I hope to be a mother one day.

It’s World Prematurity Day once again. In 2021, for the first time in over six years, the United States overall saw a reduction in preterm birth rates—one of the leading causes of infant death—but when one looked closely at the data, this was not the case for Black Americans. For Black Americans, the rates of preterm birth increased. As a Black woman who is fighting for racial equity and birth justice, I encounter statistics like these all the time, and this drives me to work harder. Even so, I remember my response to this particular fact provoking a very different response; I felt fearful.

Fast forward to this past summer when I was moved to share my fears about childbirth in a very public forum when I was a speaker at the California Black Birth Equity Summit. Something unexpected happened next. After the conclusion of my panel, several Black women approached me saying, “That was so real, thank you for sharing that,” and “To be honest, I’m scared, too.”

Why must Black women endure this fear on top of everything else we face in this country? There are regular stories in the news of the many Black women and babies dying at the hands of a healthcare system that has been proven to undervalue us. Shalon Irving, an epidemiologist for the CDC, collapsed and died in her home three weeks after giving birth to her daughter in 2017. April Valentine died in a California hospital after her cries of pain were ignored by her healthcare providers. Olympian Tori Bowie died while eight months pregnant and her baby was stillborn.

The fear of giving birth that I and many others in the U.S. feel is not unfounded, and the persistence of anti-Black racism looms constantly in healthcare settings and everywhere else. Numerous studies highlight how implicit biases and stereotypes contribute to substandard care and inadequate attention to Black women's concerns. This systemic racism perpetuates a cycle of mistrust and fear, discouraging Black women and exacerbating the risks associated with pregnancy.

The fight for births without fear requires a comprehensive overhaul of the existing healthcare system, increasing the number of healthcare providers from diverse backgrounds, implementing anti-bias training, and promoting culturally sensitive care. It requires listening to the people who are impacted most and enacting policies to dismantle systemic racism and address the social determinants of health that contribute to the higher rates of preterm birth among Black women. This involves investing in community-based programs, improving access to education and employment opportunities, and addressing the racial wealth gap.

This is an important and ongoing struggle for everyone in the United States. To ensure safer childbirth experiences for all, we must continue to advocate for change. It is crucial to amplify the voices of Black women and support initiatives that prioritize racial equity and birth justice. By addressing the underlying issues of systemic racism and providing culturally sensitive care, we can work towards a future where all women and birth people, regardless of their race, can embark on having children without fear.

I find hope in the research and the support systems being developed for Black women and birthing people. There’s a movement to promote the successful and joyful realization of a safe and empowering childbirth experience. It’s heartening to work alongside all the many powerful people with lived experience, advocates, and researchers working tirelessly to address the racial disparities in maternal healthcare and improve birth outcomes for Black women and birthing people. It's a challenging fight, but collaboration and action are the solution.

Going back to where I started, on World Prematurity Day, it is crucial to acknowledge the fear that Black women like me and birthing people experience when giving birth in the United States. It is equally important to acknowledge our dreams.

I hope to be a mother one day, and it is also my hope that sooner rather than later, you and I will exist in a world where, in place of fear, there is joy; in place of death, there is life.

Solaire Spellen, MPH, is the interim executive director of the UCSF California Preterm Birth Initiative. Voices for Birth Justice is the initiative’s public awareness campaign. You can read more about Solaire and many other birth justice advocates there.