A powerful new study published in the Journal of Racial and Ethnic Health Disparities has put clear numbers to something that so many Black women already know deeply: the fear and worry we carry into pregnancy and birth are not imagined, overblown, or unfounded. They are rooted in real, lived experiences of racism — both in healthcare and in the broader systems that shape our lives.

The article, “Manifestations of Anti-Black Racism and Worry About Pregnancy and Birthing While Black," by Odems, Czaja, Vedam, Evans, Saltzman, and Scott, offers one of the clearest quantitative analyses to date of what many of us have long felt in our bones. In the study, more than 71% of Black women surveyed reported worry about pregnancy and childbirth — both for themselves and for their communities.

But this worry wasn’t tied to general anxiety or fear of the unknown. It was directly and measurably linked to obstetric racism (mistreatment during maternity care) and structural racism (fewer healthcare options, biased assumptions, and unequal systems of care).

The authors contextualize worry not as pathology, but as a form of wisdom. It’s a reflection of perceived risk and anticipated harm — a rational response to navigating pregnancy and birth in a healthcare system marked by anti-Black racism. This framing aligns with what scholars have described as weathering: the toll of accumulated stress, trauma, and vigilance required to survive systems not built for our safety.

One of the study’s most striking findings was that Black women who had experienced mistreatment during maternity care were over six times more likely to express worry about pregnancy and birth than those who had not. And when that mistreatment occurred in communities already marked by limited care options for women of color — what the researchers called “hidden resources” — their worry skyrocketed even higher. In these circumstances, they were 15.6 times more likely to report worry.

These numbers confirm what many Black parents and advocates have been raising alarms about for decades: that racism is not a side issue in maternal healthcare — it is a central force shaping both the experiences and the outcomes of pregnancy and birth.

This study confirms and contextualizes the call from many Black and health-equity researchers, healthcare professionals, and health equity leaders to more intentionally and tangibly center emotional and psychological safety in how we define “quality care.” We cannot claim to advance birth equity if Black birthing people continue to enter perinatal spaces burdened by the fear that they will not be listened to, believed, respected, or protected.

It solidifies that we cannot talk about birth equity without naming the ways anti-Black racism permeates not only physical care but emotional safety. We cannot measure progress only by reducing mortality rates if Black parents still enter birth spaces burdened by valid fear that their dignity, autonomy, and humanity may not be honored.

This study adds to a growing body of evidence showing that meaningful solutions must address the impacts of racism at every level: not only improving individual provider behavior but transforming the systems and structures that deny Black communities equitable access to respectful, responsive, high-quality maternity care. For example, expanding the availability of culturally congruent care options — community birth centers, Black midwives/OBs, doulas, and supportive services — creates more pathways to safer, affirming care.

The authors argue that addressing maternal health equity must go beyond reducing morbidity and mortality; it must also reduce the emotional burden of fear and distrust that Black women rightfully carry into maternity care. They illuminate that only by eliminating obstetric racism within healthcare and tackling structural racism in society can Black mothers be free from worry about pregnancy and childbirth.

It’s not enough to tell Black parents to “advocate for themselves” in broken systems — to perpetuate patterns of “racial reconnaissance” (going to great lengths to present themselves in ways that preempt bias). We need multi-level action: from individual action to hospital protocols to government policy. We need to be building and expanding care models that are inherently safer, more affirming, and more accountable to Black communities. We need policy that funds and protects Black-led care spaces. We need healthcare education that trains providers to confront and dismantle their own biases and complicity in systemic harm. This would mark a meaningful start to combatting a complex and expansive web of (intended + unintended) harms.

As birth workers, educators, advocates, and community members, we should take this study as both validation and call to action. The worry Black women carry into pregnancy and birth is not irrational; it’s an informed, protective response to a care system that has too often failed them. Real change means creating conditions where that worry is no longer necessary.

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