I’ve missed my maternal grandmother my whole life. She died in 1950 in Cleveland, a city in east Tennessee, following a botched tubal ligation surgery after the birth of her fourth child. My mother said that they tied her tubes too early after delivery, and she bled out on the table. Her death certificate cites the cause of death: Ventricular fibrillation due to cyclopropane arithmetic—a heart attack. She was 29.
From records I uncovered in March of this year in Cleveland’s Bradley County Archives and Records Center, gynecological surgeries at Physicians & Surgeons Hospital, where my grandmother died, were routinely performed by nurses and other medics, including ENTs (ears, nose and throat doctors) with no prior training in women’s reproductive health matters.
As a Black woman under the care of an all-White staff of doctors and nurses in the segregated South, Grandmama Catherine had no voice on her own care or who would administer it. And there was no legal recourse for her widower, and no justice for the children she left behind—eleven, ten, six, and a newborn less than 24 hours old—a family fractured by loss, profound grief, and my grandfather’s inability to care for their offspring without her. An unhealed wound for generations.
Still, I would find myself having to explain my aversion to, and complete lack of interest in, having children. That was such a long time ago! was the overriding response from those who would ask. Despite suggestions to the contrary, Black birthing women die.
As one expectant Black mother sums up in the 2022 Hulu documentary Aftershock: “A Black woman having a baby [in the United States] is like a Black man at a traffic stop with the police. You have to pay attention every step of the way.”
The film, directed by Paula Eiselt and Tonya Lewis Lee, recounts the activism of two bereaved fathers following the preventable deaths of their partners due to childbirth complications. I caught myself wiping away tears; the horrors that continue to be perpetuated against Black women in America, and those who love them.
“Black lives matter because Black wombs created Black lives, and when we forget that, we lose our humanity,” rallies social services professional and activist Shawnee Benton Gibson at the Commitment March in Washington, D.C. Her daughter, Shamony, is among those remembered in the documentary. Shamony died from a pulmonary embolism two weeks after giving birth. She was 30. The question remains: why is this still happening to Black women?
Long before the emancipation of enslaved women on plantations, African American women have been used as guinea pigs in White, predominantly male institutions to advance the study and practice of obstetrics and gynecology.
From the devaluation of Black women’s bodies from slave masters’ economic stake in bonded women’s fertility through the sterilization of poor Black women in the late 1970s, it’s not just White men who have neglected women’s procreative interests, but also the mainstream women’s movement, writes sociologist and law professor Dorothy Roberts in her seminal work, Killing the Black Body: Race, Reproduction and the Meaning of Liberty, published in 1997 (and reissued in 2017 by Vintage Books).
Black women, she writes, “especially those who are poor, must deal with a whole range of forces that impair their choices,” including a lack of resources necessary for a healthy pregnancy and parenting relationship.
Research shows that the current maternal mortality rate among Black women is alarming. In a TIME op-ed piece published during Black Maternal Health Week in April 2024, journalist and TV host Elaine Welteroth and world-renowned former tennis player Serena Williams shared their own experiences with childbirth and how unsafe it was for them. Welteroth turned to midwifery care, which she affirmed as “the best decision I ever made.”
Helena Grant is a certified nurse midwife of more than 25 years, and current president of the New York State Association of Licensed Midwives. She told me the only way to improve outcomes for Black women and Black birthing people is a “deep unlearning” of long-held beliefs by clinicians that give them control over a birthing person’s body—and their child.
“People are having conversations around informed consent and shared decision-making,” she said. “But if they really understood what that meant, they wouldn’t like it. Because they, as clinicians, would have to stop some of the behaviors that have become so normalized
in their [various] years of practice.”
For her part, UC Irvine’s Yuqing Guo, associate professor at the Sue & Bill Gross School of Nursing, is working to unlearn old practices by connecting and collaborating with doulas in BIPoC communities—doulas like Jemilla White, director of Doula Programming and Affairs and co-creator of BIRRTH Womxn O.C. The goal of this association is to begin modeling new behaviors for training students and provide team-based support care for the mother and baby.
“We need to ask our clients, ‘What do you want?’” said White. “And some don’t know because they’ve never been asked. So, it’s about making sure our clients feel seen and heard among all of the medical and professional staff: doulas, nurses, midwives, and doctors.”
Though decidedly liberal politically, California is not without its own past ills of segregation, redlining and high mortality rates for Black women. That’s why Black maternal health was identified by the California Reparations Task force as part of a distinct category of harm, and is detailed in their final report.
This non-regulatory state agency was established by California Assembly Bill 3121 in 2020 to study and develop reparation proposals for African Americans.
In her testimony to the task force on Transgenerational Epigenetic Inheritance and Systematic Racism in America, Dr. Joan Kaufman cited well-established studies of how trauma, adversity and discrimination can get “under the skin” and increase risk for a whole host of negative and physical health outcomes.
These negative experiences in one generation can be passed down to affect the health and wellbeing of future generations through transgenerational epigenetics. Which means grandchildren and great grandchildren can be negatively impacted by ancestral trauma even when they’ve not been exposed directly
to any harms themselves.
“In humans, we can’t separate transgenerational trauma from ongoing systemic racism,” said
Dr. Kaufman, the former director of research at the Center for Child and Family Traumatic Stress at Kennedy Krieger Institute and professor of psychiatry at Johns Hopkins School of Medicine. (Kaufman left academia in August of 2022).
“We know no matter how privileged you are, you can still be pulled over, or your child can be pulled over, your child could be killed being in the wrong place, the wrong time, and those are realities. That means that we can’t have a generation that’s non-stressed.”
During my research trip to Tennessee just before spring, I visited the cemetery where my grandparents are buried to oversee the placement of a new headstone for my grandmother. As the bronze headstone was pressed into the red earth, her picture framed in the center, I felt my soul exhale. After nearly 75 years since her death, I was able to help my mother, now 84, honor her mother in a manner she felt was befitting.
Perhaps it’s not the justice we would have wanted for her. Though telling this story goes a long way.
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About the Author: Janice Rhoshalle Littlejohn is a Los Angeles-based essayist and author. Her work-in-progress autoethnography draws on the themes of reproductive choice and America’s obsession with a woman’s womb, through her grandmother’s story and her own.
