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“I don’t want to die.”
That’s what a pregnant Black woman told Adriana Hawkins-Smith, a doula serving McComb, Mississippi, during a prenatal visit last year.
The two met up over coffee to discuss birth plans when the mother’s fear bubbled to the surface. The expectant mom was afraid of dying at the town’s only hospital after hearing multiple Black women died there during childbirth.
As the only Black doula serving McComb’s population of 12,000, Hawkins-Smith wasn’t surprised by her concern — many local women had it.
“That’s a known statement in the Black community of Black moms here,” she says. “Some of them say, ‘Well, that’s all we have. I just pray they don’t kill me.’”
Hawkins-Smith says by the end of the meeting, the mother decided to leave McComb and drive 80 miles north to the capital, Jackson, to have her baby at a different hospital.
“We had no complications,” she says about the December birth.
That’s the reality for Black moms in rural communities: maternity care options are limited, and systemic racism makes it even harder to choose.
Hospital Closures Are Leaving Moms Deserted
McComb isn’t alone in its lack of maternity care options.
A recent report from March of Dimes revealed that a third of the nation’s counties are designated as “maternity care deserts” — areas with no hospital obstetric care, birth center, or obstetric provider.
Rural counties in the South, where most Black Americans live, and Midwest represent the majority of maternity care deserts.
And Black families are feeling the impact.
One in six Black babies were born in areas with limited or no access to maternity care services in 2020.
Georgina Dukes-Harris, senior director at Unite Us, says pregnant Black women and mothers are vulnerable because of rural hospital closures.
Since 2005, 181 rural hospitals have shut down nationwide, leaving rural women stranded.
As a result, compared to urban residents, rural women and mothers are 9% more likely to experience severe morbidity — potentially life-threatening complications during or immediately after childbirth — or mortality.
Hospitals are closing for various reasons, including shortages of obstetricians and family physicians.
“If we keep down the path that we’re going, we’re going to continue to cause harm to our mothers, especially our Black mothers in those rural communities who already have significantly high disparities,” Dukes-Harris says.
Dukes-Harris says motherhood is “extremely terrifying” for Black women because of the racist society Black children are born into, but not having access to care makes it harder.
“You’re in a community that has to pull itself up by its bootstraps,” she says.
States like Mississippi, Georgia, and Florida have rejected Medicaid expansion, which supporters say could reduce maternal mortality and preterm births. In the meantime, doulas are showing up as educators, advocates, and caregivers for pregnant women.
“Doulas play a significant role in [the workforce] because they are a person of trust when it comes to mothers,” Dukes-Harris says.
Doulas Can’t Do It All, But They Try
Hawkins-Smith became certified as a doula in 2020 as the COVID pandemic unraveled. She’s served roughly 10 families in McComb and surrounding areas, even traveling as far as 100 miles south to New Orleans.
While research has found doula care improves birth outcomes, Hawkins-Smith says moms in her area “genuinely cannot afford it.”
“Every now and then, I do offer pro bono…I will offer discounted services depending on what has been explained to me,” she says.
But she can only do so much.
She wishes grant programs that cover doula fees existed in her area so finances wouldn’t be the difference between a healthy pregnancy and a tragic one.
“There’s a lot of single moms in the area…they need that support,” she says.
Overall, Hawkins-Smith is focused on making sure moms in her community know one thing.
“You don’t have to go through birth and postpartum alone.”
