Why Black mothers need the Mamas First Act to pass

Black lawmakers speak out about the Mamas First Act, reintroduced in Congress in July, that could make pregnancy so much safer.

For many expectant Black parents, a doula can be the difference between becoming empowered and being dismissed. Meanwhile, a lactation consultant could leave an overwhelmed new mother feeling finally seen and heard. Then you have midwives who can, at times, advocate for a family when it seems like no one else can. At a time when the Black maternal mortality rate remains concerningly high, this type of support can be life-saving care. However, these services can be costly for many Black families to fund out of pocket—something lawmakers are hoping to change with legislation that puts mamas first.

Last month, the Mamas First Act, which seeks to expand Medicaid benefits to include doulas, midwives, and more, was reintroduced in Congress with Democratic senators Cory Booker and Elizabeth Warren leading the charge.

“The Mamas First Act meets a crisis that is costing mothers their lives—especially Black and Indigenous women who walk into delivery rooms carrying risks no family should bear,” Booker said in a statement. 

He continued, “By ensuring Medicaid reimburses doulas, midwives, tribal midwives, and lactation support professionals, this bill delivers the trusted care that keeps mothers safe and babies alive. Congress must act now.”

Introduced alongside Representatives Gwen Moore (D-WI-04), Debbie Dingell (D-MI-06), Alma Adams (D-NC-12), and Ayanna Pressley (D-MA-07), the bill—which would amend the Social Security Act to allow doulas, midwives, tribal midwives, and lactation support providers to be reimbursed by Medicaid—could be a huge step in addressing the Black maternal health crisis. 

“It is incumbent upon us all to treat mothers with the dignity, respect, and care that they deserve—and that means tackling the maternal morbidity crisis head on, especially for Black communities who feel the disproportionate impact of this crisis,” Pressley said in a release.

Presently in the United States, according to the Centers for Disease Control and Prevention and the National Council of Urban Indian Health, Black, American Indian, and Alaskan Native mothers are dying at four to five times the rate of their white counterparts during childbirth or from pregnancy-related complications. It’s also been reported by the CDC that more than 80% of these deaths are preventable. 

This grim rate is partly because women of color continue to face systematic barriers and racial biases, leading to delays in recognizing symptoms, not acknowledging the patient’s pain, not fully elaborating on treatment options, and being pushed towards C-sections at higher rates.

The Mamas First Act would confront this discrimination head-on by making it easier for Black and Brown women to afford not just this essential care but also culturally competent care and support that too often remains out of reach. 

Midwives, tribal midwives, and lactation support providers have all been proven to combat discrimination in some cases while reducing C-sections, decreasing maternal anxiety, improving communication between pregnant women and their health care providers, and ultimately improving the odds for families. Lactation consultants have also been proven to dramatically improve outcomes for lactation challenges early on. Yet, at the same time, doulas can range in price from roughly $400 to $3,000, the Bump reported, while lactation consultants can range anywhere from  $150 to $500 per visit. 

“Every mother deserves the care and support needed for a healthy pregnancy and safe delivery,” said Rep. Adams, Co-Founder and Co-Chair of the Black Maternal Health Caucus. 

She added, “Research shows that doula and midwife care can improve maternal health outcomes and reduce pregnancy-related complications.”

“Yet the United States continues to face an unacceptable maternal mortality crisis, and Black women are nearly three times more likely to die from pregnancy-related causes than women of other racial and ethnic groups,” Adams said. “Moms can’t wait, and neither should Congress. We must expand access to high-quality maternal care and ensure every mother has the opportunity to thrive before, during, and after pregnancy.”

While the bill could address an urgent need, it also essentially seeks to expand Medicaid at a time when the political climate is ill-suited to doing so. Even though this bill would have a tremendous benefit for all, the lawmakers involved have also led with the ways it could benefit Black and brown families at a time when there have been concerted efforts to pull back on diversity, equity, and inclusion, including in health programs targeting diverse mothers. This bill is also being reintroduced after it failed to pass in 2024.

Despite those odds, lawmakers say this cause is too urgent to just throw in the towel. Several different Black organizations have endorsed the bill, including Ujima, The National Center on Violence Against Women in the Black Community, BMMA Inc. (Black Mamas Matter Alliance, Incorporated), and In Our Own Voice: National Black Women’s Reproductive Justice Agenda.

Rep. Underwood, co-founder and co-chair of the Black Maternal Health Caucus, shared in a release why she was proud to join her colleagues in reintroducing this bill. 

“Support from care workers like doulas and midwives can make the difference between a positive and healthy pregnancy outcome, and a devastating one. Every mom should be able to access this critically important care,” she said. “As Co-Founder and Co-Chair of the Black Maternal Health Caucus, I’m proud to join my colleagues and introduce the Mamas First Act, a bold step to address our country’s maternal mortality crisis by expanding Medicaid coverage to include doula, midwife, and lactation care. Together, we can, and must, take decisive action to save lives and end disparities.”

“Our Mamas First Act would save lives and improve the quality of care,” Pressley added. “I’m proud to co-lead this legislation with my colleagues to put an end to the maternal morbidity crisis and protect mothers now.”