The short answer
Black moms carry an invisible load that goes beyond the one all mothers know: navigating racial bias in a medical system where Black women are 3 to 4 times more likely to die of a pregnancy complication, doing extra research to advocate for themselves, managing stereotypes and microaggressions, and carrying fears for their children that other moms are never asked to hold. The bias is systemic, baked into a medical system designed around white patients, which is why advocates call for structural change alongside individual tools: self-advocacy scripts, anti-racist birth planning, strong support systems, and daily mental health care.
Listen to Episode 116 · with Dr. Jennifer Adaeze Okwerekwu
In honor of Black Maternal Health Week, I am happy to welcome women's mental health and reproductive psychiatry specialist Dr. Jennifer Adaeze Okwerekwu.
Black moms face health struggles and discrimination in the medical system, and they also carry an additional invisible load specific to women of color. Dr. Okwerekwu shares valuable insight into the world of Black maternal health.
Same Planet, Different Worlds
As passionate as I am about the invisible load for all moms, I am also very aware of how much heavier that load is for women of color. I was honored to discuss the very important topic of Black maternal health with Dr. Okwerekwu.
She not only advocates for her patients and brings her experiences as a Black woman into her practice, but she also writes about social justice and race in motherhood.
We all live on the same planet, but we really live in different worlds.
As she said, “We all live on the same planet, but we really live in different worlds, depending on your background, your identity, your cultural upbringing, and your privileges.”
Black moms face burdens that stem from a history of systemic racism, leading to additional complications in pregnancy, birth, and the postpartum period. If we’re ever going to address these burdens, we have to have open and honest conversations around the topic of Black maternal health.
Why Black Maternal Health Week is Important
The medical profession has been used to disenfranchise people of color throughout history, leading to both heightened risk and distrust in healthcare for Black moms.
Black Maternal Health Week is focused on advocacy, awareness, and community building in the space.
Maternal healthcare in the United States is often inadequate, leading to the highest maternal mortality rate of developed countries. But minority moms are even more likely to suffer pregnancy-related complications.
Dr. Okwerekwu experienced this firsthand. During her pregnancy, she sought help for pain, but wasn’t taken seriously. Within a few days, she went into preterm labor. She felt disenfranchised because, despite her training and education, she found herself “on the verge of becoming a statistic.”
Find the cause that can unite Black moms and provide a pathway to joyful Black motherhood.
However, she believes that Black Maternal Health Week doesn’t have to focus solely on the negative. While sounding the alarm is important, it’s equally as important to find the song—the cause that can unite Black moms and provide a pathway to joyful Black motherhood.
Why and How Racism Shows Up in Medicine
Black moms are not shocked by racism in the medical system—for them, it’s the norm they have lived with for their entire lives. Dr. Okwerekwu pointed out that Western medicine was designed to serve white males.
Moms of color experience discrimination on many levels. Dr. Okwerekwu shared that she dresses her children nicely for doctor’s appointments so that her white pediatrician doesn’t view her as neglectful.
Racial bias influences the questions doctors ask, the seriousness in which they respond to pain or potentially dangerous systems, and even diagnoses. For example, while fibroids and endometriosis are major health issues for Black women, doctors might subconsciously diagnose women experiencing symptoms with pelvic inflammatory disease—a condition caused by sexually transmitted infections.
Racism is baked into the core, the foundation, of the system.
Racism is baked into the core, the foundation, of the system. That’s why Black maternal health advocates call for a systematic overhaul.
As Audrey Lorde said, “You can’t dismantle the master’s house with the master’s tools.” We ultimately need new systems designed to serve people of color.
The Additional Invisible Load that Black Mothers Carry
Black moms are also carrying an additional invisible load. I polled my Instagram followers to find out some of the ways this load shows up. The answers showed a crushing weight.
They have to manage microaggressions and stereotypes—including assumptions that there is no father or that they are living in poverty. They also have to grapple with added fears during pregnancy—Black moms are 3-4 times more likely to die of a pregnancy complication.
My followers also reported not being taken seriously in regard to their pain levels or symptoms—just like Dr. Okwerekwu experienced. Consequently, Black moms feel like they must do their own additional medical research so they can advocate for themselves, along with the mental labour of finding a provider who will listen to them.
I know that I did not carry some of these loads during pregnancy—and even the ones that I did carry didn’t involve the same stakes.
The added load for Black moms doesn’t end after pregnancy. Dr. Okwerekwu pointed out that Black moms have to grapple with postpartum hair loss on a different level—one entwined with their identity and cultural roots.
They also worry about being discriminated against by systems of power—for example, having children’s services called on them or being accused of negligence.
And, perhaps the hardest piece of the load to bear, Black moms have to watch news reports of violence against black bodies, wondering how they will protect their sons. Dr. Okwerekwu shared how hard it was to experience that in the wake of the Black Lives Matter movement while pregnant, to the point where she felt a wave of relief when she gave birth to a daughter instead. As a mom to three multiracial boys, I understand how heavy and encompassing these fears are.
All of this weight puts extra pressure on Black moms, overloading their nervous systems and depleting their energy.
The Role of Black Maternal Mental Health
Those pressures, that added load for Black moms, has a direct impact on their mental, and in turn, physical health.
Undiagnosed mental health issues during pregnancy increase the chances of developing complications. Complications during pregnancy then increase the odds of being diagnosed with other diseases down the line.
People often wait until they’re in crisis to address mental health issues.
