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Valuing Black Women’s Pathways to Motherhood

How can we advance Black maternal autonomy and reproductive justice efforts?

Key points

  • Black mothers should have the right to determine the conditions under which they will give birth and/or create a family with children.
  • Black mothers need accessible options to prevent or end pregnancy, and structural supports that are responsive to their family planning needs.
  • To improve Black women’s sense of maternal autonomy, we must recognize and value their multiple pathways to motherhood.
Photo by Andrea Ricketts on Unsplash
Source: Photo by Andrea Ricketts on Unsplash

This post was co-authored by Dr. Leath and University of Virginia graduate, Erica Stephens.

One day after giving birth to her daughter, legendary tennis player, Serena Williams, realized that she felt short of breath. Given her prior experience with a pulmonary embolism in 2011 (i.e., a life threatening condition where a blood clot restricts oxygen flow to other parts of the body), Serena quickly reported her symptoms to a nurse for treatment. However, rather than accommodate her request for a CT scan and blood thinner, the nurse and doctor opted to perform an ultrasound of her legs — which revealed nothing. After performing a CT scan as she requested, they found several blood clots in her lungs that required immediate treatment.

Serena Williams’s story is, unfortunately, one of many, and shows just how difficult it can be for Black women — including a wealthy, internationally renowned athlete — to get the maternal care that they need. While she and her daughter made it home safely, her story offered critical insight into Black women’s maternal health experiences in the United States. Currently, Black women are three to four times more likely to die of pregnancy-related causes (e.g., Shalon Irving) compared to White women, highlighting maternal health as a critical public health issue (Black Maternal Health Momnibus Act of 2021).

Black Maternal Health Disparities

We know that Black women’s historical and contemporary experiences with misogynoir (i.e., the ways in which racism and sexism intersect to produce racialized gendered violence and harm against Black women and girls; Bailey, 2021) increase their vulnerability to adverse maternal health outcomes. Scholars trace current racial disparities in maternal and infant health back to the exploitation of Black women’s reproduction during enslavement, as Black women were forced to bear children to generate labor (Owens & Fett, 2020). Decades later, Dr. Dorothy Roberts highlighted how Black women’s reproductive capacities remained under surveillance and control in the 1980s and 1990s through state-sanctioned policies that promoted contraception, abortion, and sterilization among Black mothers more often than with White mothers.

As recent as 2020, studies have found that regardless of age, education, wealth, or healthcare resources, systemic misogynoir endangers the lives of Black women and their babies. For instance, some White medical students and professionals still believe racist biological myths that were disproven decades ago (i.e., Black skin is thicker than White skin and Black patients have a higher pain tolerance), which may result in a denial of care and poorer treatment for Black female patients (e.g., Dr. Susan Moore).

The Center for American Progress’s Maternal and Infant Mortality Report reviewed multiple studies and found that Black women consistently reported that they experienced “bias and discrimination based on their reach and gender in health care settings…feeling invisible or unheard when asking medical providers for help and when expressing issues with pain or discomfort during and after the birthing process.” This work highlights the importance of addressing misogynoir in the healthcare system, in part, by being more sensitive to the concerns — both personal and cultural — of Black women and mothers, themselves.

Reproductive Justice and Black Women’s Maternal Autonomy

In a recent study under review in Qualitative Health Research, my colleagues and I explored Black women’s “pathways to motherhood,” or the multiplicative ways in which Black women arrive at mothering responsibilities. We talked to 31 Black mothers (ages 25-50) across the United States, and used a reproductive justice framework to explore the women's genetic, gestational, and/or social entry to motherhood.

We drew on Sister Song’s reproductive justice framework as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” This framework rests on the premise that systemic inequality has shaped Black women’s decision-making around childbearing and parenting, and highlights how contextual factors (e.g., ability, sexual orientation, age, carceral status, and employment status) affect reproductive and family planning options.

Pathways to Motherhood among Black Women*

The women described three main pathways to motherhood: (1) intentional family planning, (2) contextual factors surrounding an unintended pregnancy, and (3) othermothering. Below, we highlight a few key takeaway points in each theme.

Intentional Family Planning

For most of the women, their entry to motherhood involved conversations with their partner or spouse about starting a family with children.

  • Most of the women were in long-term relationships or marriages when they decided they wanted children, and they felt financially and emotionally prepared to plan and execute their family planning desires.
  • Although the majority of the women were heterosexual, one of the lesbian women in our sample highlighted how they and their wife’s pathway to motherhood required the intentional use of assisted reproductive technologies — an understudied area of family planning for Black women and women of color.

Unintentional Pregnancy

Most of the women had an interest in becoming mothers eventually; yet, some women described how an unintentional pregnancy hastened this process.

  • While some mothers described an unintended pregnancy during their late teens, several of the unintended pregnancies occurred later in the women’s lives — challenging the stereotype that unintentional pregnancies occur only among younger and/or unwed Black women. For those who were not in relationships, they discussed how they established positive co-parenting relationships and drew on their village of family and friends for support.
  • Some women did not have access to birth control or family planning clinics, highlighting how the overreliance on employer-based health insurance in the U.S., makes unemployment a reproductive justice issue.
  • Unintended did not mean unwanted. All of the women felt positively about their decision to become mothers.


Some women described how their pathway to motherhood occurred through significant caretaking responsibilities for younger siblings or other family members — which they described as “othermothering.”

  • In many cases, their experiences mirrored studies on parentification, which refers to a family dynamic in which children assume parental responsibilities – often due to inadequate financial and/or supportive resources.
  • In its original context, othermothering is a positive component of kinship and support within the Black community. However, it represented a significant burden for the women who had to assume mothering responsibilities during girlhood.

What Factors Affected Black Women’s Pathways to Motherhood?

The women cited a number of significant influences on when and how they decided to become mothers, including:

  • Access to family planning services (including contraception, abortion, IVF and ART)
  • Desire (or lack thereof) to have children
  • Extended support (i.e., family, fictive kin, and friends)
  • Fertility and other health-related factors
  • Financial feasibility
  • Intimate relationship quality with partner and/or potential co-parents
  • Parentification during childhood
  • Timing (i.e., alignment with personal and professional goals)

To find more resources on reproductive justice, check out the Sister Song network and to find more ways to advance Black maternal health, check out Black Mamas Matter Alliance.

*While our study focused on motherhood among cisgender Black women, we wanted to highlight a great resource on inclusive birthing terms.