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The constant vomiting and nausea began early during Tonya Abari’s first pregnancy in 2014.

It was far beyond the typical morning sickness, which happens once or twice daily, most commonly during the first trimester. Abari was throwing up multiple times—sometimes, she took as many as 20 trips to the nearest receptacle. “There was not one day that I didn't have five or more episodes of vomiting throughout the entire [10 months of] pregnancy,” Abari, now 42, said. “I was very weak and lost a lot of nutrients, and the only thing that made me feel better was eating bread. I ate a lot of bread.”

While the bread soothed her stomach, it also caused her to gain weight, which led the midwives and obstetrician she was working with in Nashville, Tennessee, to question if the vomiting and nausea were due to her size, even though her illness predated the jump on the scale. She wasn’t offered nutrition counseling or blood tests to determine what was wrong. Toward the end of her pregnancy, her blood pressure began to fluctuate, eventually ticking upward to hypertensive levels. She doesn’t remember how high, but she knows it was well above her pre-pregnancy average of 115/65. She believes she had preeclampsia, a disorder characterized by high blood pressure and the leading cause of death in the pre- and postpartum periods for Black women, but she was never officially diagnosed. (She later found out from her doctor that her vomiting was hyperemesis gravidarum, a severe form of pregnancy-related nausea and vomiting that can lead to dehydration, weight loss, and nutritional deficiencies.)

Another complication arose once it was time to deliver her daughter. Abari went to the hospital because her amniotic sac was damaged. It wasn’t wholly ruptured, or, as is more commonly said, her water hadn’t broken. The sac was torn and slowly leaking—a complication that can potentially lead to infection if not treated. She was admitted and told she’d need an emergency C-section due to her weight. “I refused because my weight is not a determinant of whether I need a C-section or not,” she recalls. “Let me walk around. Let me see if we can move the needle. I was zero centimeters dilated. Let me do what we've been talking about according to my birth plan.”

After 56 hours of labor, Abari got the C-section. Her heart rate dropped after, another potential sign of preeclampsia, and so did her newborn daughter’s. Abari’s first pregnancy and birthing experience were a nightmare.

“I felt like I was not heard. I felt like there was a lot of bias during the entire process,” said Abari. “The first birth was so traumatic that I felt that I didn't want to have any more children after that.”

Six years later, Abari and her husband decided to have another child. While planning the baby’s birth, they were adamant about having a birth team that could actually see and hear them, people who could navigate the complex relationship Black birthing people have with clinicians who often disregard and ignore Black patients. She also wanted to reclaim her autonomy and power within the birthing experience.

Abari met Tanzye Hill, a doula and owner of Birth Manifesta, an organization that offers full-spectrum doula support to birthing people and focuses on reducing rates of Black maternal and infant mortality, in Nashville, and they became friends. When Abari found out she was pregnant, Hill was the first person she went to, and she helped Abari by looking for a Black care team that would respect her wishes, and adding a doula was key.

What differentiates doulas professionally from obstetricians, nurses, or midwives is that they don’t have clinical duties or give medical advice. Instead, doulas fill in gaps that overworked clinicians often can’t or won’t in the birthing person's care. This includes emotional and physical well-being support to their patients during pregnancy, labor, birth, and postpartum. They supplement knowledge gaps between clinicians who don’t explain complicated medical knowledge well to patients and the birthing parent.

Across all causes of maternal mortality, Black birthing persons experienced 49.5 deaths per 100,000 live births in 2022—nearly three times the rate for their white (19) and Hispanic (16.9) counterparts, respectively, and almost four times as often as birthing persons of Asian descent (13.2). Sixty-five percent of pregnancy-related deaths happen in the 365 days after delivery, according to a report from the Centers for Disease Control (CDC). Death by suicide is the leading cause. Between 29 and 44 percent of Black women exhibit symptoms of postpartum depression, but many are not diagnosed or directed to mental health care. The CDC estimates that 80 percent of these deaths were preventable.

