Obstetric Racism and Ableism: A Narrative Review of Barriers to Obstetric Care and Maternal Health Outcomes for Black Disabled Women

Abstract

Introduction:

Black disabled women face disproportionality high rates of maternal morbidity and mortality in the United States. This review synthesizes academic and community perspectives to assess how ableism and racism shape obstetric care and maternal health outcomes, identifying gaps for policy and practice reform.

Methods:

Using an intersectional ecological framework, we conducted a narrative review of peer-reviewed and gray literature on how racism and ableism shape obstetric care for Black disabled women. We searched PubMed, Google Scholar, and targeted sources for studies published in the last 25 years that addressed maternal health outcomes, barriers, or structural racism and ableism. Included sources encompassed qualitative studies, epidemiologic analyses, community reports, and policy analyses that examined barriers across the obstetric care continuum.

Results:

One hundred and fifteen sources were included in this review. Barriers to obstetric care for Black disabled women include: (1) maternal care deserts and inaccessible facilities; (2) inadequate preconception and prenatal care; (3) provider bias, surveillance, and reproductive coercion; (4) gaps in provider knowledge and training on disability and culturally congruent care; and (5) policy failures, such as weak disability rights enforcement, Medicaid nonexpansion, restrictive reproductive laws, and absent intersectional data. These barriers are rooted in racism and ableism, which intersect to cause care delays and denials, fuel mistrust, and increase risks of severe maternal morbidity and mortality.

Discussion:

Obstetric inequities for Black disabled women are rooted in the intersecting structures of racism and ableism that shape policy, access to care, and clinical culture. Yet, this intersection remains underexamined in research, leaving critical gaps in knowledge and action. Closing these gaps requires intersectional, community-led research and policy reforms—expanding Medicaid, enforcing accessibility, mandating provider training, collecting intersectional data, and investing in inclusive care grounded in disability and racial justice.

Keywords

Ableism Racism Maternal Mortality Health Equity

Introduction

ShaRhonda Dawson, a disability advocate and coauthor on this article, shares the following first-person account drawn from her lived experience navigating obstetric care in the United States:

I am a Black woman with multiple chronic conditions, including lupus, cardiovascular disease, and mobility challenges. During my pregnancy, I was classified as high risk and received care from multiple providers—including a general obstetrician–gynecologist (OB/GYN), a maternal fetal medicine specialist, and several subspecialists to manage my chronic illnesses and disability-related health needs. Despite this extensive care team, there was no formal system in place to coordinate my treatment. When complications arose during my pregnancy, my doctors and health providers weren’t talking to each other. The consequences of this lack of integration became evident during a serious clinical episode.

When I was five months pregnant, I suddenly had a fever (105° F!). I began shaking and couldn’t move. We rushed to the emergency room. The emergency room doctor felt unsure how to help me; he knew that I was pregnant but was unaware of my comorbidities. I was transferred to the operating room and promptly put in an ice-bath to lower my temperature. Then, I lost consciousness. When I awoke, there was my obstetrician (OB) doctor, the maternal fetal medicine doctor, an infectious disease doctor, and my rheumatologist by my bed. It was at that time that I was told that both my life and my baby’s life were in danger.

Significant time was lost identifying appropriate diagnostic and treatment steps because there was no shared care plan or communication protocol among providers. With multiple clinicians responsible for both reproductive and disability-related care, there was no accessible written document outlining the care team, completed tests, or key contacts.

As I reflect back on my experience, I believe that having a clearly coordinated plan—showing where I was receiving care, who my doctors were, who should be contacted, and who was in charge—could have stopped the escalation of my situation from urgent to critical. Gaps in care coordination put my health and my baby’s health at risk.

This individual story illustrates systemic failures that this review documents across the literature. Specifically, Black, disabled women report inaccessible or inadequate prenatal care, fragmented treatment across multiple providers, and provider bias compounded by insufficient disability-related training.

