Birthing Barriers: Designing for Black Birth Equity

About the Project

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This Designmatters Studio challenged transdisciplinary students to learn about the disparity and dangers facing pregnant Black birthing people in Los Angeles County who are four times more likely than white birthing people to die of complications related to pregnancy and childbirth. Students collaboratively designed a comprehensive multi-modal awareness campaign with the goal of expanding access to equitable child birthing experiences and increasing awareness about choosing Black midwifery to improve health outcomes – for the birthing person, baby and the entire family.

Project Brief

Transdisciplinary students in this Designmatters Studio learned how systemic racism, lack of midwifery care options and dearth of midwives and doulas of color contribute to an alarming disparity between Black and white birthing people in Los Angeles County. Black babies are three times more likely than white babies to die before their first birthday; likewise statistics shows that Black birthing people are four times more likely than white birthing people to die of complications related to pregnancy and childbirth.

With a goal of facilitating access to equitable birthing experiences and increasing awareness about Black midwives, student teams designed a comprehensive multi-modal campaign targeted to Black birthing people but one that would resonate with birthing people from all backgrounds, cultures and sexual identities.

About Midwifery and the Black Birthing Experience

As far back as ancient Egypt in 1550 BC, midwifery was recognized as a female occupation. Throughout the ages and across cultures, older women passed on medical traditions and trained younger midwives to care for pregnant women before, during and after baby was born as well as offering newborn care and ongoing sexual/reproductive health advice.

According to a Library of Congress blogpost, the practice of midwifery within the African and African American community “has roots dating back to the 17th century when Europeans brought African slave women skilled in midwifery to the United States…for each delivery they made, African American midwives could receive as little as two to three dollars in payment.”

In the early1800s, the burgeoning field of obstetrics (dominated by white men) asserted that their modern scientific techniques were superior for mothers and infants rather than midwives. Incorporating racist and xenophobic views, they declared foreign-born and Black midwives as illiterate, incompetent and ignorant – which eventually resulted in the 1921 passage of the Sheppard-Towner Act, a federally funded statute that regulated midwifery workforces – and curtailed much of their activities.

Hospital doctors and physicians soon replaced most midwives in Northern communities, but African American midwives continued practicing in the rural South. The decline of the practice in the South, however, was noticeable. One newspaper article describes that in the 1920s there “were more than 400 of these midwives; in 1950 only two.”

In the late 20th Century, however, more accepting attitudes about midwives prevailed; even the World Health Organization recommended women should have a natural, normal and humanized birth. Midwives started to regain traction and achieve welcoming recognition as highly-trained and specialized professionals in obstetrics. Today, by some accounts, the profession is more than 90 percent white.

Black pregnant women often suffer disproportionate disparities in health outcomes; the CDC reports that Black women experience maternal mortality at a rate 2 to 3 times higher than white women. Black women are 3 times more likely to die from a pregnancy-related cause than white women. Quality healthcare, underlying conditions, structural racism and implicit bias make up some of the contributing factors.

Lately, there has been a grassroots movement by Black midwives to revive and reenergize the practice, offering competency and compassion for Black birthing people, their babies and their families.

Research and Project Development

Kicking off the studio students were introduced to the founders of Kindred Space LA, a birthing community center in South Los Angeles, who presented an informal discussion about the nature of midwifery and their work as one of the few birthing centers that reaches out to the Black community.

Through questions and answers, the two founders – Allegra Hill and Kimberly Durdin – discussed their professional midwifery careers which led them to create this unique birthing center that serves as medical and emotional support for Black and all POC pregnant people.

Students heard about the history of midwives, especially Black midwives, and the differences between doulas and midwives. There was much discussion about the current health care crises that faces the Black pregnant community. On the average, Black women are 2-3 time more likely to die or have serious complications from their pregnancy. Black babies are dying at a higher rate than white ones. Structural racism contributes to Black pregnant women being typically shuttled quickly through doctor’s appointments with little time for in-depth consultations.

Choosing a midwife allows Black birthing people to have an alternative to the typical brief doctor interactions and impersonal hospitalizations. Students learned that midwifery incorporates more than just medical care, but rather addresses the holistic needs of the pregnant person at all stages of pregnancy and beyond. Local grassroots efforts are seeking to engage and enlighten more Black, POC and the transgendered and binary communities about the option of midwifery.

To demonstrate how midwives assist with a homebirth, Hill shared a personal video of her own experience giving birth. The students witnessed first-hand how midwives attended the couple, gave them proper space, and welcomed the newborn. The gentleness and care demonstrated was emotional and uplifting.

Over the following weeks, students were deeply engaged in researching the topic, both the historical aspects as well as how present-day midwives and pregnant people who are continuing the tradition of supporting the Black birthing experience.

A field trip to Kindred LA provided the students with an up-close sense of how care is administered and the life-affirming work of midwives. Students toured the facilities, observed interactions and gained a better understanding of the issues; the experience also sparked students with tangible opportunities that could fuel their final presentation/campaign element.

During the research phase, presentations from experts helped the students deeply understand the topic.

Teams heard from a variety of speakers and panelists who included: Dr. Carlene Fider, professor at Pacific Oaks College who discussed the Social Determinants of Health and Racism in Medical Practice; Isis Rose who operates a birthing and post-partum care facility in Central, Illinois where the bulk of her clients are Black; Dr. Keisha Goode, an assistant professor of Sociology at SUNY Westbury who has done extensive research on Black midwifery in the U.S.; Sonya Young Adan and Raena Granberry of the California Black Women’s Health Project; and Priska Neely, a public radio journalist who reported on birth equity issues.

Students examined the work and writings of New York-based artist Jordan Casteel who paints intimate portraits of friends, lovers, family members as well as neighbors and strangers; her depictions, especially of Black masculinity, offered the students an example of how art can provide alternative narratives and showcase the power of representation.

Realizing that equity for birthing people also extend beyond race into sexual identities, students examined the disparity in the birthing experience for queer and transgendered/non-binary individuals. Students strived to expand their concept – which would include inclusive language – to be welcoming to all pregnant people.

Students engaged in in-class activities that involved how sketching, art-making and portrait design communicates big ideas. They also viewed the documentary, Deliver Us, a film about the growing role of Black midwives in addition to When the Bough Breaks, about post-partum depression.

To prepare students for reaching out and soliciting one-on-one interviews with subjects, instructors presented guidelines and best practices for initiating outreach and conducting interviews.

Additional audio testimonies by midwives and pregnant individuals provided the students with rich personal experiences that would inform their design but also assist them in developing empathy with this population segment.

Midterm Presentation

Student teams shared their conceptual designs to members of Kindred Space LA and documentary filmmakers Randi Matthews and Jenny Callaghan, ArtCenter faculty and other guests. Before describing their idea, teams explained their research findings and how their findings helped direct their design thinking. Teams shared their overall focus and mission of the project, how it would be created and the impact they expect to achieve.

Students shared ideation that involved creating a website, a mural and an app; they presented mood boards, initial sketches, personas, color pallets and possible next steps they wished to take to make their project come to life.

Honest and heartfelt critique encouraged the students to keep moving forward with their concepts; teams were challenged to expand their ideas, keep up with research and, if possible, field test a prototype.

Following the midterm, students continued to research how their design thinking can mesh with their objectives; teams reached out and conducted interviews with community members who offered constructive feedback on their project concepts.