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In March, a month before the beginning of Black Maternal Health Week, the American Journal of Obstetrics and Gynecology published a disparaging study claiming that maternal deaths have been overestimated. Let’s make one thing clear: Black women are dying at disproportionate rates during and after childbirth – and nothing will change until we confront it. Community-based initiatives, in a world of expanding restrictions on abortion and health care systems that were never designed for women of color, are key to creating actual steps forward for birthing people.

Midwife care and doula support during pregnancy and birthing, especially when those providers are Black, is a proven way to combat many of the problems associated with “traditional” medical care for Black birthing people. Doula support has been shown to reduce inessential C-sections, preterm births and unnecessary interventions like epidurals, while increasing breastfeeding rates and overall positive experiences with care for birthing people.

Although they are seen as an alternative to “traditional” hospital births with an OBGYN, doulas and midwives have been immersed in the Black community forever. Before birthing shifted to hospitals, granny midwives played a huge role in the labor and delivery of newborns – especially during the enslavement of Black people. Enslaved women sat in the presence of a birthing person, coaching soon-to-be mothers through breathing, positioning their bodies, advocating for the mother – acting as what we refer to as doulas today while midwives did the work of an OBGYN.

Midwives were used during slavery as vessels to bring more healthy children into the world that would then be used as further commodities under slavery. Midwives literally helped to birth the next generation of enslaved people. Granny midwives were used to train future white male doctors who forcibly experimented on the bodies of many enslaved Black women to further their research and credibility. Yet another example of America being built on the backs of Black women and our bodies – with no credit whatsoever.

Unsurprisingly, white men started to co-opt this field during the 20th century, seeing how much they could profit from women giving birth every day. They referred to midwifery as “witchcraft,” creating fear about the safety and training of midwives, ultimately resulting in labor and delivery largely moving into the care of white male physicians in segregated hospitals.

The shift to hospital birthing also meant a shift from patient-first to provider-first care. There’s a reason why pregnant people are instructed to lie down while giving birth – against the way gravity works, might I add – and it’s not because it actually helps with the process of labor. Many tools used today, including speculums that wouldn’t have existed without the labor of enslaved Black women, weren’t created with patient comfort in mind.

Now, if it’s true that birthing is proven to be better for mother and child with the use of doulas and/or midwives, and if the field of gynecology wouldn’t be what it is today without the centuries of knowledge and experimentation of Black women, why are doulas and midwives not widely given hospital privileges for families that choose to give birth in a “traditional” setting but want the additional protection afforded by a doula?

Birth and postpartum doulas aren’t the only form of doula support, however. Abortion doulas are becoming more common post-Roe, especially as local Planned Parenthoods implement abortion doulas for their patients. Abortion doulas require similar training that birth and postpartum doulas undergo before working with a patient. They’re able to educate the person needing an abortion through their decision, acting as a hand to squeeze or shoulder to cry on during what can be a scary time, especially during increasing uncertainty about the state of abortion. Black women are so afraid to give birth in a system that has continued to fail them that abortion is a key issue during this year’s election.

To tell the story of reproductive justice without the long history of the labor of Black women’s bodies is to do a disservice to the reproductive justice movement. On this 7th annual Black Maternal Health Week, I’m remembering Black Mamas Matter Alliance’s theme – my body still belongs to me. Together, we can create an America where reproductive justice includes Black women and other women of color – both women who want children and those who choose not to.