Doulas also catch other complications in the early stages and encourage the birthing person to receive life-saving care. They teach parents the skills needed to care for a newborn, like changing diapers and soothing, and they assist with housework and other chores to take the burden off new parents. Despite evidence showing that doula care could significantly reduce the U.S. maternal mortality rate, doula care is underutilized. A study in the American Journal of Managed Care found that Black women are more likely to desire doula care than their white counterparts.

‘The Buck Doesn’t Stop with Giving Birth’

Community-based doulas are especially adept at providing culturally competent care, which is what Abari was seeking, to those most susceptible to adverse birthing outcomes. Think of a doula as a birthing parent’s caregiver, helping parents, their children, and their communities thrive by reshaping the birthing experience and empowering parents to take control.

“In our history, communities have always had what we call now doulas,” said Myriam Webb, a longtime doula. “They didn't have a formal title. They were community members who would come by and drop off food, or help you with the baby, or they would attend the birth and help you with the labor.”

While many people think of doulas as additions to the birthing process, they play a crucial role during postpartum, providing vital emotional, physical, and informational support to new parents. Doulas can offer new moms a safe space to navigate their postpartum emotional ups and downs and alleviate the feelings of overwhelm and isolation new parents often feel. They’re also trained to recognize when postpartum depression has taken root and can refer families to critical mental health services.

After attending her first couple of births, Takeallah Rivera, a longtime doula based in Memphis, realized that the postpartum period needed more attention.

“I saw that the birth aspect as it pertains to being a doula was very saturated,” she said. “And I noticed the very critical postpartum period was being neglected, which is where Black women tend to suffer even more. [But] the buck doesn't stop with giving birth.”

“Usually, with a postpartum client, I'm there maybe a night or two to help mom prepare meals, making tea, tending to the other children she may have,” said Rivera, who also works as a postpartum counselor with the National Maternal Mental Health hotline. “I also focus heavily on the mental health aspect, so getting moms connected to resources for postpartum mental health supports, therapists, psychologists, online support groups, anything that would foster their wellbeing during the postpartum period.”

Covering Doula Care Under Medicaid and Private Insurance Could Expand Access

In December 2023, De Ajanae Gunn contacted Black Infant Health, a health equity program that provides resources to pre- and postpartum Black birthing persons toward the end of her pregnancy. She wanted to know what resources were available to her as she approached her due date. They pointed her to United and Guided, a Sacramento, California-based organization offering various services, including doula care. “My baby, during birth, his heart rate kept dropping, so I had to have an emergency C-section,” said Gunn, a 36-year-old child care provider. “It was very tough because I wanted to have a very holistic birth. I wanted to have a water birth, but it just didn't work out.”

Although her doula wasn’t there in person for the birth—she was sick and attended via Zoom—she helped Gunn navigate the postpartum period mood swings, offered breastfeeding support, and was an active listening ear.

Accessing the doulas who helped Gunn through a challenging birth and postpartum period would not have been possible were it not for Medi-Cal, California’s Medicaid program, which offers doula services to any pregnant person who wants one up to one year after pregnancy. As of June 2025, 24 states and the District of Columbia actively cover doula services for people on Medicaid, according to data from the National Health Law Program’s Doula Medicaid Project. Eight additional states are implementing doula coverage under Medicaid, and 15 others have programs adjacent to Medicaid coverage for doulas, such as pilot programs or exploratory efforts. But research shows that Medicaid expansion, even when it doesn’t include doula care, is crucial to reducing Black maternal mortality.

“Having a support person is very important, especially while you're going through pregnancy,” said Gunn. “With everything going on in healthcare and how systems are already not for us, it is important that we do have that support.”

Nearly 40 percent of births are covered by Medicaid, with this figure rising to 65 percent for Black birthing people. Disruptions in postpartum health coverage, particularly among Medicaid enrollees, are a persistent issue in preventing access to necessary care during this critical time, which is why expansion is associated with lower rates of maternal mortality. The American Rescue Plan Act of 2021 introduced a provision that allows states to extend Medicaid postpartum coverage from 60 days to 12 months through a state plan amendment. As of January 2025, 49 states and the District of Columbia have implemented 12-month Medicaid postpartum coverage, and Wisconsin has implemented limited coverage for up to 90 days.

