Expecting Inequity: How the Maternal Health Crisis Affects Even the Wealthiest Black Americans
Khiara M. Bridges
MIT Press, 312 pages
Published March 31, 2026
Expecting Inequity is required reading for me, a full-spectrum birth worker/doula and childbirth educator; if we are to address the maternal health crisis in America, it is essential reading for health care leaders, as well. Law professor Khiara Bridges reminds us that the U.S. has one of the worst maternal mortality rates in the developed world, with Black birthing people two to three times as likely to die during the childbearing year. Many states have acknowledged this gap and expanded access to quality prenatal care through Medicaid and state doula programs. Still, maternal deaths are more common even among the most privileged Black people, with Black college-educated new parents more than five times as likely as their White counterparts to die from perinatal-related complications. Bridges asks the important question, “How does medical racism show up in the lives of wealthier pregnant people?”
In a brilliant interdisciplinary analysis of maternal health disparities, Bridges examines the experiences of Black pregnant people at two hospitals, one less resourced in New York City and a more-resourced one in San Francisco. She analyzes the historical oppression and racial history that lay the groundwork for hospital funding in San Francisco, which mirrors the funding foundations of other American cities. Bridges also evaluates the science behind the Black maternal health crisis, including epigenetics, and how racial trauma can be passed down from one generation to the next.
Most striking, however, is her discussion of how Black birthing people try to increase the likelihood that they’ll be seen as fully human, just to receive adequate care. I get it. I, too, seek out Black physicians and obstetricians, hoping they won’t disregard my concerns or ignore my pain. I have also worn an “insert Ivy League school here” sweatshirt, praying that my doctor will assume I know how to do my research. However, Bridges is clear that White supremacy and implicit biases strip all Black people of their dignity in the medical industrial complex, regardless of socioeconomic status. These deaths are preventable, and the U.S. health care system must do more. If a health care provider doesn’t believe that a Black person is truly in pain or can understand abnormal symptoms during pregnancy and postpartum, delays in treatment can lead to fatalities.
James 3:9 tells us that, “we bless the Lord and Father, and with (our mouths) we curse people, made in the likeness of God.” How do we seek justice for those who lose their lives to preventable deaths? We lean into the conviction that followers of Christ must see the Imago Dei in each other. I am a doula and an agent of peace who helps folks feel seen by El Roi, “the God who sees,” in a medical-industrial complex that may choose not to see them or acknowledge their adverse experiences. Khiara Bridges encourages us to reflect on the sin of racism and then understand how public theology requires us to bring our “imago dei goggles” into all we do.
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