Boston Women’s Fund has never been afraid to be the first. Our founding mothers broke the mold in Boston 40 years ago when they created the first women’s fund in Massachusetts. We established ourselves to be a first-of-its-kind foundation — one run by and for diverse women and gender-expansive folks, bucking traditional philanthropic conventions in the name of propelling more equitable giving. While other foundations often find it too risky to be the first investor in a new organization, since day one, we’ve thought that the real risk lies in a reality where life-changing ideas never get the funding they deserve.
In 1984, a new organization called the Traditional Childbearing Group (TCBG), the first Black home birth nonprofit organization in the nation, was among BWF’s first group of grantee partners. Our grant was the first they’d ever received. TCBG’s co-founder, Shafia Monroe, from Roxbury, MA, went on to train thousands of doulas and midwives, and today is known as the Queen Mother of the Midwifery movement.
We had a chat with Shafia to learn more about how the Boston Women’s Fund’s early investment into Shafia’s first grassroots organization propelled her efforts to jumpstart the Black midwifery movement in Boston and beyond, the catalyst of what would become a legendary, nationally renowned career.
Boston Women’s Fund: You were co-founder of the Traditional Childbearing Group in Boston, a grassroots non-profit working “to reduce infant mortality through homebirth, training midwives, and prenatal education.” What inspired you to create this organization and get involved with midwifery?
Shafia Monroe: Back in the mid-70s, infant mortality was making the news, and Roxbury had one the highest mortality rates in the country. At the same time, natural birth as an option was being brought to light by the feminist movement. This sparked my interest because at the same time, I had just begun to learn about the contributions of Black midwives of the 20th century, who protected Black birthing women.
As I read about midwifery, I learned more about Black midwives in the South, who were to me, my sheroes. These women made themselves available to all who needed them, even if it meant walking through the woods at night — they were courageous. They knew African history, they were taking care of women, advocating for them, and being kind and loving amid the most abject poverty all through the Jim Crow South, and I thought, “Oh my God, I want to be like them.”
I was hearing about the trauma that Black families were experiencing to have a baby, and Majeeda Workneh and I wanted to create something in Boston to help Black families have a positive birth experience, emotional and physical, something that would protect them, empower them, and give them an option — and that option was to have home births with Black midwives. So, we were the home birth midwives for much of the Boston area. I went as far as Brockton one night to do a birth for a Black family. It was just a wonderful time, Black women coming together for self-determination, and not just women. The men were so excited to have a place for the women to be safe and for them to be respected.
Did you witness something in your community that sparked this interest?
I will not share the names of the hospitals, but often hospitals were treating Black women badly and disrespecting Black men who accompanied their laboring partner to the emergency room. If a woman went in by ambulance, you couldn’t get in to be where she was. Unfortunately, like today, we had a lot of security officers acting negatively. We did a lot of policy work as well. Our organization was able to meet with the presidents of a few hospitals and they changed some of their policies.
The Traditional Childbearing Group was one of the very first organizations The Boston Women’s Fund funded back in 1984. Can you tell me more about receiving that grant? What impact did it have on your organization then?
It was the first grant we ever had! BWF was the first one to ever fund us. It was amazing because we had just been working out of our houses and using the Jeremiah E Burke High School cafeteria for meetings. With more funding, we were able to do childbirth classes for teenagers, offer snacks, and put gas in our cars to get to births. It made an enormous impact! We were encouraged.
The impact of BWF’s funding was critical. It allowed us to be true to our mission of empowering Black women to know their patient rights, to increase the number of Black homebirth midwives, and to celebrate Black culture. My experience has been that many funders did not support my proposals written from a strength-based approach. We said, “We’re trying to build Black pride and Black capacity. We want to honor the Black midwives.” We wanted Black people to be homebirth midwives. BWF appreciated that we wrote from a place of strength and historical pride. And they funded that.
So, we do appreciate BWF letting us speak the truth that we are a powerful, wonderful group of people, doing important things, and we got this! If you can just fund us, we can fix this problem. And we did. It was so great to see premature births and infant mortality rates decline in the Black community and to be able to go into hospitals and advocate for pregnant Black women.