Private insurance plays a role, too. The risk of maternal mortality for Black birthing persons is not bound by socioeconomic lines—wealthy Black mothers and their infants are still more likely to have an adverse outcome during the perinatal period. The coverage of doula services by private insurance varies across the country, depending on state regulations and individual insurance plans. Rhode Island became the first state to mandate that private health insurance plans cover doula services in 2021. Elsewhere, it’s less direct. California is encouraging private insurers to cover doula care. Lawmakers in Indiana introduced a bill in 2021 requiring state employee health plans to cover doula care, but it failed. Massachusetts and New York lawmakers are considering bills that would mandate all health plans to cover doulas. A bill in Virginia failed.

Research suggests doctors may be more likely to recommend doulas to their patients if Medicaid and private insurance cover their services. A doula in Rhode Island told the Women’s Bureau of the U.S. Department of Labor that since Medicaid and private insurance started covering their services, they’ve seen increased requests, especially from high-risk clients, because doctors are encouraging these patients to work with a doula.

However, following the 2024 election, the ability of millions to keep this critical coverage could depend on politics.

In May, House Republicans pushed through a budget reconciliation bill that would cut Medicaid by more than $800 billion over the next decade. Black women across the country would be left more vulnerable if Medicaid funding is slashed. Fewer providers amid an ongoing shortage, hospital closures, and the erosion of essential programs—like home visiting services—would exacerbate already staggering disparities in maternal and infant health.

Insurance isn’t a perfect solution. Medicaid doesn’t have the best reputation for paying providers. Plus, the payment rates are low and may not include the entire scope of a doula’s services. There’s also a significant administrative burden associated with insurance reimbursement—hours of paperwork, thoroughly logging hours, and filing precise claims to avoid an expensive medical audit. But having no option for people to afford doula care isn’t ideal or sustainable, either.

In Memphis, where Rivera practices, the demand for doulas is high, but so is poverty. Nearly 25 percent of Black residents in the city live below the poverty line. “I was pregnant with my son in Memphis, and there were virtually no doulas available to me,” Rivera recalls. “The doulas that were available to me were charging anywhere from $1,000 to $1,500 for support, and I recently left a pretty abusive relationship, so I was low-income. I could not afford that.”

Now, Rivera charges a sliding scale for her services, especially within the Memphis City limits. And, usually, she won’t charge Memphis residents at all. “Within the city limits is the highest rate of poverty and infant mortality, and I often do those for free,” she said.

“I have been thinking a lot recently about the future of doulas, especially Black doulas, because it's emotionally taxing, it's physically taxing—especially if you are in a red state like I am, and you're a proponent for reproductive justice as a whole,” Rivera continued. “We have a hell of a fight ahead of us for reproductive rights.”

(Editor’s note: Rivera told me in March 2025 that she has since stopped practicing as a doula in an effort to focus on taking care of herself.)

Despite GOP Desires to Slash Family-Supportive Policy, the Effort to Diversify the Perinatal Workforce Remains

That fight includes efforts to provide financial access for doula services and ensure the demographic makeup of doulas reflects the diversity of their patients. Few remedies to address the U.S. Black maternal health crisis are as directly impactful as getting more Black people into the perinatal workforce, research shows. Black patients live longer when they are cared for by Black care providers due to the reduction of implicit biases and a boost in trust, communication, and the chance that patients will adhere to medical advice when the person providing it looks like them. Currently, only 5.7 percent of physicians, 6.3 percent of nurses, eight percent of nurse practitioners, and 10 percent of doulas are Black—all of which are disproportionately low compared to the 13.7 percent of the U.S. population identifying as Black.