Maternal mortality has been rising dramatically in the United States—increasing by 136% between 1990 and 2013 and by another 90% between 2018 and 2021.^1,2 However, these trends are not distributed equally. In 2023, the pregnancy-related mortality rate for Black non-Hispanic women (hereafter, Black women) was 50.3 deaths per 100,000 live births—3.5 times higher than the rate for white non-Hispanic women (hereafter, white women) (14.5).³ Black women also experience higher rates of pregnancy-related morbidities, including preeclampsia, hypertension, and gestational diabetes.^4,5 Disabled women, defined under the Americans with Disabilities Act (ADA) as having a physical or mental impairment that substantially limits one or more major life activities,⁶ face similar inequities, with women with physical disabilities having maternal mortality rates nearly 11 times higher than those without disabilities.⁷ Disabled women also experience significantly higher rates of pregnancy complications, including preeclampsia, gestational diabetes, and hemorrhage.^7–9

For Black disabled women, these maternal mortality disparities are not merely additive but compounding. Black disabled women experience higher rates of adverse birth outcomes compared with their nondisabled and non-Black counterparts.¹⁰ One national study found that Black women with physical disabilities were more than six times as likely to experience severe maternal morbidity (SMM)¹¹ compared with white, nondisabled women.¹² An additional analysis of 8.2 million deliveries showed that the combined impact of being both Black and physically disabled significantly increased the risk of adverse birth outcomes beyond either identity alone.¹³

The disproportionate burden of SMM among Black, disabled, and Black disabled women reflects the impacts of structural racism and ableism. Structural racism systematically determines access to the conditions that shape health—such as safe housing, equitable education, stable employment, and quality food—by reinforcing policies and practices that disadvantage Black communities. In addition, racism within health care itself remains a central driver of health inequities.^13–17 Structural ableism operates across these same social conditions, while distinctly shaping health care systems and practices through inaccessible facilities, equipment, and provider bias.^18,19

Together, racism and ableism create distinct barriers to equitable and comprehensive obstetric care for Black disabled women.¹³ Obstetric care, as defined by the American College of Obstetricians and Gynecologists (ACOG), encompasses medical care during pregnancy and childbirth, along with preventive counseling and education to support reproductive health across the life course.²⁰ It requires health care providers to have clinical expertise, as well as an understanding of the physiologic, social, cultural, and environmental factors that shape reproductive health.²¹ While research has documented maternal health disparities and barriers to obstetric care for Black and disabled women, the intersection of racialized ableism remains understudied in relation to obstetric care access and outcomes. Subsequently, the unique experiences of Black disabled women remain largely absent from obstetric research and resulting practice. This narrative review critically examines and consolidates what is known about the effects of racialized ableism on obstetric care access, experiences, and outcomes for Black disabled women, and highlights what remains unknown. By integrating academic literature with community-reported experiences, this review identifies critical gaps in obstetric care and policy for Black disabled women and calls for intersectional approaches in both research and practice.

Methods

Positionality

Our team included a Master of Public Health Student (M.E.M.), three social scientists with PhD training (C.H., K.C., and T.B.A.), a research coordinator (C.B.), a Maternal–Fetal Medicine specialist and researcher (K.H.), and a community member with lived experience as a Black disabled birthing person (S.D.). As a group of individuals with heterogeneous racial, disability birthing experiences (including no disability and no pregnancy or birthing experience), we recognize the insights our lived and professional experiences offer while remaining aware of their limitations and embracing cultural humility. We approach research with an understanding that knowledge is not neutral and that Western, academic, and medical institutions have long upheld systems of racism, ableism, and eugenics. As a team, we are committed to antiracist, antiableist, feminist research and practice that works toward health equity and justice to foster meaningful change.

Study framework

This narrative review uses an intersectional ecological framework²² to examine how racialized ableism shapes obstetric care access and outcomes for Black disabled women. Integrating intersectionality²³ and ecological systems theory,²⁴ this approach recognizes that health is influenced by interactions across individual, interpersonal, organizational, community, and policy levels, and these levels are shaped by intersecting systems of oppression including ableism and racism.^25–27 This approach situates Black disabled women within their full social and political contexts, demonstrating how racialized ableism produces compounded barriers and harm across the obstetric care continuum.

