Black mothers face disproportionately high rates of Black maternal mortality and morbidity,¹ and we’re seeing that fear around maternal mortality and morbidity in the women we work with at Black Women’s Blueprint. The stories and fear of Black maternal death are also impacting the mental health of Black women. Stressors with systemic racism in health care, disparities, and fear of getting inadequate medical care can also contribute to this trauma. None of this is new, though the issue has recently received more attention because of some high-profile cases including the Olympic athlete Tori Bowie, who died of childbirth complications at 32.

I’m especially interested in the Black maternal psycho-spiritual state. To understand why this is so important, I want to start by looking back at the story of Margaret Garner in 1856, whose experience was the basis for Toni Morrison’s novel Beloved. Margaret Garner was born into slavery June 4, 1834, on Maplewood plantation somewhere in Kentucky. Working as a house slave for much of her life, Garner often traveled with her masters, and even accompanied them on shopping trips to free territories in Cincinnati, Ohio.

The 1850s were also the period in which the Underground Railroad was at its height, transporting numerous slaves to freedom in Canada. The Garners decided to take advantage of such an opportunity and escape enslavement. On January 27, 1856, they set out for their first stop on their route to freedom, Joseph Kite’s house in Cincinnati.

The Garners made it safely to Kite’s home on a Monday morning where they awaited their next guide. Within hours, the Garner’s master, A. K. Gaines, and federal marshals stormed Kite’s home with warrants for the Garners. Determined not to return to slavery, Margret decided to take the lives of herself and her children.

When the marshals found Margaret in the back room, she had slit her two-year-old daughter’s throat with a butcher knife, killing her. The other children lay there on the floor wounded but still alive. In a bid to gain freedom for Margaret and her children, Joliffe, another abolitionist and lawyer, convinced officials to arrest Margaret. They say she was charged for the murder of her children, but really it was for stolen property, right?

Margaret Garner was released back into freedom, but she went through several trials. And what I want us to ask about Margaret Garner’s story is: What was her psycho-spiritual state when she made the decision that pulled her to the edges of herself? The question we typically hear is: Is slavery worse than death when it comes to Margaret Garner? But I also want to ask: Is the horrific nightmare of the psychic trauma of slavery worse than death?

Joy James’s work on “the captive maternal” is essential while we’re investigating this issue of Black maternal mental health and the legacies of slavery. James says,

We move or fall, breathe or suffocate, while living and caretaking amid hostilities toward Black life. Black parents and communities labor to keep children, elders, and themselves stable and protected. That care can be fueled by fear or love, or loyalty, or a mixture of motivations. Our labor is often used to stabilize the very structures that prey upon us, particularly our rebels and resisters. In the first stage of the Captive Maternal, we are conflicted or celebratory caretakers in the “hold” or in the big house. Agape—love through political will—is our cradle and compass. Our generative powers are often stolen, siphoned, and repurposed by the state, corporation, and nonprofit. Steal them back. We fear but crave rebellions, walk like a toddler given the mixed messaging, (re)steal oneself from slavery.²

Again, I turn to Toni Morrison, whose work has been the place where I and others have been able to bear witness to the testimonies of Black women and the Black maternal in ways that weren’t possible otherwise, because there’s a deep silence around these issues in our societal spaces. Toni Morrison actually delivers for us a catalog of the Black maternal psychosocial posture. We see it in all of her novels. We see examples of God’s immaculate presence, plenty of examples even of women laughing at God when others bring God to them in the midst of maternal crisis, or in some instances, communing with God, or shouting.

These radical sites of undoing are actually the Black religious spaces that we keep asking about. This room where Margaret Garner is seeking and searching for personal and collective divinity that is linked to liberation, a divinity that is tied to her sovereignty and her dignity, is one of these sites.

Andrea O’Reilly shows us how Morrison’s fiction is actually a Black religious space. It provides this theological perspective where we see, in various examples, recognition of the divine, reclamation of the body, cultivation of Earth, and gathering of community.³

There’s a mercy in seeking the lineage and genealogy of mothers that we discover in the sermonic chapters of Toni Morrison, and also in the work we do every day around unmonstering Black mothers. There was so much work done to monsterize Black women, to claim that we were not fit to parent our children or to have the reproductive choice that we fight for.

So Toni Morrison shows us the past in her historical fiction, but we also have a current present example in Ebony Wilkerson. Ebony Wilkerson is a Black mother whose headlines read, “A pregnant mother drives a minivan into the Florida surf, carrying her young children with her into the waves.” Several years ago in Daytona, a Black pregnant mother who was experiencing a pregnancy psychosis, but also potentially postpartum psychosis as well because she has young children, reports in court, “I just kept going, kept following the Holy Spirit. I was following the Holy Spirit wherever I went.” While her children were screaming in the backseat, she was driving into the ocean, telling her children to go to sleep. “The Holy Spirit is calling me to the waters,” those were her words. So what is this edge that we’re seeing the Black maternal on? What is this edge that the captive maternal is working through and how does it happen?

To answer this, we can return to some data around Black maternal health that I think are really poignant, including that Black mothers are more likely to experience these perinatal disorders, these mood disorders, and these anxiety disorders, and at the same time they still receive lower-quality mental health care than their white counterparts.

