Confronting the Black Maternal Health Crisis: Strategies to Address and Reduce Systemic Harms Impacting Black Mothers

By CHLPI Team

On April 21, 2026, CHLPI co-hosted a panel with the Black Law Students Association of Harvard Law School, the Harvard Health Law Society, and the Alliance for Reproductive Justice titled “Confronting the Black Maternal Health Crisis: A Panel Discussion on Strategies to Address and Reduce Systemic Harms Impacting Black Mothers.” CHLPI houses the Health Law and Policy Clinic (HLPC) and the Food Law and Policy Clinic (FLPC).  

The conversation, moderated by Health Law and Policy Clinic student Tia Patrick, brought together:

• Dr. Lacee Satcher, sociologist and environmental health scholar
• Dr. Brigette Davis, public health researcher focused on structural racism and maternal health
• Professor Jamille Fields Allsbrook, health law professor and CHLPI alum

The panel explored how structural racism, environmental factors, social policy, and legal systems converge to endanger Black birthing people—and what concrete steps can begin to change those conditions.

Key Concerns Raised by the Panel

1. Structural racism is a central cause, not a side factor

All three panelists underscored that the Black maternal health crisis cannot be explained away by individual behavior or isolated medical errors. It is a predictable outcome of systems built on racial hierarchy.

Professor Jamille Fields Allsbrook, who was a clinical fellow at CHLPI, described how her work in reproductive justice illuminates the limits of a narrow “reproductive rights” frame and how race fundamentally shapes who is supported—or harmed—by our systems. “A Black woman with a master’s degree is more likely to die from maternal causes than a white woman with a GED. When you control for education, income, housing—all the factors we usually think of as protective—and you still see Black and Indigenous women more likely to die, that tells you something else is going on. That ‘something’ is systemic racism,” she said.

She emphasized that reproductive justice necessarily brings in environmental justice, criminal legal systems, housing, and public health, because those are the arenas where racism is enacted.

2. Environmental exposures and chronic stress become “embodied”

Dr. Lacee Satcher and Dr. Brigette Davis connected environmental and social conditions directly to pregnancy and birth outcomes for Black women.

Dr. Davis explained how her research treats structural racism as a health exposure in itself. “Structural racism isn’t a bug in our social environment—it’s a feature. Just like pollution, it’s embedded in policy. I can be agnostic about the specific outcome—HIV, maternal mortality, adverse birth outcomes—because racism touches so many parts of our lives that it will show up everywhere.”

She described work on the criminal legal system—policing, fines and fees, and revenue-driven enforcement in places like St. Louis—and how those experiences of stress and surveillance are linked to elevated cortisol, preterm birth, and pregnancy complications. She also highlighted environmental chemicals in products disproportionately used by Black women, like certain hair relaxers and nail products, as reproductive toxins.

Dr. Satcher drew out the multi-generational implications of these environmental harms. “If I’m exposed to something like a pesticide today, it doesn’t just affect me if I’m pregnant now—it can affect the eggs that are already in my body, the future children and even grandchildren. Environmental harm is multi-generational.”

She also noted that climate change, extreme heat, and increasingly frequent severe weather are making it harder for people to access essential resources—green space, grocery stores, pharmacies, and healthcare—and are making harmful exposures more dangerous, especially in already overburdened Black communities.

3. Deep problems inside the healthcare system

Professor Allsbrook focused on how U.S. healthcare financing and regulation both reflect and reinforce racialized inequities:

• Accountability gaps: Most births still happen in hospitals that receive federal dollars, yet there is limited accountability for discriminatory, low-quality care.
• Misleading designations: Recent federal efforts to label hospitals “birthing friendly” have resulted in that label being awarded to the vast majority of facilities, despite persistent poor outcomes. As she noted, if over 90% of hospitals were truly birthing-friendly, we would not be facing a national maternal health crisis.
• Coverage and access: Insurance status and benefit design—what’s actually covered, and for how long—shape whether people can access childbirth education, adequate prenatal and postpartum visits, doulas, midwives, and culturally concordant providers.

She also raised concerns about the interaction of Medicaid policy and maternal health. “Medicaid is, in many ways, our primary reproductive health program—it pays for about 40% of births. When you add work requirements and budget cuts to that, you’re not just cutting a line item; you are cutting off people’s ability to access prenatal care, postpartum coverage, and the services that keep them alive.”

Both Allsbrook and Satcher noted how provider-side barriers—like caps on how many Medicaid patients a clinician will see, or the administrative burdens associated with public coverage—further erode access and quality.

4. Paternalism and racism in nutrition and safety-net programs

Satcher drew on her experience as a former teen mom who relied on WIC and SNAP to describe both the importance and the limitations of nutrition and income-support programs:

• Importance: As SNAP eligibility rules have tightened, WIC often fills critical gaps, providing basic foods like milk, cereal, juice, and formula that families otherwise might not be able to afford.
• Limitations: Because programs like WIC and SNAP are discretionary and politically vulnerable, progress is fragile and funding is subject to shifting political winds.

Even well-intentioned programs can be designed and implemented in ways that undermine dignity, Dr. Davis added. “I worked with a program that put money on people’s cards so they could buy food. But to ‘regulate’ what they bought, the benefits were restricted to dollar stores. When we looked at the data, the top item was Vienna sausages. Nobody wants to eat Vienna sausages— but they’re cheap, and they fill little bellies. That’s what paternalism and racism in our programs looks like in practice.”

