Black maternal health: why addressing inequity must be a “collective effort”

Black mothers are three times more likely to die from a pregnancy-related cause than white mothers, with over 80 per cent of these cases thought to be preventable. We speak to Dr Ndidiamaka Amutah-Onukagha, founder of the Center of Black Maternal Health and Reproductive Justice at Tufts University, about what’s driving these disparities, why she has dedicated her career addressing them, and how this can—and should—be a collective effort.

Dr Ndidiamaka Amutah-Onukagha, the Julia A. Okoro Professor of Black Maternal Health at Tufts University School of Medicine, believes we are facing a “maternal health crisis”. 

Even with its vast resources, in the US, Black women are two to three times more likely to die during childbirth than their white peers. It’s no better in the UK, where maternal mortality for Black women is currently almost four times higher than for white women.

“Structural racism, inadequate healthcare access, and the dismissal of Black women’s pain and concerns continue to fuel these disparities, making it critical to push for systemic change in policy, clinical care, and community support,” Dr Amutah-Onukagha who has spent her career addressing these disparities, tells Femtech World.

For Dr Amutah-Onukagha, who has dedicated decades to researching Black women’s experiences of maternal health, infant mortality, reproductive health and HIV/AIDS, Black maternal health and mortality is a social justice issue. 

Culturally-rooted and community-based

Aged 16 she lost a close friend —someone she describes as “more like a sister”— to childbirth complications, igniting a passion for addressing health disparities among women. This tragic loss would be the catalyst for her career, but maternal health was always in her roots. 

Her grandmother, Julia Okoro, was a traditional birth attendant who delivered hundreds of babies, in Imo State, Nigeria, saving the lives of many women and children in the process.

“As a Nigerian immigrant, my background has given me a deep understanding of how culture, systemic barriers, and community impact maternal health, ” says Dr Amutah-Onukagha.

“Growing up in a society where midwifery and traditional birthing practices are central, I advocate for integrating culturally rooted, community-based solutions into US healthcare to improve Black maternal outcomes.”

She adds: “Here in the United States, my lived experience navigating bias and inequities fuels my commitment to ensuring that Black women receive respectful, quality maternal care, regardless of background or status. I have witnessed firsthand how discriminatory practices in healthcare, including under-diagnosis, overt racism, and biased treatment, hinder equitable access to necessary services.”

Creating the blueprint for maternal health equity 

This was the basis on which Dr Amutah-Onukagha founded the Center of Black Maternal Health and Reproductive Justice (CBMHRJ) at Tufts University to serve as a catalyst for maternal health research, policy, and workforce advancement through “cross-disciplinary partnerships, thought leadership, and community engagement”. 

The centre is focused on advancing maternal and postpartum care, strengthening maternal mortality data, and addressing structural issues in severe maternal mortality, she explains. Its approach advocates for supportive policies, expanding birthing options and insurance coverage, and improving data reporting.

In August 2024 this worked played a key role in the passing of the Massachusetts Maternal Health Momnibus legislation, which is thought to be one of the most comprehensive maternal health bills nationwide. 

Dr Amutah-Onukagha says this legislation has the potential to “become a blueprint” for the rest of the country on how best to address maternal health inequities.

“The most impactful initiatives have been those that place access to non-clinical and community health workers at the forefront, initiatives that embrace and aim to increase birthing centres, as maternity care deserts and OB-GYN shortages continue to exacerbate our system,” she says.

“We need initiatives that allow us to access and analyse clinically accurate data in real-time to capture disparities in maternal health outcomes and better understand the underlying factors contributing to these disparities.”

Prioritising marginalised voices in research

Prioritising research that centres the voices and lived experiences of marginalised communities is also “critical.”

The Maternal Outcomes of Translational Health Equity Research (MOTHER) Lab, a student-run unit founded by Dr Amutah-Onukagha, conducted research advocating for increased multilingual accessibility of doula care in Massachusetts.

This was then used to provide informed recommendations to the State, healthcare systems, and doula organisations to expand linguistic access and diversity in services.

“We have people here, living, who can provide us with the information we need,” she says. “Women shouldn’t have to die for us to change the systems that are failing them.”

Through grant and foundational funding, the centre has also developed an interactive toolkit to support doulas and MassHealth members in becoming Medicaid reimbursable. The content of this is guided by its Community Advisory Board, composed of doula stakeholders, guides the toolkit’s content, intuitive design, and information dissemination. 

Dr Amutah-Onukagha adds: “This is not just an ordinary advisory board; they don’t simply check a box to fulfil a role. They hold real decision-making power over what is shared and how we best provide trained doulas to local birthers who want them.”

Addressing Black maternal health disparities as a ‘collective effort’

Fresh off the back of hosting the eighth annual conference on Black maternal health, held from 4-5 April, Dr Amutah-Onukagha’s, is now focused on creating the right partnerships and securing resources to continue the work of the centre moving forward.

It is self-funded and relies on federal grants and strategic partnerships, something which she describes as an “ongoing hurdle”, particularly as the US “shifts its health focus and redefines research, policies, and public health”. In his first days in office, President Donald Trump issued a series of executive orders targeting diversity, equity, and inclusion programmes.

Perhaps now more than ever, addressing Black maternal health disparities requires a “collective effort” in which the private sector also has a “crucial role to play”.

“Companies can invest in research, advocate for equitable healthcare policies, fund community-based initiatives, and implement workplace protections such as paid parental leave, flexible schedules, and culturally competent healthcare that extends to full-spectrum pregnancy care and mental health support,” Dr Amutah-Onukagha explains.

“It will take all of us healthcare providers, policymakers, businesses, and communities—to drive meaningful and lasting change. Our work is not done until equity for all Black mothers, before, during, and after pregnancy, is achieved.”

Find out more about Dr Amutah-Onukagha’s work here.

In honour of Black Maternal Health Week (11-17 April), we also asked Dr Amutah-Onukagha what Femtech World readers can do to help address disparities in Black maternal health?

“Be intentional, start with small efforts, where you are, and build upon those actions. In what ways can you help raise awareness of the crisis in your community? What current efforts are in place that you can lend your expertise to? What policies are being implemented in your state? Is it time to call your state representative or congressperson?

“If you’re a business owner or a leader at your company, take a look at your parental leave policies—are they inclusive? If you’re in the office, stop by the lactation room, does it have everything needed for nursing parents? Review your healthcare plans, are they based on an income scale? Do they support the lowest earners as much as they do the highest earners? What remote offerings do you have for expecting families? Are they flexible?

“And finally, share what you learn! Whether it’s with colleagues, communities, or leaders, sharing knowledge is a powerful step toward achieving maternal health equity.”