Literature search and review strategy

A literature search was conducted by M.E.M. and C.B., in consultation with T.B.A. and C.H., using the electronic databases PubMed and Google Scholar. The initial literature search was completed in January–April 2025, and additional literature was added when identified through reference lists. We used a broad combination of search terms related to obstetric care and maternal health (obstetric care, reproductive care, pregnancy, maternal mortality), racial and disability identity (Black, disabled, racism, obstetric racism, disability, ableism, disability justice), and structural outcomes (health outcomes, barriers, policy, health disparities). These searches produced a large volume of results. We reviewed the top-matched results for each term combination, and screened titles and abstracts for relevance.

Articles were included in this review if the following criteria were met: (1) studies included people of color, Black people, and/or disabled people; (2) studies reported on maternal health outcomes, barriers to obstetric care, structural ableism and/or racism in obstetric care, experiences of care; (3) studies were based in the United States; (4) studies were published in the last 25 years (since 2000). Studies were excluded from this review if they did not meet the inclusion criteria. After the initial review of titles and abstracts, the full-text review was performed by M.E.M. Sources for the review (type of source, publisher, date, population of focus, topic) were extracted into Excel for review.

In addition to peer-reviewed sources, we reviewed gray literature, policy documents, and personal narratives using the same search terms in a Google search. To identify relevant policies, M.E.M. compiled a preliminary list based on literature themes and community concerns. Through targeted searches and consultation with K.C., we refined this list to focus on policies impacting maternal health for Black disabled women. Resources were identified through targeted Google searches and organizations cited within the peer-reviewed and gray literature. We included national organizations with publicly available materials that are presented to be useful to Black disabled women experiencing obstetric care, as well as researchers and advocates.

To characterize the scope and focus of the literature reviewed, we extracted the population, topic, and intersectional relevance from each source. The final set of 115 sources meets our criteria but is not exhaustive. Table 1 summarizes the distribution of sources by disability status, race and ethnicity, and primary topic area.

Table 1.

Characteristics of Sources Included in Narrative Review (N = 116)

Category	Count
Total sources reviewed	115
Population focus
Sources addressing race or ethnicity	69
Black	49
Hispanic	9
Native American	8
Asian	4
Sources addressing disability	60
Unspecified/mixed disability types	39
Physical disability	4
Intellectual/developmental disability	3
Deaf/hard of hearing	1
Sources addressing both race and disability	29
Topic focus
Barriers to access	55
Maternal health outcomes	45
Policy	40
Theory	10
Antibias interventions	8
Resources	23

Many sources were tagged with multiple population and topic categories; totals exceed 115.

Results

About 114 sources were included in this review, representing various disability experiences and demographic groups (Table 1), and only 29 sources examined the impact of both race and disability on the experiences of pregnant women. The following areas are addressed: (1) maternal care deserts and inaccessible facilities; (2) inadequate preconception and prenatal care; (3) provider bias, surveillance, and reproductive coercion; (4) gaps in provider knowledge and training on disability and culturally congruent care; and (5) policy failures, such as weak disability rights enforcement, Medicaid nonexpansion, and absent intersectional data, that together sustain and reinforce obstetric racism and ableism.

Geographic barriers and maternal care deserts

Historic and ongoing racist policies—including redlining, disinvestment in Black communities, and hospital closures in economically marginalized neighborhoods—have created maternal care deserts that disproportionately harm Black women.^16,28 Maternal care deserts are counties where residents have no access to birthing hospitals, birth centers offering obstetric care, or obstetric providers.²⁹ In 2020, 16.3% of Black babies were born in maternal care deserts, where access to prenatal and postpartum care is severely limited.³⁰ As a result, women living in these regions are more likely to enter pregnancy in poor health and receive inadequate prenatal care.²⁹

