Black women and birthing people in the United States face a pressing public health crisis, with alarmingly high maternal and infant mortality rates. According to the CDC in 2023, the national maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, not only an increase from the year prior (49.5 deaths per 100,00), but this significantly exceeds the rates for other racial groups (Hoyert, 2025). This public health disparity runs rampant across the state of Texas, exceeding the national maternal mortality rates consecutively between 2018-2021 (Moss, 2023).

To further illustrate the problem, Texas health data indicates that as of 2020, Black women are 2.5 times more likely to die from pregnancy and childbirth than white women in the state (Texas MMMRC-DSHS, 2024). To top it off, Tarrant and Dallas County are ranked high, almost very high, on the U.S. Maternal Vulnerability Index (MVI). The main contributing factors include the physical environment, socioeconomic issues, and general healthcare quality and access (Surgo Ventures MVI, 2024). These figures underscore the urgent need to address the factors contributing to Black maternal health disparities in Dallas-Fort Worth, throughout Texas, and across the nation.

Three public health professionals interviewed on this topic helped widen the perspective and understanding of how to address this crisis and best support healthy black pregnancies and mothers. All employed by a state-wide public health nonprofit, the three women interviewed include a Health Educator, a Senior Director of Training and Technical Assistance, and a Women’s Health Policy Advisor.

As emphasized by all interviewees, a critical and universally recognized need is the establishment of mandatory cultural competency within medical spaces and among healthcare providers. The Policy Advisor strongly recommended a legislative bill to enforce this, highlighting the necessity of formal policy to drive meaningful change. The Educator elaborated, stressing the importance of cultural humility; healthcare professionals must be willing to enter Black community spaces, setting aside their “expert hat” and genuinely engaging with the lived experiences of these women. As the Director articulated, trust is not readily given but earned through consistent and authentic engagement. This intentionality involves showing a holistic interest in Black women beyond simply targeting them with health initiatives, alongside acknowledging the deep-seated medical mistrust rooted in historical traumas. The underrepresentation of Black physicians compounds the feelings; Black physicians make up 5-6% of the medical workforce compared to 13% of the overall U.S. population (The Dose, 2023). This issue, highlighted by Ashlee Wisdom of Health in Her HUE, further reinforces many Black patients’ mistrust toward the healthcare system and their challenges in accessing culturally competent care.

The Director noted that these negative experiences are passed down through generations and contribute significantly to current perceptions of the medical field. This historical distrust, combined with a lack of cultural understanding, directly contributes to poor health outcomes, as women are less likely to seek or adhere to care due to feeling misunderstood, misheard, or dismissed. To bridge this gap, the Policy Advisor emphasized the importance of increasing Black representation within the medical profession and empowering trusted local Black leaders to disseminate public health messages. These initiatives and cultural connections can foster a sense of familiarity and credibility that can rebuild trust and ultimately improve health outcomes in Texas communities.

It is crucial to address not only the immediate health needs of Black mothers and birthing individuals but also their overall well-being. We must recognize that their needs extend well beyond the conventional boundaries of healthcare interventions. The Director emphasized the importance of avoiding re-traumatization by ensuring community partnerships are founded upon shared values and a genuine commitment to the mother’s well-being. This approach requires thorough research and due diligence to ensure referrals are made to individuals and organizations prioritizing comprehensive care. A ‘warm hand-off’ to a trusted partner, rather than a simple community referral, can be the difference between continued engagement and a misstep that erodes trust and disrupts the entire care process.

Moreover, the Director called upon those in positions of privilege—whether professional or social—to leverage their influence as advocates for systemic change. In her own words, “I’m tired of trying to convince people to give a damn.” The weight of the issue is not to be rested upon the shoulders of black mothers and communities being affected; it’s our collective responsibility to address this long-standing problem. The nation and the state have maintained a disastrous disservice to these women and their families, with consequences that reverberate through generations today. Wisdom’s interview with Health in Her HUE verbalizes, “Those who are closest to the problem are often more close to finding a solution to the problem” (2023). Empowering affected communities to lead change by centering Black voices and experiences is crucial for sustainable solutions.