We even created a breastfeeding group at Boston City Hospital (now known as Boston Medical Center). They let us go into the waiting room on the prenatal floor and set up a table to talk to Black women about the advantages of breastfeeding and give out brochures. We also created a breastfeeding 24-hour hotline to support Black women with their breastfeeding questions. It was a critical time to have funding.
BWF went on to fund the Traditional Childbearing Group three more times. What do you remember of your interactions with BWF back then?
BWF opened the doors for us; we attended their events and that was beneficial. BWF was the catalyst. Once they started funding us, other people got interested.
Since that time, your involvement in the midwifery movement has broadened significantly and taken on many iterations. You’ve trained thousands of doulas. Looking back, how did your work with the Traditional Childbearing Group influence your career?
When I left Boston for Portland, OR, I wanted to keep the work going and broaden it. So, we decided to create the International Center for Traditional Childbearing (ICTC), and that went for another 21 years nationally, but it was a little different. The Traditional Childbearing Group (TCBG) was more about home birth and direct services in Boston and advocating for Black families. We knew that Black families were losing their babies, and suffering from higher rates of maternal mortality. Our work there was focused on policy, advocacy, empowerment, and direct services. We also ran a midwife school twice and graduated five Black midwives in Boston, which was a lot, in the 1980s.
ICTC was intended to build capacity to increase the number of Black midwives and doulas and create a national movement for Black Midwifery to work in collaboration and have a seat at the table to address the shortage of Black midwives in the US. ICTC became that — we became the voice for elevating the work of Black midwives, increasing their numbers, and challenging systemic racism in the institutions that had small numbers of Black midwives and minimal support for Black midwife students. There were not enough Black midwives tenured in the midwife schools. We wanted these institutions to be inclusive, and culturally competent, and include the history of Black midwifery in education by adding specific reading materials and documentaries.
We also put on a conference every year called the International Black Midwives and Healers Conference. We invited Erykah Badu, a four-time Grammy award winner, singer/writer, holistic healer, and doula, to be our national spokesperson. She accepted and was the keynote for three of our conferences. And then in 2017, after many years of doing this work, it was time for me to step down and let someone else do the work. I wanted to increase the number of Black doulas and doulas of color, improve postpartum care, and write, and mentor aspiring midwives and doulas. I have a book on postpartum care that will be released in 2025.
We still have a severe shortage of Black midwives. And that needs to be acknowledged. We need midwives as much as we need doulas. If we’re going to improve birth outcomes and maternal health, we need more Black midwives. And I want to see midwives and doulas working together to save mothers and babies. I’ve been teaching doulas since 2002. We were the first Black organization that I knew to develop a Black doula training curriculum, based on the legacy of the 20th-century African American midwife. My goal was to use the doula platform to make a difference and as an entry point for doulas to continue to become midwives. I can say that we have trained over 5,000 doulas since 2002, and at least one-third have gone on to become midwives. As SMC Full Circle Doulas, they understand the midwifery model of care and will refer their clients to midwives, and that’s how we’re going to see an improvement in maternal and infant outcomes.
Can you share a bit about how having more Black midwives in the field impacts health outcomes for Black birthing people and babies?
When you have a diverse workforce, we all benefit. I think we must remember that our diverse workforce in the early 20th century was Black midwives delivering white and Black babies. They kept the American public health system improving, and that’s documented. So Black midwives have always enhanced the workforce. But later they put Black midwives out and brought in only white midwives; we got pushed back. There were 5,000 Black midwives in Alabama, Mississippi, and Georgia in 1913. In Alabama today there are probably three, in Mississippi, there are five, and in some states, there are no Black midwives. Big ups to BWF because we had eight Black midwives in Boston in my time. That’s a substantial number. We don’t think we have that many in Boston anymore.
And we need more Black midwives because they provide the culturally competent health care that people of color thrive from. I want America to understand that when we diversify the workforce, it expands our worldview, offers a chance for us to get to know other people, and helps us work better with others who are different from ourselves. And the other part is that we have our hormones, our cortisol levels. When we feel fear, our adrenal glands kick out cortisol which is the flight, fight, or freeze mechanism. Either you run from fear, you fight back, or you’re like a deer, you try to be still. Black people are in the position of navigating our cortisol levels, which, when it’s high, is causing us to have premature births and long-term healthcare issues.