Just as structural racism contributes to geographic maternal care deserts for Black women, structural ableism renders obstetric care functionally inaccessible to many disabled women, even in well-resourced settings.³¹ In a 2013 study, 44% of gynecology practices were inaccessible to wheelchair users, with gynecology identified as the least accessible subspecialty.³² Barriers included small exam rooms and diagnostic equipment (exam tables, mammography machines, scales) that cannot accommodate disabled bodies.^8,18 These barriers can lead providers to skip essential care, resulting in delayed diagnoses and greater reliance on emergency departments during pregnancy.^8,18 These persistent accessibility failures effectively create systemic maternal care deserts, where care may be geographically present but remains out of reach—exacerbating disparities and excluding disabled women from routine and life-saving obstetric care.³¹ Black disabled women are therefore impacted by both geographic and systemic maternal care deserts, although this review yielded no literature on these experiences at the intersection of race and disability.

Lack of adequate preconception care

Black disabled women have persistently been denied access to adequate preconception care. For example, Black disabled women are less likely to have had a recent OB/GYN check-up compared with white nondisabled women,³³ and face elevated preconception health risks compared with both white disabled and Black nondisabled women. Inadequate preconception care hinders early risk detection, undermines trust-building with providers, and increases the likelihood of entering pregnancy without appropriate care.

Barriers in Black disabled women’s access to appropriate preconception care are rooted in a history of medical racism, ableism, and reproductive control in the U.S. medicine. The legacy of eugenics,³⁴ forced sterilization,³⁵ and the longstanding framing of Black and disabled women as unfit for pregnancy or parenthood^8,36 continues to shape whether and how they are offered reproductive health services, as these harms are now embedded in clinical practices, policies, and provider biases.³⁷ Black women also have reduced access to reproductive health education, contraception, and timely diagnosis of conditions such as fibroids and endometriosis.⁵ Similarly, disabled women with intellectual and developmental disabilities experience limited reproductive health education, intrusive questioning about their reproductive autonomy,^38,39 and reduced clinician-initiated contraceptive counseling compared with nondisabled peers.^40,41 Together, these intersecting biases create a system that routinely excludes Black disabled women from the foundational care needed for healthy pregnancies.

Disparities in prenatal care access

Structural racism creates widespread barriers to prenatal care for Black women, particularly through maternal care deserts, leaving Black women twice as likely as white women to face difficulties securing appointments and transportation to prenatal care.⁴² As a result, between 2020 and 2022, 21.9% of Black women received inadequate prenatal care, compared with 11.1% of white women.²⁹ One study found that Black women are also more likely to begin prenatal care late or not at all: only 67.6% began care in the first trimester, compared with 82.6% of white women, and 10.0% received no care or started late, compared with 4.7% of white women.⁴³

Disabled women also face major barriers to prenatal care. They are more likely than nondisabled women to delay or skip prenatal care,⁸ nearly twice as likely to begin care after the first trimester, and more likely to report inadequate care.¹⁸ Clinical inaccessibility, negative provider attitudes, and prior experiences of discrimination reduce trust and discourage care-seeking.⁹ In addition, for disabled women, prenatal care often involves multiple providers managing both pregnancy and disability-related needs, making care coordination essential. Evidence from Oregon’s Medicaid Coordinated Care Organizations shows that person-centered coordination improves timely and adequate prenatal care for pregnant disabled women, suggesting a strategy to reduce access gaps.⁴⁴

The review did not yield literature examining race and disability together.

Provider bias

Obstetric racism is the system of medical racism and obstetric violence that devalues Black women’s knowledge and autonomy over their own bodies.^15,45 Obstetric racism manifests at every stage of care. Reproductive coercion in preconception care reflects the legacy of eugenics and reproductive control over Black women, as described earlier.^5,37 During prenatal care, many Black women report discrimination, surveillance, and delayed or lower-quality care.^46,47 Black women are overreported to child protection services,^5,48 creating fear that can lead some to withhold critical information or avoid care—acts of agency in response to structural violence that may inadvertently compromise health and safety. During labor and childbirth, one study of Black women who experienced SMM found that racial stereotyping and dismissive communication led providers to ignore or fail to document their concerns, contributing to preventable complications and reinforcing feelings of trauma and expendability.⁴⁹ These cumulative experiences of bias undermine clinical safety, erode trust, and help drive the stark maternal health disparities Black women face.

