The Midwife Purge

At the turn of the twentieth century, about half of all births in America were caught by midwives — and across the rural South, most of those midwives were Black women, working within community networks that had carried maternity care through slavery, Reconstruction, and Jim Crow. By 1935, midwife-attended births had fallen below thirty percent. By 1970, below one percent.

That collapse was not a market choice. It was a coordinated thirty-year campaign — state licensure laws, public-health authority, and professional-society lobbying, run largely through the Sheppard-Towner Act of 1921 — and it eliminated the only maternity provider that had ever served Black women in the rural South at scale. What it left behind was an absence.

A hundred years later, that absence still hasn’t been filled.

I’ll make it personal, because it is. I’m a physician. If I’d been born a hundred years earlier, none of that training would have mattered — the Flexner Report had already shut down five of the seven Black medical schools in the country. I wouldn’t have been the doctor in this story. I would have been the midwife — until the state licensed her out of existence and called it progress.

You can see the inheritance in today’s data: Black women die in childbirth at roughly 2.6–3× the rate of white women, and the map of America’s ~1,104 maternity-care deserts falls, with eerie precision, on the same Black-belt counties where the granny midwife was once the only provider. Essay Two traces exactly how it was done — and why it’s happening again right now.

Read Essay 2 — The Midwife Purge

New here? Start with the Introduction and Essay 1:

• The Long War, Introduction — We Can Read Too

• Essay 1 — Comstock, 1873

You can read me anywhere. There are louder takes. There are faster newsfeeds. There are bigger names. What you get here that you don’t get anywhere else is THE SPINE — a permanent argumentative scaffold you can stand on, walk along, share with the people you’re trying to convince, and keep coming back to over years.

The reason your premium went up $1,000. The reason your sister’s cancer trial got pulled. The reason Pap smears are disappearing from rural counties.

THEY ARE THE SAME REASON.

That’s the case we’re making, week after week, until the country can see it.

Thank you for being here. Forward this to one person who needs the spine.

— YC

Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective