Until the mid-20th century, Black midwives, especially in southern regions, were the primary health care providers for Black, Indigenous, immigrant, and white pregnant people alike. Black midwives, also called “Granny midwives,'' were enslaved women and community healers who utilized many techniques and practices passed down from generation to generation, which could be traced back to many parts of Africa. Granny midwives were essential to the health and wellbeing of their communities. They not only provided obstetric care to pregnant people, but also provided many other reproductive and medical health services, including abortions.
The number of Black midwives across the nation began to dwindle in the early 20th century. A national smear campaign organized by the public health, social welfare, and obstetric community stereotyped Black midwives as unclean, uneducated, and dangerous. Childbirth began to be seen as a medicalized procedure rather than a natural phenomenon. Physicians, predominantly white wealthy males, emerged as the primary care providers. Hospitals were seen as places that were safe, hygienic, and clean environments to deliver a child compared to having a child a home. Although intensive research in the 1930s revealed that better birth outcomes were achieved by midwives compared to physicians, Black midwives were blamed for the nation’s mortality rates. The combination of negative messaging campaigns and the passing of new laws and policies regulating the practice of medicine and who could provide services like attending childbirth resulted in only fifteen percent of babies being delivered by a midwife by 1930. The ramifications of their absence in the communities across the nation can be seen today.
Today, people of color experience worse health outcomes than white patients. Compared to white pregnant people, Black pregnant people are four times or more likely to die from pregnancy-related causes. Specifically, even when Black pregnant people’s socioeconomic, marital, and educational levels are higher compared to white pregnant people, the risk of experiencing a negative outcome during pregnancy is still great. Studies show that people who choose a midwife as their care provider during pregnancy and childbirth experience lower numbers of medical interventions and better outcomes for both birthing patient and baby. Moreover, several studies confirm that among low-risk pregnant people, planned home births result in low rates of interventions without an increase in adverse outcomes for both pregnant person and baby. While the rate of out-of-hospital births have increased significantly in the last 50 years, from 0.3 percent in 1975 to a little less than 2 percent of all births today, Black pregnant people are still primarily delivering in hospitals.
Presently, Tennessee matches the national rate of nearly twice the number of Black infants dying in comparison to white infants. Many studies show that states that had integrated midwifery care, where midwives and traditional healthcare providers engage in inter-professional collaboration, were associated with significantly higher rates of physiologic birth, fewer obstetric interventions, and fewer adverse neonatal outcomes. Overall, the more included midwives are in the prenatal and postpartum process, the better the health outcomes for pregnant people and their babies.
CHOICES: Memphis Center for Reproductive Health seeks to do its part by not only increasing the number of Black midwives who are exposed to the full spectrum of sexual and reproductive health services in the South, but to give all pregnant people options to choose which type of care is best for them.
CHOICES was founded in 1974 - we've been a trusted provider of patient-centered medical care in the Mid-South for almost 50 years. CHOICES provides a full spectrum reproductive and sexual health practice with a range of services for more than 4,000 patients each year. Many patients are un- or under-insured and receive outside funding to assist with the cost of medical services provided. Services include medication and procedural abortions, perinatal care and out-of-hospital birth, gender-affirming hormone management, HIV testing and prevention, birth control, and sexual wellness. CHOICES is the only independent abortion provider in Memphis, Tennessee. With the opening of its new health and birth center in September 2020, CHOICES became the first nonprofit health care provider in the country to offer both birth services and abortion care under one roof. Grounded in the principles of reproductive justice, CHOICES centers those with the least access to quality, affordable, inclusive care. To learn more about our patient demographics, please review CHOICES 2020 Annual Report.