For disabled women, provider bias often stems from ableist assumptions about competence, sexuality, and parental fitness. In preconception and prenatal care, many report being infantilized, coerced into birth control, or denied reproductive care.^35,50 Women with disabilities are sterilized at higher rates and younger ages than nondisabled counterparts, often without adequate information or consent.^35,51–53 During pregnancy, many report providers assumptions about parental unfitness that often trigger heightened surveillance and unfounded reports to child protective services.^8,54 Ableist surveillance in obstetric care fuels fear of judgment, child welfare involvement, and neglect, eroding trust and reducing engagement with essential care.^9,50,55,56

For Black disabled women, racism and ableism compound to intensify harm. Clinical dismissal and provider bias are often more severe for Black disabled women than for nondisabled Black patients or white disabled patients.^57–59 Providers compounded assumptions about patient competence and autonomy lead to deeper mistrust, disengagement from care, and increased risk of poor outcomes.^40,60–62 Rather than offering support, providers may respond with suspicion or initiate investigations, placing Black disabled parents at risk of family separation, traumatization, and avoidance of services.^36,63 These practices reflect a persistent legacy of eugenics and systemic neglect that continue to frame Black disabled parents as “unfit”, devaluing their right to parent and receive equitable care.

Although evidence for interventions to improve obstetric care experiences for Black disabled women remains limited, antiracism workshops and disability curricula have been shown to increase provider reflection and awareness of bias, and confidence in addressing bias.^64–68 However, most evaluations assess short-term changes in provider attitudes rather than patient outcomes, highlighting the need for structural change that embeds antiracism and antiableism into everyday clinical practice and policy.⁶⁹

Provider knowledge

Despite well-documented racial disparities in maternal health and growing acknowledgment of the role structural racism plays in driving maternal health inequities, medical education lacks a national accreditation requirement for antiracism training.^70,71 While organizations like ACOG recommend anti-racist practices⁷² and have disability-inclusive care guidelines,⁷³ these guidelines are unenforced and often limited to optional content. This educational gap fuels provider bias and leaves providers ill-equipped to recognize how medical exploitation, reproductive coercion, and systemic racism affect Black women’s experiences today.^70,74 As a result, providers may rely on stereotypes, pathologize patient choices, or dismiss Black women’s concerns.⁷⁰

Many providers receive little to no formal training on disability, pregnancy, or communication with disabled patients.⁷⁵ In one survey, only 19% of OB/GYNs felt prepared to manage pregnancies among disabled patients, though 92% wanted more training.⁴⁰ Another study found that 40% of women with physical disabilities said their provider knew little or nothing about how disability could affect pregnancy.⁵⁴ These knowledge gaps begin in medical school, where training on disability care, accommodations, and civil rights laws is often absent^75,76 and rarely includes strategies for coordinating care across specialists, which is essential for patients with complex, disability-related health needs. Poor preparation can lead to miscommunication around consent, medications, and procedures, heightening fear, confusion, and risk of harm.^18,40 Lack of education has led providers to over-pathologize pregnancies among disabled women, labeling them “high-risk” regardless of clinical need, and overmedicalizing care through unnecessary interventions like cesarean deliveries, even when not medically indicated.^50,55

While provider knowledge gaps for Black and disabled patients are well-documented, education and training rarely address their intersection. Anti-racism initiatives and disability competence frameworks have been developed and shown to increase provider understanding of racism and ableism.^{64–67,77,78} Yet these efforts remain largely siloed with little attention to the intersection of race and disability. Integrating anti-racist and disability-competent training is necessary to meaningfully improve obstetric care for Black disabled women.

Policy failures and recommendations

Disparities in obstetric care are driven by systemic policy failures. Inadequate enforcement of disability rights laws, gaps in Medicaid coverage, restrictive reproductive policies, and the absence of intersectional provider training all uphold structural racism and ableism in maternal health care. These failures disproportionately harm Black disabled women by reinforcing inaccessibility, limiting care options, and exacerbating surveillance and control. Table 2 outlines key policy-level drivers of inequity, along with actionable recommendations grounded in disability and racial justice frameworks.