Dr. Okwerekwu said that people all too often wait until they’re in crisis to address mental health issues—putting their mental health up on a shelf where it is not cared for. But, just as we brush our teeth or shower every day, moms should also be taking daily steps to take care of their mental health.
Mental health is a crucial part of Black moms caring for themselves holistically. That is what Dr. Okwerekwu commits herself to helping Black moms with—to help them take care of their mental and physical health and find peace.
She said that mental health maintenance is a part of investing in oneself to create the space for that peace to exist.
How Black Moms Can Care for Themselves During Pregnancy, Birth, and Postpartum
Dr. Okwerekwu also pointed out that, while the burden of labour should never be put on the oppressed, there are ways that Black moms can help themselves during the perinatal period.
The first is by advocating for themselves with providers. She recommended the article Protecting Your Black Birth, which provides scripts and lines to help Black moms bring up the issues of Black maternal health with their providers.
The authors of the article also created The Anti-Racist Birth Plan to help Black moms plan for birth and protect themselves.
The importance of maternal health carries on into the postpartum period and beyond. That’s why it’s crucial to not neglect oneself in the process of becoming a mom. Dr. Okwerekwu urged moms to keep their appointments and continue monitoring their mental and physical health.
Another important way Black moms can protect themselves is by building a support system. Dr. Okwerekwu shared that in the Igbo culture, the word “omugwo” refers to the period of time after a mother gives birth.
A baby is born, but the mother is also born, and she deserves to be cared for.
A baby is born, but the mother is also born, and she deserves to be cared for. It is the cultural norm for relatives to come help care for the mother as her body heals and she transitions into motherhood. Dr. Okwerekwu remembers how valuable that support was after her first baby was born.
This is in stark contrast with the isolated American culture that often leaves new moms struggling and alone. But it doesn’t have to be that way. Moms can create their own village—recruiting doctors, family members, friends, doulas, and midwives, and building up that support system in advance.
Dr. Okwerekwu said that with the right plans in place, and the right language to speak about the issues surrounding Black maternal health, Black moms can help create a perinatal period that is not only safe, but that it is also full of joy.
Work with a Momwell therapist who specializes in maternal mental health.
In summary
- Black moms are 3 to 4 times more likely to die of a pregnancy complication, within a US maternal care system that already has the highest mortality rate among developed countries.
- The bias is systemic, not incidental: Western medicine was designed around white patients, and racial bias shapes which questions get asked, whose pain gets believed, and which diagnoses get made.
- The invisible load of Black birth includes extra medical research, the labor of finding a provider who listens, managing stereotypes and microaggressions, and fears for Black children that other moms are never asked to carry.
- Advocacy tools exist: the Protecting Your Black Birth scripts and the Anti-Racist Birth Plan help Black moms raise these issues with providers and plan for birth.
- Mental health care belongs in the daily routine, not on a shelf until crisis. Untreated mental health struggles during pregnancy raise the risk of physical complications.
Common questions
Why are Black moms at higher risk during pregnancy and birth?
Because of systemic racism in a medical system that was designed around white patients, not because of anything inherent to Black bodies. Racial bias shapes the questions doctors ask, how seriously they take reported pain and warning signs, and even which diagnoses come to mind. Black moms are 3 to 4 times more likely to die of a pregnancy complication, and many, including physicians themselves, report not being taken seriously when they sought help.
What is the invisible load of Black birth?
It is everything Black moms carry on top of the load all mothers know: doing extra medical research to advocate for themselves, the labor of finding a provider who will listen, managing stereotypes and microaggressions, navigating discrimination fears with systems of power, and holding fears for their children's safety that other moms are never asked to hold. That weight taxes the nervous system and depletes energy through pregnancy and beyond.
How can Black moms advocate for themselves with providers?
Tools built for exactly this exist. The article Protecting Your Black Birth offers scripts and lines for raising Black maternal health concerns directly with providers, and its authors created the Anti-Racist Birth Plan for planning and protection during birth. Keeping every appointment, monitoring your own mental and physical health, and building a strong support system for the postpartum period all add protection, even though the burden of fixing the system should never rest on the people harmed by it.
What is Black Maternal Health Week?
A week dedicated to advocacy, awareness, and community building around Black maternal health, in a country where maternal care is already the weakest among developed nations and minority moms face the highest complication rates. It sounds the alarm about the disparities, and it also holds the other note: uniting Black moms around a pathway to joyful Black motherhood, not only the statistics.
Why does mental health matter so much in Black maternal health?
Because mental and physical health are entwined: undiagnosed mental health struggles during pregnancy increase the chance of complications, and complications raise the odds of later disease. Waiting until crisis to address mental health leaves it uncared for exactly when the load is heaviest. Daily mental health maintenance, treated as routinely as brushing your teeth, is part of caring for yourself holistically. Momwell's therapists are here if you need support. Learn more about navigating resentment →
Written by
Erica Djossa
Registered Psychotherapist · CEO & Founder of Momwell
Erica Djossa is the CEO and founder of Momwell and a registered psychotherapist specializing in maternal mental health with over a decade of experience. A mother of three boys, she founded Momwell to set a standard of care for providers and ensure mom-centred, specialized mental health support at every stage of motherhood. She is a regular media contributor, featured in Time, USA Today, the Toronto Star, Cityline, and more.
Featured guest
Dr. Jennifer Adaeze Okwerekwu
Psychiatrist
Jennifer Adaeze Okwerekwu, M.D., M.S., is a psychiatrist specializing in women's mental health and reproductive psychiatry and a columnist for STAT. She is passionate about social justice and exploring issues of race and motherhood in medicine.