60 percent of Black mothers suffering from these illnesses do not receive any treatment or support at all. In the case of Ebony Wilkerson, she called her sister and said, “I’m being called to the water.” Her sister called the police. The police came and interviewed her. The police left her at home just hours before she drove to the edge of the water.

While postpartum depression can affect one in seven women on average, studies suggest that Black women experience postpartum depression at higher rates.⁴ And Black women face barriers to accessing mental health services. When we talk about these barriers, we’re talking about the need for culturally competent, spiritually informed responsive care for Black women.

Maternal suicide is also on the rise. While there’s not a lot of data around Black women and maternal suicide, we have data around how diagnoses of suicidal ideation amongst Black women have surged more than 700%. Several studies have shown an increase in depression, suicide, and suicidal ideation among Black women in the past 10–15 years.⁵

One of the main reasons we see this disproportionate onset of psychosis among pregnant and postpartum women is due to the racism and toxic stress that Black women are always weathering, in the present day as well as in the past. So exposure to racism, racial discrimination, this is a significant stressor for Black women.

And then there is obstetric racism. Dána-Ain Davis gives us six dimensions of obstetric racism that we’re seeing more and more in hospital-based care, gynecological care.⁶ The six dimensions include diagnostic lapse, which is when a clinician’s uninterrogated belief that blackness and Black people’s conditions are pathological and leads them to de-emphasizing, or exaggerating, or ignoring their pain.

“Just go home and lay down. Just rest,” Black women are told. They are treated with neglect, dismissiveness, or disrespect. Medical professionals ignore or dismiss a person’s expressed need for reproductive health or care, intentionally causing pain because these professionals fail to appropriately manage pain, steeped as they are in a racialized belief that Black women don’t experience pain.

We also see coercion, ceremonies of degradation where we have ritualistic and routinized ways of causing pain for Black women, medical abuse, and racial recognizance which describes the Herculean effort made by Black women to avoid and mitigate racist encounters that include hypervigilance against their care.

So there’s no dearth of data and research on Black maternal mental health and obstetric racism. Black feminist scholars are taking that up. We see it, but we’re not intervening. We see existing neurobiological presentations of trauma in the prenatal period, and in the perinatal arc which includes hormonal changes, epigenetic modifications, neurotransmitter imbalance, attachment and bonding, and the one we know so well, transgenerational transmission of trauma.

This happens in the perinatal period. It happens in gestation. And so, of course, the question is: Where can religious spaces intervene? Where was the church for Ebony Wilkerson who was following God out to the water? Where was God in the room with Margaret Garner?

I would say there is a missed opportunity across religious communities in our spaces. We’re not taking up for the Black family, folks who are parents, people across the gender spectrum as well who are pregnant and parenting. This kind of care and support needs to go beyond a cry room on Sunday morning, where you can get up from the pew and take your nursing baby and sit in the back, which actually separates mothers from the kind of community that they need.

Black Women’s Blueprint (now Restore Forward) was born and raised in Brooklyn more than ten years ago, so New York City is our original stomping ground. In recent years, we’ve expanded to a 300-acre campus in upstate New York where we are actually holding and facilitating retreats to integrate somatic modalities and interventions. We create ceremonies for Black women and girls to come around their sovereignty and their dignity.

Among our organization’s important milestones are the following:

• Convened the first-ever Black Women’s Truth & Reconciliation Commission (BWTRC) to focus on Black women and sexual violence.
• Testified at the United Nations, demanding Black women be written into international human rights history, offering testimony in front of the International Committee on the Eradication of Racial Discrimination (CERD) and International Committee to End Torture (CAT), and demanding that the Convention on the Eradication of All Forms of Discrimination Against Women (CEDAW) be ratified.
• Created the Sista’s Van, a mobile healing unit to serve survivors of sexual violence, trafficking, reproductive violence, and physical abuse.
• Developed the Sexual Abuse to Maternal Mortality Pipeline report and training series. 
• Designed trainings geared towards the prevention and intervention of gender violence in the workplace. Notable clients included the NFL, NYPD, HBCUs, and A+E Networks.
• Created the Liberatory Trauma-Healing model through an iterative cycle, which we as survivors used to liberate ourselves. Through our Liberatory Trauma Healing Model, we cultivated and built brave space, mobilized communities, truth councils and cohorts of fierce advocates, activists, and community leaders.

This is life-giving, essential work that we are honored to do, but I challenge each one of you: In whatever role you hold, how can you support or advance efforts toward sovereignty and dignity for Black women and girls? Churches, schools and universities, hospitals and clinics, and law enforcement agencies all meet Black women at crucial crossing points in their lives. What kinds of hiring and training and instituting new models are you engaging in to challenge the histories and practices of your organizations?

Sevonna Brown, national director of Black Women’s Blueprint, leads the Safer Childbirth Cities Initiative through Merck for Mothers maternal health portfolio. She is a doula and has been featured in the documentary The Business of Birth Control directed by Ricki Lake and Abby Epstein as well as Aftershock directed by Tonya Lewis Lee and Paula Eiselt. She has written numerous op-eds and published articles on issues of reproductive and maternal health in Ebony, TIME Magazine, For Harriet, Rewire News, and other publications.