Table 2.

Policy Failures and Recommendations

Policy failure	Description of policy failure	Policy recommendation
Weak Enforcement of Disability Rights Laws	Underenforcement of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, relying on individuals to file complaints.⁷⁹ Essential accommodations are often denied, leaving Black disabled women to self-advocate or go without care.²	Strengthen Enforcement of Disability Rights in Health care: Agencies must enforce ADA and Section 504 compliance, including routine accessibility audits, transparent complaint systems, and consequences for noncompliance.^2,18
Inaccessible Medical Equipment and Physical Barriers	Inaccessible diagnostic equipment despite clear legal mandates.^18,80 For example, no height-adjustable exam tables or wheelchair-accessible machines, delaying screenings and increasing risk. New ADA standards set in 2024 are delayed until 2026 and lack strong enforcement.⁸¹	Ensure Accessible Medical Equipment: Enforcement must be paired with investment in accessible diagnostic tools and penalties for facilities that fail to comply with existing standards. Recent Department of Justice (DOJ) standards must be implemented and enforced without delay.
Medicaid Policy Gaps and Non-Expansion	Low Medicaid reimbursement, non-expansion, and the 2025 federal budget cuts to Medicaid drive care deserts and service cuts in under-resourced communities.^4,29,82 Nonexpansion states continue to deny racially minoritized disabled people access to essential preconception, prenatal, and postpartum care.^83,84	Expand and Improve Medicaid Coverage: Increase provider reimbursement rates, expand postpartum coverage to at least 12 months,⁸⁴ and eliminate state-level barriers to Medicaid access.⁸⁵ Many states have expanded Medicaid, leading to a decline in maternal mortality.^83,84
Lack of Intersectional Data	Lack of intersectional data on race and disability limits accountability in maternal health policy. Inconsistent implementation of Affordable Care Act (ACA) data mandates and a lack of intersectional tracking make it difficult to identify, monitor, or address the compounded harms faced by racially minoritized disabled birthing people.^58,79	Require Intersectional Data Collection: Agencies and hospitals must collect and report intersectional data. Maternal Mortality Review Committees should be equipped to analyze outcomes using an intersectional lens and recommend equity-driven interventions.^79,86
Lack of Care Coordination	Care coordination under Medicaid is left to state discretion through Section 1115 waivers and Managed Care Organization (MCO) contracts, access depends on local policy choices and funding, leaving some hospitals that serve Black disabled birthing women especially under-resourced.^87,88	Standardize perinatal care coordination as a Medicaid benefit, with equitable funding and workforce allocation across states and hospitals.⁴⁴ Incentivize partnerships with community organizations that do care coordination.^89,90
Lack of Provider Training Requirements	No mandated training in disability competence or antiracism for obstetric providers. Gaps in medical education accreditation and physician licensing standards mean that most providers receive little to no formal education on equitable care for disabled or racially minoritized patients, contributing to miscommunication, bias, and substandard outcomes.^40,76	Mandate Intersectional Provider Training: Require medical schools, residencies, and licensing bodies to implement training in disability-competent, antiracist obstetric care. These must be co-developed with Black disabled people.^74,76,91
Limited Investment in Equitable Care Models	Equitable care models like doulas and midwives improve outcomes but remain underfunded and underutilized.^92,93 Despite evidence that doula care reduces cesareans, preterm birth, and racial bias, Medicaid reimbursement is low and few doulas are trained in disability-inclusive care.^94–98	Invest in Equitable Care Models: Expand Medicaid reimbursement for doula and midwifery care and invest in disability-inclusive training for these providers.^92,98,99 Create state-level directories to help patients identify practitioners with expertise in culturally responsive, disability-competent care.

