through a searchable list of Black healthcare professionals," Bolden says. This can include physicians, midwives, and nurse practitioners.

When choosing a provider, ask as many questions as you can. For example: What is your cesarean delivery rate, and when would you recommend I have one? Will you help me write a birth and postpartum care plan to keep my baby and me safe?

Know that you have the right to respectful and high-quality care, during and after your pregnancy.

Certain childbirth practices have been shown to improve maternal outcomes, including having extra support from doulas, midwives, and group prenatal care. "If possible, utilize a doula or a support person who can advocate for you and your wishes while you are in labor and ensure that you are being taken care of after birth," McDonald-Mosley says.

Of course, that’s only a stopgap solution. Ultimately, the medical community needs to make such resources accessible to underserved communities. "The most critical step is to develop a larger pool of physicians who can treat Black women, free of bias," McDonald-Mosley says.

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