When Antonia Mead began overseeing Johnson C. Smith University’s (JCSU) doula and lactation program in 2017, its capacity to diversify North Carolina’s perinatal workforce was limited. Black maternal mortality was being discussed more in the news and online, and more people were discussing the benefits of doula support to birthing people. Interest in the program peaked as national conversations picked up more steam following the death of Shalon Irving, an epidemiologist at the Centers for Disease Control, from postpartum complications, becoming the focus of an in-depth ProPublica report. The story quickly went viral, shedding unprecedented national light on a crisis that has plagued Black birthing people for generations. But Mead was in a bind. She was the only full-time staff member for the program, tasked with scheduling courses, promoting them, and finding a doula to teach the students.

Mead’s reality shifted in January 2023 when the school became one of 75 projects in Mecklenburg County, North Carolina, to receive funding from the American Rescue Plan. JCSU, a historically Black college and university, was granted $943,000 to flesh out its Lactation and Doula Program. She used the funds to hire staff, invest in marketing, and increase the frequency with which the university offers the training.

“I was like a one-woman band with too many instruments—as the department chair, as the point person who would try to coordinate with our facilitator. It was all on me,” she said. “Those two things have been a blessing before God with everything I'm juggling.”

Even before receiving the funding, the course was open to anyone who wanted to take it—whether a student or a community member—with the primary target being North Carolinians. However, the school could only offer the course once or twice a year, depending on the schedule of the contracted trainers, one of whom lives in Raleigh. (Charlotte, where the university is located, is a roughly two-and-a-half hour drive one way with the usual traffic. Hitting rush hour in both cities can easily tack another hour or more onto the trip.) Marketing was also very “low budget,” Mead said, with the school depending heavily on social media.

Now, the program can appear at events and train students three times a year or once a semester, including the summer term. Funding from the American Rescue Plan has also allowed the university to fully cover the training cost and financially assist students with a portion of their total certification costs.

According to Mead, 75 students have graduated from the program, the most thus far.

That’s just step one. Becoming a certified doula is a multipronged and expensive process—and many states have some type of certification or training requirements. (They vary state-by-state and, in some states, they’re as simple as registering for a vague “certification course.”) Several organizations offer this distinction, but DONA International is the most popular. The nuts and bolts of DONA’s process begin with participating in a birth doula workshop. If a student is lucky enough to join a program like the one offered at Johnson C. Smith, the workshop will fulfill the childbirth and lactation support education requirements. If not, the student has to find additional classes. Next, the student completes two research papers and reads four books before completing a self-assessment, compiling a referral list of doulas in their community, and attending three births. The last step is submitting all materials in an application packet and uploading them to DONA International’s site, for a fee. Students have three years after participating in the training to complete all requisites.

While DONA International estimates this process costs prospective certified doulas anywhere between $600 and $1,000, Mead said $1,000 is closer to the low end. “If someone tried to do this program without our assistance, it could range anywhere from $1,200 to $3,000 for them to get their [full] training,” said Mead. “We removed that barrier, and we're able to help them move the needle closer to that certification.” JCSU’s facilitators also offer one-year mentorships to interested students working to get their certification—the university partners with local organizations to help students attend live childbirths.

JCSU, being an HBCU, is crucial to this effort and to increasing and diversifying the perinatal workforce. In June 2023, the Supreme Court effectively eliminated race-conscious affirmative action in higher education, which is expected to lead to declines in the number of Black students attending college.

The effect of that expected decline on the health and well-being of Black communities is currently unknown, but history offers up a grim possibility. In 1910, Abraham Flexner released a report that led to the closure of 75 percent of U.S. medical schools. Commissioned by the Carnegie Foundation to evaluate and standardize medical education, Flexner's investigation included six Black medical schools, four of which were shut down by 1923. Although the goal was to enhance the quality of medical care—and due to a lack of access to quality secondary school education, Black students arrived at medical schools unprepared—the consequences were particularly harsh for Black communities. Researchers estimate that, had those schools not closed, 30,000 to 35,000 Black doctors would have received a medical degree in the past century. With limited acceptance of Black students into predominantly white institutions, the number of healthcare providers willing to serve Black populations significantly decreased.