Community Supports

Across studies, disabled and Black women emphasized the power of self-advocacy in navigating obstetric care. Many described carefully selecting clinicians who demonstrate responsiveness to accessibility needs and respect for patient autonomy, which led to positive experiences.¹⁰⁰ During obstetric care, doulas were highlighted as particularly valuable, providing culturally competent and accessible care, serving as advocates and buffers against provider bias or medical neglect, and offering emotional support while assisting patients in navigating complex health care systems.^98,99

In addition, peer support and community networks were repeatedly identified as critical sources of guidance, validation, and strength when confronting provider bias and structural barriers.^36,100,101 Utilizing resources developed by and for Black disabled mothers, such as those listed in Table 3, could provide essential support in navigating obstetric care and empowering women to assert their needs.

Table 3.

Community, Advocacy, Legal, and Medicaid Resources for Black Disabled Women Seeking Obstetric Care

Resource	Topic	Description	Link
Ramp Your Voice Conference	Community Discussions and Solutions Conference	This interdisciplinary conference centers Black disabled people’s experiences and voices to discuss issues that matter to us.	https://www.rampyourvoice.com ¹⁰³
National Black Disability Coalition	Advocacy and Community	Black-led coalition offering support, advocacy, and resources at the intersection of race and disability.	https://www.blackdisability.org ¹⁰²
Disability Visibility Project	Advocacy and Community	Disability-led advocacy and storytelling platform featuring lived experiences of disabled people of color navigating pregnancy and childbirth.	https://disabilityvisibilityproject.com/ ¹⁰⁴
Black Mamas Matter Alliance (BMMA)	Maternal Health Advocacy Organization	National network advancing Black maternal health, rights, and justice, with policy briefs and community resources relevant to disabled Black mothers.	https://blackmamasmatter.org ¹⁰⁵
Disabled Parenting Project	Community resources	This site, which is part of the National Research Center for parents with disabilities, includes first hand accounts of eperiences and guidance for navigating parenting as a person with a disability.	https://blackrj.org ¹⁰⁶
SisterSong Women of Color Reproductive Justice Collective	Women of Color Reproductive Justice Organization	National collective that provides advocacy, community organizing, and resources centering women of color, with disability inclusion.	https://www.sistersong.net ¹⁰⁷
Reproductive Health Guide by and for people with disabilities	Resource hub for disabled women in reproductive care	This guide explains the reproductive and civil rights of women with disabilities, offers strategies for self-advocacy, shares findings on local (Chicago) provider accessibility, and provides resources for parenting and for those experiencing domestic or sexual abuse.	https://medicine.umich.edu/sites/default/files/downloads/Take-Charge-Reproductive-Health-Guide.pdf ¹⁰⁸
The Lurie Institute for Disability Policy (Brandeis)	Disability Justice Reproductive Health Research	This page offers resources and research on Black disabled women’s experiences and outcomes when seeking obstetric care.	https://heller.brandeis.edu/lurie/news/bmhw2025.html ¹⁰⁹
National Disability Rights Network (NDRN)	Legal Advocacy	Federally mandated protection and advocacy system offering legal assistance if care access is denied or discriminatory.	https://www.ndrn.org ¹¹⁰
The Arc	Legal Advocacy	Legal advocacy organization with chapters across the country that works to ensure enforcement of disability civil rights laws.	https://reproductiverights.org ¹¹¹
Centers for Medicare and Medicaid Services	Medicaid Services	Official CMS resources explaining Medicaid maternity coverage, postpartum extension, and state-by-state benefits.	https://www.cms.gov/search/cms?keys=maternal+health ¹¹²
Centers for Medicare and Medicaid Services	Medicaid Services		https://www.plannedparenthood.org/planned-parenthood-illinois/patient-resources/payment-options/medicaid
National Health Law’s Doula Medicaid	Medicaid and Doula Access	Project dedicated to expanding Medicaid coverage of doula care, with resources for advocates and policymakers.	https://healthlaw.org/doulamedicaidproject ¹¹³

Discussion

Despite growing recognition of maternal health disparities, little research examines how racism and ableism intersect in obstetric care. While some quantitative analyses have centered Black disabled women’s maternal health outcomes, lived experiences remain underrepresented, underscoring the need for qualitative and community-engaged approaches. Without intentional investment in intersectional research, health care systems and policymakers will continue to overlook the unique barriers this population faces. This review begins to address those gaps by synthesizing evidence across disciplines to illuminate the complex effects of racism and ableism as they intersect to shape obstetric care. The barriers Black disabled women face in obstetric care stem from racialized ableism operating simultaneously across policy, community, organizational, interpersonal, and individual levels.