The Policy Advisor highlighted the vital role of Medicaid in safeguarding maternal health, advocating for a robust safety net that extends access and resources to those who fall outside traditional eligibility. The Health Educator highlighted the complex barriers faced by Black mothers and the importance of strong community networks in overcoming these challenges. Building connections is crucial for linking mothers to the support and resources they need, and we should be taking the time to nurture a safe, compassionate, and culturally competent care network.

A consistent theme across all interviews was that acknowledging historical biases and systemic racism is foundational for a meaningful shift. This means working through improvements at all levels, including state legislation, community engagement, and medical spaces. The Director emphasized the importance of recognizing doulas as vital members of the maternal care team, highlighting the improved health outcomes associated with doula support. However, medical spaces often dismiss doulas or impose restrictive certification requirements from monetized organizations, creating unnecessary barriers. The Director strongly advocated eliminating these obstacles and making doula services universally accessible. The Policy Advisor echoed this, calling for extended Medicaid coverage or reimbursement for doulas, integrating them into care settings to build trust and comfort for Black women.

Successful community-based programs further evidence the growing recognition of doulas’ vital role. For instance, in the 76104 area, a United Way program trained 120 community-based doulas to support healthy moms, pregnancies, and babies. These doulas provide comprehensive support, including prenatal education, labor coaching, and postpartum assistance, leading to healthier outcomes and improved labor and delivery experiences. In partnership with TrustHer and Paradigm Doulas, this program highlights the effectiveness of doula support and underscores the need for broader community accessibility. The fact that 23 additional Tarrant County ZIP codes have expressed interest in these services reinforces the demand and impact of doula care (United Way, 2025).

Additionally, the Policy Advisor pointed out that doulas play a crucial role in educating women about navigating health systems and advocating for themselves. Still, misinformation and restrictive legislation currently impede their work. The Director emphasized the need to protect doulas and their vital services actively.

Based on the consistent interview feedback, a health communication campaign should prioritize promoting mandatory cultural competency training within healthcare institutions. This campaign should also focus on fostering trust by acknowledging the historical traumas experienced by Black communities within the medical system. Messaging should emphasize the importance of increasing Black representation in healthcare professions and uplifting trusted community leaders to disseminate health information. The campaign should regularly work to dismantle implicit biases and promote a culture of respect and understanding within healthcare settings.

Furthermore, the health communication campaign should advocate for increased access to doula services, including expanding Medicaid coverage or reimbursement. The campaign should highlight the benefits of doula support and work to eliminate barriers to their integration into maternal care spaces. It should also emphasize the importance of building strong community networks and support systems for Black mothers. The campaign should promote early and standardized health education, empowering people to advocate for themselves and navigate the healthcare system effectively. Additionally, the campaign should actively combat misinformation regarding doula services and advocate for policies that protect and support doulas in Texas.

One of the limitations of this study is its small sample size of three interviewees from the same organization. Furthermore, the study did not include direct interviews with Black women from the affected Texas communities, which would have provided valuable first-hand perspectives and a more comprehensive understanding of the issues.

Future research should include more extensive and diverse participant groups. Studies should also explore the effectiveness of specific cultural competency components or programs and the impact of doula services on maternal health outcomes. Future research should also focus on the personal experiences of Black women within the medical field, utilizing qualitative methods to gain a deeper understanding of their perspectives and challenges. Additionally, after an implementation period, research should be conducted to evaluate the effectiveness of the proposed health communication campaign.

In conclusion, the realities of Black maternal health disparities in Texas and across the nation demand immediate and multifaceted action. The insights from public health professionals and statistical evidence stress the urgent need for systemic change. Change must be driven by mandatory cultural competency training in medical settings, real efforts to rebuild trust in Black communities, doula protection and integration, and empowering those affected to have their voices heard. While this analysis highlights the need for broader research and community engagement, the proposed health communication campaign offers steps towards a solution to address disparities. By prioritizing cultural humility and amplifying Black voices, we can create a healthcare environment where every Black mother and birthing person receives the respect and care they deserve to live healthy lives with their loved ones.