Structural and interpersonal racism is blocking aspiring midwives of color from joining the workforce at a critical time for the health of pregnant and birthing people.

The U.S. has alarming disparities in maternal health that will likely intensify following the erosion of reproductive health access in states across the country. Midwifery care and care from providers who share a racial and cultural identity with their patients are proven to improve outcomes for parents and babies. Yet an overwhelming majority of midwives in the U.S. identify as white.

Research from the Abortion Care Training Incubator for Outstanding Nurse Scholars (ACTIONS) program at the University of California, San Francisco, and Commonsense Childbirth found that the high cost of midwifery education and related expenses like loss of income while enrolled in school were major barriers for people of color wanting to enter midwifery education.

People also frequently cited the lack of midwives of color to teach and mentor them. Barriers to becoming a midwife were greater among people with lower levels of income or education.

This survey of aspiring midwives of color across the U.S. is the first study exploring a wide range of barriers to entering midwifery education.

“Aspiring midwives of color are motivated to provide care in their communities to counteract the effects of racism on maternal and infant health,” says Renee Mehra, Ph.D., ACTIONS postdoctoral fellow and first author on the paper. “We need them in the workforce, yet the cost of midwifery education and the lack of racial and ethnic diversity in the profession are standing in their way.”

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“We must act now to train, diversify and deploy a midwifery workforce that can tackle the persistent maternal morbidity and mortality that disproportionately plagues Black and marginalized people in the USA today,” says midwife Jennie Joseph, Founder and President of Commmonsense Childbirth.

The structural and interpersonal racism that impacts people’s ability to become midwives also motivated them to want to provide this care. The strongest motivating factors in the study were providing racially concordant care in their communities, reducing racial health disparities, and their own prior experiences of discrimination in healthcare settings.

To help aspiring midwives of color meet their goals, the researchers suggest solutions including providing funding for students of color for tuition and other living costs, creating a pipeline for midwives of color by enrolling more students of color, and supporting and hiring more teachers of color, and opening more midwifery schools, especially in Historically Black Colleges and Universities.

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