Access to obstetric care for Black disabled women is shaped by structural conditions that determine not only where care is located, but whether it is meaningfully accessible. At the policy and community level, systemic maternal care deserts reveal how racism and ableism jointly determine where care is provided and who it is designed to serve, leaving many Black disabled women without physically or structurally accessible options.³¹ Inaccessible facilities and equipment transform care settings into spaces of exclusion and harm. These conditions are upheld by policy failures. Black disabled women disproportionately rely on Medicaid for reproductive care, yet persistent underfunding, the 2025 federal budget’s Medicaid cuts, low reimbursement rates, and nonexpansion already limits access in many states.^16,29,82 Despite these barriers, we found no research that specifically examines Black disabled women’s access to prenatal care—a critical gap in the literature that allows compounded barriers to persist and deepens disparities in care and outcomes.

Experiences of obstetric care are largely shaped by providers knowledge and attitudes toward Black disabled women. At the policy level, medical education still lacks national accreditation requirements for training in antiracism or disability-informed care, leaving clinicians underprepared and often reliant on harmful stereotypes.^40,72,76 At the organizational and interpersonal levels, this translates into real harm. Providers often know little about how disability affects pregnancy, dismiss pain and self-advocacy based on racist assumptions, and infantilize or overmedicalize care based on ableist beliefs.^46,50,55,70 For Black disabled patients, this means being misheard, mistrusted, or surveilled—not only because of any one provider’s intent, but because racialized ableism is built into clinical culture. In many cases, Black disabled women are forced to delay or avoid care as a form of self-protection—navigating a system where seeking health care can mean being disrespected, pathologized, or even reported.⁶³

The cumulative effect has contributed to an obstetric care system in which Black disabled women experience reduced access to autonomy, safety, and support. Addressing these disparities requires better access and provider training, and a structural shift toward justice, accountability, and care that centers those most marginalized. Structural reforms based on justice-oriented frameworks recognize Black disabled people as full agents in their reproductive lives, who deserve access, autonomy, dignity, and freedom from systemic violence, and are imperative.^114,103 Grounding policy, practice, and research in these principles is essential to repair longstanding harm and create obstetric care systems that truly serve Black disabled women.

Alongside calls for structural reform, Black disabled women and allied organizations have created resources and networks that offer guidance, advocacy, and support in navigating obstetric care. Table 3 highlights national-level resources that can be leveraged by patients and advocates to promote access, autonomy, and equity.

Study Limitations

As a narrative review, the literature search strategy was targeted, which may limit comprehensiveness and introduce selection bias. In addition, our search terms may not have captured all relevant literature, particularly studies using alternative terminology. We focused on U.S.-based studies, which may underrepresent work conducted in global contexts. Despite these limitations, this review draws on a diverse array of sources to highlight barriers and supportive practices for Black disabled women.

Conclusion

Racialized ableism creates compounded barriers to health care access, experiences, and outcomes for Black disabled women. Achieving justice requires an intersectional lens: dismantling siloed frameworks that treat racism and ableism as separate issues, investing in community-led research that centers disabled people of color as experts, and holding health care systems accountable for inaccessible and discriminatory practices. Without urgent action on the intersecting impacts of racism and ableism, these systems will continue to drive preventable harm.

Authors’ Contributions

M.E.M.: Conceptualization, methodology, formal analysis, and writing. C.H.: Conceptualization, methodology, and writing—reviewing and editing. K.C.: Writing—reviewing and editing. C.B.: Project administration, writing, and writing—reviewing and editing. S.D.: Writing. K.H.: Writing—reviewing and editing. T.B.A.: Conceptualization, methodology, and writing—reviewing and editing.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Abbreviations

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