In America, your ZIP code can predict everything from your income to your lifespan. For Black mothers, it can also determine whether you and your baby make it out of childbirth alive. That’s not poetic exaggeration—it’s data.

As of 2025, more than one-third of U.S. counties are classified as maternity care deserts—places with no hospital offering obstetric care, no birth centers, and no OB-GYNs or certified nurse midwives within easy reach. For the women who live there, the closest delivery room might be an hour or more away. And in those hours, a complication that could be survivable with prompt care can turn fatal.

Black women already face a staggering disadvantage: we are 2.6 times more likely than white women to die from pregnancy-related causes. That’s not because our bodies are weaker—it’s because the systems around us are. Racism in healthcare, economic inequities, and limited access to quality facilities create a perfect storm. And the storm is deadliest in rural Black communities and low-income urban neighborhoods.

Even when Black mothers survive childbirth, we’re often left to navigate the postpartum period alone. Nationally, 1 in 7 mothers experiences postpartum depression, but rates are higher among Black women—especially those in care deserts. These mothers are less likely to be screened for depression or anxiety, less likely to receive mental health referrals, and more likely to be dismissed when they say something feels wrong.

The American College of Obstetricians and Gynecologists recommends early postpartum follow-up, including mental health screening, for all new mothers. But in maternity care deserts, that’s a recommendation without infrastructure. If there’s no provider nearby—or if Medicaid coverage ends 60 days after birth—those follow-ups don’t happen.

The result? Untreated depression, strained bonding with newborns, and, in the worst cases, tragedy.

The good news is that solutions are emerging—not from state capitols or federal agencies, but from communities themselves. Grassroots organizations in Black neighborhoods are creating birth justice models that fill the gaps left by policy neglect.

Some are training community doulas who not only assist during labor but check in for weeks after birth. Others are developing peer-led psychosocial programs, where trained mothers from the community visit new moms at home to offer emotional support, answer questions, and connect them to resources. Studies show doula care can reduce postpartum depression symptoms by up to 58% and lower C-section rates by over 50%.

In Jackson, Mississippi, the “Sister Circle” program pairs experienced mothers with first-time moms, offering weekly home visits for the first 12 weeks postpartum. In Detroit, a coalition of doulas and mental health professionals runs a hotline for new moms experiencing anxiety, depression, or breastfeeding struggles—staffed entirely by Black women.

These programs work. But they survive on shoestring budgets and grant cycles, not guaranteed funding. Without systemic investment, they can’t reach every mother who needs them.

If the United States is serious about addressing the maternal mortality crisis—especially for Black women—policy has to match rhetoric. That means:

• Expanding Medicaid coverage for a full year postpartum in every state.
• Funding community-based doula and peer support programs in high-risk ZIP codes.
• Mandating universal postpartum depression screening, with telehealth options for rural mothers.
• Addressing the root causes of maternity care deserts by incentivizing OB-GYNs, midwives, and mental health providers to practice in underserved areas.

We know what works. We just have to decide that Black mothers are worth the investment.

No mother should have to calculate how far she lives from a delivery room before deciding whether she can safely have a baby. No mother should have to rely on luck to survive childbirth. And no mother should have to navigate postpartum depression in silence because the nearest provider is miles—or months—away.

The maternal health crisis for Black women isn’t inevitable. It’s the predictable outcome of policy choices. Which means it’s also solvable.

Our lives—and our babies’ lives—are not negotiable. And until the country treats them as nonnegotiable, we’ll keep building our own care systems in the shadows. Because when the state abandons us, the village will deliver us.