Maternal mortality rates in the United States are the highest of any high-income country.[1] And within the US, Alabama has the highest maternal mortality rates for all races,[2] with Black people three times more likely to die from pregnancy complications and two times more likely to die during giving birth than people of any other race.[3]
Birthing in Alabama
Lori A. Brown, Katrina Collins, Dalton Johnson, Dr. Yashica Robinson, Whitney Leigh White
Eugenia Broughton conducting an examination of a pregnant African American woman, photographed by E. S. Powell, ca. 1950–60s; National Library of Medicine, History of Medicine Collection, Archives, 1946–76, Box 2
To be pregnant in Alabama is to anticipate giving birth in the most vulnerable and unsafe state in the country.[4] Alabama’s long history of poor maternal health outcomes can be traced to scarce prenatal care access, hospital closures across the state compounding rural/urban divisions and producing uneven geographies with no providers, and ongoing systemic racism fostering distrust of the medical profession, which disproportionately affects Black people. Safe home-based midwifery care has remained central for Black women in Alabama given the legacies of slavery and longstanding segregation across the region. Alabama stopped issuing permits to lay midwives in 1977, and it was not until 1980 that nonwhite Alabama hospital birth statistics began to compare to those of the white population.
There are many people steadfastly committed to radically changing the high rates of maternal mortality, including doctors, facility directors, midwives, doulas, grassroot organizers, and attorneys arguing for more just and equitable birthing licensing, regulation practices, and building codes. This conversation brings together advocates on the front lines of this work to identify the challenges of and opportunities for improving maternal health outcomes, especially for Black people, who have experienced the greatest inequities in care.
LORI A. BROWN Given that at-home-birth midwifery practice has a long and successful history serving pregnant people in Alabama, providing care to populations not historically served by the medical establishment, I would like to begin our conversation by asking how you each think about the relationship between birthing and home.
KATRINA COLLINS Back in the day, birth was at home; it was normalized. Women saw their mothers, aunts, and sisters pregnant, giving birth, breastfeeding, and being cared for. Now we have segregated ourselves into our individualized little square boxes that we call homes, and we no longer see or participate in the birthing experience. Moved into the hospital, birthing is a private and individual experience. I have met so many people who fear the birthing process because they have never seen it.
I gave birth to three children in a hospital setting and two at home under the care of certified professional midwives. As a hospital-based midwife, I know that being able to help define “home” for the mother, no matter where she is giving birth, is most important.
DR. YASHICA ROBINSON I think about birthing at home in terms of how bodies work best when they feel most safe. For some, that can be in a hospital; for others, it may be at home; and still for others, it may be in a setting that is between the two. Our goal at Alabama Birth Center (ABC) is to create options for people in our community so that they can choose the environment where they feel most comfortable, where they are safe, where they can be surrounded by people who they feel are able to support them during that time that is so special but can also be scary.
Notes:
[1] “Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries,” Commonwealth Fund, November 18, 2020, https://www. commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries; Lucy Tu, “Why Maternal Mortality Rates Are Getting Worse Across the U.S.,” Scientific American, July 25, 2023, https://www.scientificamerican.com/article/ why-maternal-mortality-rates-are-getting-worse-across-the-u-s/.
[2] Katherine Sacks, Lawson Mansell, and Brooke Shearon, “Maternal Mortality among Vulnerable US Communities,” Milken Institute, August 2023, https://milkeninstitute.org/report/ maternal-mortality-vulnerable-us-communities.
[3] Alander Rocha, “Report: Alabama has Highest Rates of Maternal Mortality among Southern States,” Alabama Reflector, August 2, 2023, https://alabamareflector.com/2023/08/02/ report-alabama-has-highest-rates-of-maternal-mortality-among-southern-states/.
[4] Sacks, Mansell, and Shearon, “Maternal Mortality among Vulnerable US Communities.”
Excerpt from Making Home: Belonging, Memory, and Utopia in the 21st Century, (Cooper Hewitt | The MIT Press, 2025) published in companion with Making Home—Smithsonian Design Triennial (New York, Nov. 2024-Aug. 2025)
“Maternal Deaths, 1957,” Map from the 1957 annual report of the Alabama State Department of Public Health; Alabama Department of Public Health
Lori A. Brown, Kelsey Benitez, and Dr. Yashica Robinson, Birthing Spaces in Alabama: Hospitals, Birthing Centers, and the Home, 2024; Drawing by Kelsey Benitez
See related authors
Lori A. Brown, Katrina Collins, Dalton Johnson, Dr. Yashica Robinson, Whitney Lee White