The panel stressed that social programs must be designed not only to exist and be funded, but to preserve the humanity and autonomy of the people who use them.

5. Threats to pregnant patients’ autonomy

Responding to stories like the recent widely shared video of a woman in Florida in labor on Zoom, trying to avoid a court-ordered C‑section, the panel discussed an underappreciated reality: in the United States, pregnant people’s medical decisions can be overridden by courts and providers.

Allsbrook described these cases as part of a broader pattern of obstetric violence. “People are shocked to learn that, in pregnancy, your health decisions can be overridden. We have a whole body of law saying competent adults get to make their own medical choices—until they’re pregnant. Then a doctor or a judge can decide what happens to your body. That’s not about a conflict between maternal health and fetal health; it’s a conflict between maternal health and doctors.”

She and Davis noted that post‑Dobbs abortion bans and fetal personhood laws are intensifying this trend by treating fetuses as separate legal persons, making it easier to justify coercive interventions.

6. Community-based care as both remedy and resistance

Despite sobering statistics and stories, the panel also highlighted promising, community-driven responses.

Dr. Satcher pointed to the Neighborhood Birth Center in Roxbury—soon to be the community’s first birth center—as an example of holistic, community-rooted care. “Places like the Neighborhood Birth Center in Roxbury—with midwives, doulas, and wraparound care—are literally building the infrastructure we’ve always needed. They’re navigating red tape just to give people the kind of community-centered care that should already exist.”

Dr. Davis shared her experience at a “maternal social health home” in St. Louis, where she received support as a new mother. “I’m doing this talk from a place called Korede House here in St. Louis—a maternal social health home. We have therapists, massage therapists, home visits, postpartum groups. It’s community care. Even when stats and policies feel overwhelming, spaces like this remind us that we’ve always cared for one another. We just need to protect and expand that.”

These models show how non-clinical supports—childcare, mental health services, peer groups, and practical help—can be as critical as clinical interventions in keeping mothers and babies healthy.

Student Questions

As future attorneys, the law students in attendance asked questions around what they could do to fix the issues discussed by panelists. A summary of the responses to their questions follows:

Q1. “While we work on long-term structural change, what short-term things can mothers do right now to support better outcomes for themselves?”

Panel’s response:

• Educate yourself about your options.
  Evidence-based childbirth and prenatal classes can help you understand common procedures, ask informed questions, and recognize when you can decline or delay an intervention.
• Bring advocates into the room.
  Doulas, partners, family, or friends can help you navigate care, especially when you are in pain, exhausted, or intimidated. Their role is to support your decisions, not replace them.
• Engage in local advocacy now.
  While structural reforms take time, there are immediate levers:
  • Urge state legislators not to cut Medicaid maternal and postpartum benefits.
  • Push hospitals and insurers to cover doulas and midwives and to track and address racial disparities.
  • Support local organizations that are already building alternative models of care.

Q2. “How should people navigate situations where the state or courts override mothers’ wishes—for example, court-ordered C‑sections in places with strong fetal personhood ideology?”

Panel’s response:

• Recognize this as a systemic, not isolated, problem.
  Court-ordered C‑sections and coerced interventions have been documented for years and disproportionately impact Black and marginalized patients.
• Know that the law is contested here.
  General medical law supports bodily autonomy, but pregnancy has been treated as an exception. Advocates are working to challenge that.
• Take action where possible:
  • When feasible, document experiences and file complaints with hospital systems, state licensing boards, and civil rights agencies.
  • Legal advocates and students can support litigation and policy reforms that challenge coercive practices and fetal personhood laws.

Q3. “What can individuals do to support Black mothers and families, starting right now?”

Panel’s response:

• Show up for the mothers in your life.
  • Offer concrete help: meals, rides, childcare, time so they can shower or sleep.
  • Ask specifically, “What do you need?”—not just, “How’s the baby?”
• Don’t forget long-term motherhood.
  Motherhood is ongoing, not limited to pregnancy and the first year. Black mothers raising children of any age may still need support, rest, and community.
• Support local organizations.
  • Volunteer with or donate to local birth centers, doula collectives, and maternal social health homes—especially those led by and serving Black communities.
  • Offer your skills—legal, policy, research, communications—to help them navigate regulations, prove impact, and secure funding.
• Center dignity.
  In all advocacy—whether for federally funded healthcare programs, nutrition programs, or environmental protections, the goal is not just access, but dignity and autonomy for Black mothers and families.

As one panelist put it, “Getting money into people’s hands to feed small bellies and big bellies is always important—but how we do it has to respect people’s humanity.”

Continuing the Work

The panel closed with a reminder that the Black maternal health crisis is not inevitable. It is produced by choices—policy choices, funding decisions, regulatory priorities—and it can be changed by different choices.

For law and policy students, advocates, and community members, that means:

• Challenging racist and paternalistic structures in healthcare, environmental policy, and social programs.
• Supporting and resourcing Black-led, community-based models of care.
• Remembering that reproductive justice requires more than a formal “choice”—it requires the material and social conditions to safely parent and to live with dignity.

Students interested in working on these issues can explore opportunities with CHLPI’s Health Law and Policy Clinic and Food Law and Policy Clinic, which engage directly with communities and policymakers to advance health equity and food justice, or email the center at chlpi@law.harvard.edu