The urgency of this issue cannot be overstated: there is a Black maternal health crisis in the United States that is a public health and racial justice issue with alarming disparities in maternal health and outcomes for Black mothers and Black babies.
Black Maternal Health Week, April 11 -17th, has been recognized since 2021. In the United States — the wealthiest country in the world — statistics show that Black women are more than three times more likely than White women to die from pregnancy-related causes, regardless of income or education. Research also shows that Black babies are twice as likely to die before their first birthday as White babies. And while we have done a better job, we have not done enough to resolve this crisis, and it continues to rob families of their mothers, their daughters, and their futures.
The CDC estimates that 84% of maternal deaths in this country are preventable. But too often, access to quality care depends on where you live, your skin color, and the quality of your health insurance. In California, Black mothers make up just 5% of those giving birth, yet they account for 22% of pregnancy-related deaths. In Los Angeles County, the numbers are just as stark.
Behind the data are stories like April Valentine’s. In January 2023, April, a 31-year-old healthy Black woman, went to Centinela Hospital in Inglewood to give birth. She was denied the presence of her doula (a person trained to provide emotional, physical, and educational support for an expectant mother or one who has recently given birth), subjected to racially charged comments, and had to endure multiple failed attempts to administer an epidural. Her pain and symptoms were ignored. She died in childbirth.
April’s story is heartbreaking but tragically not unique. Following public outcry, California’s Department of Public Health issued a $75,000 fine to Centinela — a rare occurrence but hardly enough to create change. Instead of committing to do better, the hospital shut down its maternity ward altogether, leaving the surrounding community — disproportionately Black and Latino — with even fewer options for safe, respectful care. Centinela was one of 56 maternity units in California that closed since 2012, 13 of which were in L.A. County and owned by for-profit companies. These closures are not just business decisions but life-or-death decisions for entire communities.
Neighborhood Legal Services of Los Angeles County (NLSLA) is rising to the challenge, working to close the critical gaps in care and support that have fueled the Black maternal health crisis through our Health Consumer Center and Medical Legal Partnerships that are embedded in hospitals like Olive View and LAC+USC.
NLSLA’s attorneys in the Health Consumer Center work alongside patients and providers to eliminate legal and systemic barriers to maternal health. We’ve helped clients access out-of-network specialists for high-risk pregnancies when health plans failed them. We’ve secured newborn insurance coverage when red tape threatened care. We’ve advocated for better provider communication, defended clients against medical debt from labor and delivery, and referred discrimination cases to civil rights agencies.
NLSLA’s Medical Legal Community Partnerships collaborate with medical providers, training them to identify the social determinants of health that impact their patient’s health and well-being. Factors like poverty, inadequate housing, food insecurity, and lack of social support can negatively impact maternal health and attorneys and legal advocates from NLSLA address these issues in partnership with medical providers.
When systems fall short, we ensure pregnant people are not navigating this crisis alone.
While preventable deaths continue, there have been improvements. Medi-Cal now covers doula care, as well as postpartum mental health care. Studies have shown that doulas help reduce complications, improve communication with care teams, and even lower the risk of postpartum depression. Access to doulas and postpartum care has the potential to greatly improve outcomes for all women of color.
We know what needs to be done to help protect Black women. We must increase access to quality care earlier in pregnancy — especially for Medi-Cal patients. We must further invest in support services like doulas and mental health care, ensuring the resources and the workforce are available. We must improve the quality of care through education and lived experience to address racial bias and ensure the concerns of all patients, but especially black pregnant women, are heard. We must also expand Medical Legal Partnerships that connect healthcare with legal advocacy to address the social and systemic drivers of poor health.
The Black Maternal Health Crisis will not fix itself. It demands urgent action — not just from policymakers but from health systems, providers, insurers, and communities. Black mothers deserve more than awareness. They deserve justice. They deserve care that sees them, hears them, and protects them. At NLSLA, we’re committed to making that future a reality.
Bernadette Manigault is the Director of Litigation at Neighborhood Legal Services of Los Angeles County (NLSLA).