I want the hormones activated that keep the baby inside. The leading cause of infant mortality for Black women is premature birth. Our babies have higher rates of being born before 37 weeks. Having more Black midwives is going to create more trust and reduce perinatal stress. Often, when a Black person has shared, “I feel like something’s wrong,” the medical personnel replies with “Oh it’s just stress,” and sends them home. Black providers are more likely to say, “You know what, let me check. Okay, you do have preeclampsia, you do have a heart problem. We need to take care of this.”
If you go to my website, shafiamonroe.com, there’s a story of Shalon, a woman with a dual Ph.D., who worked for the CDC, her whole work was this kind of work, and she died from maternal mortality and it was preventable. She went back and forth to the hospital; her blood pressure was increasing. They kept telling her to go home and said that there was nothing wrong. Her mother found her dead at home, she had had a stroke. But there are so many stories like this.
Mr. Johnson, who’s suing the state of California, said his wife said on the table in the hospital “I think something’s wrong.” He tells the nurse, and the nurse says, “She has to wait. We’re busy.” And his wife died in front of him.
They say to him, “Why didn’t you say something?” And he said, “I’m a Black man. If I say the wrong thing, they’re going to arrest me, and then I won’t be with my wife at all.” There’s all this trauma for Black birthing families.
That’s the biggest thing that we’re hearing about maternal mortality from The CDC — 60% of deaths are preventable and most deaths are because the medical system does not listen to Black women, who know their bodies.
This is a heavily complicated time for reproductive justice. Black women have the highest maternal mortality rate nationwide. When you think about what it might take to turn this tide and create some real change, what are a couple of things that give you hope in this moment?
I’ll be honest, what gives me hope is the next generation; they are pushing hard and creating systems in direct services and policies to make a difference. Even the building of a birth center in Boston spearheaded by a Black organization is a positive action. There are just so many organizations: Black Mamas Matter Alliance, and Sistersong. We have Black OBs talking about trauma and systemic racism and calling out that they were taught in medical school that Black people don’t feel pain, which means Black people weren’t getting appropriate pain medication in surgery. There’s much more awareness, and I am happy to see that there is policy change, even though it is slow.
I do see some hospitals making changes to address why our women are not surviving. More institutions understand that cultural competency needs to be a part of the required education for healthcare providers, not an elective. It needs to be part of the system [to communicate] “You may be thinking with your privilege. Here’s what you’re doing without even realizing it, and here’s how it causes harm.”
For the first time, the American College of Nurse-Midwives has its first Black president. I am also happy to see that we have so many Black midwife student scholarships. The Shafia Monroe Consulting Black Student Midwife Scholarship began in 2019. It is in honor of Ayana Ade, an amazing midwife who then became a nurse midwife. She was my mentor and she created Childbirth Providers of African Descent (CPAD); she brought Black midwives together, yearly. She died in 2013. It’s called the Ayanna Ade Black Student Midwife Scholarship Award, which we give out every year.
Other good news— We now have the first National Black Midwives Alliance that came out of ICTC, that came from TCBG in Boston. We have a legacy, and we are so proud. It’s all connected.
What are you most looking forward to about BWF’s Reproductive Justice Symposium this spring?
It’s nice to be able to go full circle. From a midwife's perspective, I'm going back to the womb. You all helped us grow and you nurtured us by giving us four years of funding. You gave us a foundation and validated our work. I’m excited to come back to thank you all, to be a part of it, to let people know that it’s important that we fund Black women’s organizations, and that we fund foundations that support Black people’s work. And that our legacy continues through our future generations who are doing this work.
Thank you again for making space for us this morning! We appreciate it!
Thank you! Have a great afternoon!
See Shafia Monroe speak at our upcoming Reproductive Justice Symposium on April 22nd, featuring crucial grassroots perspectives, local policy and philanthropic leaders, and more! Sign up for early-bird updates here to be the first to know when registration opens.