Of the Black doctors currently practicing, 80 percent were educated at Meharry Medical College or Howard Medical School, the only two Black medical schools left.

“Advocacy is the thread throughout this; that's key. That's the beauty of why we're doing it. History and advocacy are connected to the history of HBCUs,” said Mead. “HBCUs existed to educate us when nobody else would. Even if we didn't attend an HBCU, we were likely educated by someone who did. So, the legacy of HBCUs and that connection of advocacy and empowerment ties into what we're doing now.”

Doula Care Saves Black Lives

Tonya Abari’s second pregnancy was much different than the first.

Abari planned to have a vaginal birth at home—a decision that turned off many potential care providers due to her age and past complications. Abari and her husband decided that their six-year-old daughter would be as active in the birthing process as a small child could be. Their care team jumped on board, including the six-year-old in appointments, giving her homework—like keeping her mom’s food journal and writing down her blood pressure readings—sharing affirmations, and bringing her coloring books. It was a stark shift from her first pregnancy already. Her former OB didn’t even allow children in the office, which Abari found nonsensical.

“We needed a care team that was understanding of us needing to have her in the room—and I mean in the room literally while I'm giving birth,” she said. “A prerequisite for us in choosing was that you have to understand that we do things as a family.”

For centuries, Black birthing traditions have included a communal element. Abari’s doula arrived on the morning of labor and delivery with an apprentice, a birth photographer to document the process, and a therapist to provide mental health support, considering the trauma experienced during her first birth experience. Her care team held her hands during contractions, sang, made a playlist of her favorite songs, and recited affirmations with her. I am strong. I am magnificent. I am capable. They decorated her bedroom with photos of her family and art. More coloring books showed up for her six-year-old daughter, and they cooked for her family.

Labor and delivery went smoothly. In November 2021, Abari and her family welcomed a healthy baby girl.

Two weeks after giving birth, Abari had excruciating leg pain. But, suffering from postpartum depression, she kept that to herself. Late one night, she shared a photo of her swollen legs with her doula and midwife. They told her to get to the hospital. There, a kind-hearted Black woman OB told Abari that she had a blood clot and was having a light stroke. She was rushed into surgery to remove the clot. Her Black OB prayed with her alongside a few nurses.

Of Abari’s care team, her doula was the one who made it to the hospital. While there, she noticed Abari had been left to “sit in her own dirt.” She went to the managerial team and the doctors, demanding they clean Abari up. She was also able to help Abari pump so that she could continue feeding her daughter, who refused formula.

At this point, when sharing her story, Abari breaks down.

“I don't know how I pumped milk, but I pumped milk in the hospital, and my doula was there picking up the milk and delivering the milk. My baby would not drink anything other than my milk,” Abari said once she had collected herself. “She made runs. She was there. She did so much, so much, so much. And, honestly, it was lifesaving.”

“The most important time was postpartum because I didn't know things could fall apart that fast,” Abari continues. “I didn't know that I needed that extra help and that extra care after I had the baby—and what helped to save my life was their care.”

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The Louisiana Cup Cure involves placing a glass of cold water upside down on the head, with a towel in between, to treat heat exposure and headaches. I’d never heard of it until I saw a video on Twitter in December, but I understood the principle as someone who’s had migraines since I was seven. When you feel like you’ve just been punched in the face by Thanos, a cool rag over your head, however it’s cooled, is akin to a forehead kiss from God. Still, my curiosity about Black ancestral healing practices got the better of me, so I went and found the original TikTok video.

@anitrapowell4A tradition in these parts of Louisiana my son being treated for the SUN #ifyouknowthenyouknow😌

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Users in the comments said their elders did the same for them in Brazil, Mississippi, Texas, and elsewhere across the American South. Then, a few follow-up searches on the platform led me to several creators who pretty much confirmed this is an old hoodoo practice, which is what I figured.

That’s why the reactions to the cup cure I saw on X were so disappointing.

I’m always let down when people call Black ancestral knowledge “stupid.” But this moment bothered me more so than usual because the denigration was rooted in seeing a Black woman practicing a Black folk remedy, and that was enough for a significant portion of the internet to dismiss it as superstition, at best, and idiocy, at worst. Writing Black folk medicine practices off as “superstitious” has never been a neutral observation. It was used to dehumanize enslaved Africans, suppress their religious practices and the cultural offspring that arose from them in the Americas, and frame complex systems of knowledge as primitive.

Besides, the gag is that the cup cure isn’t bunk, scientifically speaking.

Before I get into the research, we need to note the difference between a migraine and a headache since the majority of the data I found focuses on migraine, which is more severe. I’m going to let this cool graphic from Tandem Clinical Research do it for me:

Migraines almost always require medication in addition to any home remedies. Now, the data!

Mechanically, the cup cure is doing two things at once. First, it’s providing a localized cold compress—a method for treating headaches that has been documented for at least 150 years—that lowers skin temperature and constricts blood vessels, reducing the transmission of pain signals to the brain. Second, there’s a mild suction element, since the inverted glass creates a partial vacuum against the towel and scalp, a principle shared with cupping. There are two types of cupping: dry and wet. The former involves creating suction between the cup and the skin using heat or by sucking air out of it, while the latter is the same process, except that small incisions are made in the skin beforehand, and the recipient bleeds.

A 2024 analysis found an 83 percent improvement in migraine symptoms among patients who received cupping therapy, with wet cupping alone showing the strongest results. Still, the research in this area is limited, more rigorous trials are needed, and pain medication offers the best relief for a migraine. As for the other half of what the cup cure is likely doing, cold therapy for head pain has stronger evidence behind it. Frozen neck wraps targeting the carotid arteries reduced migraine pain by nearly 32 percent within 30 minutes, according to a 2013 study, and the short-term benefits of cold therapy were further confirmed by a 2023 meta-analysis.

But, as I said, if you’re a migraine patient or if you have frequent headaches, you already know about the additional relief provided by cold therapy, cupping, or other tension-relieving practices. What you may not have known is that there’s a strong ancestral history behind the mechanics of the cup cure, too.

I couldn’t find documentation of cold therapy being practiced by Black folks in the American South. That likely says more about what got recorded and by whom, and the limitations of online research into historical documents, than about what was actually practiced, since there is strong evidence that cold therapy was used on the continent and may have survived the Middle Passage.

The Edwin Smith Papyrus, the oldest known medical text, mentions hydrotherapy, and an article indexed in PubMed lists the practice as a core component of African traditional medicine. Research published in the Journal of Advanced Research in Humanities and Social Sciences explains that practitioners used cold and hot baths, as well as steam, to treat fever, headache, and pain.

While the provenance is debated, and some research attributes it to European colonists, “cooling” the practice of drawing excess heat from the body to restore balance, is a foundational principle of traditional medicine across the Caribbean. In Brazil, the Candomblé tradition, brought over by enslaved Yoruba people, includes herbal baths and head treatments used to address what practitioners call “doenças da cabeça” (illnesses of the head). One such practice, borí, involves applying preparations directly to the head to care for the ori, the seat of consciousness. The “cooling” is spiritual as much as physical, but the principle is familiar: when the head is disturbed, you restore balance by drawing the heat out.

There’s also plenty in the literature about cupping.

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Though in the mainstream it’s often directly correlated with Traditional Chinese Medicine (TCM), applying suction to the skin is cross-cultural and among the oldest documented medical practices in the world. It appears in the Egyptian Ebers Papyrus from 1550 BC, in TCM texts dating to the Jin dynasty, in Islamic medical tradition as hijama, and throughout Africa, where practitioners used animal horns.

These practices didn’t stay on the other side of the Atlantic either. In Medicine and Healing in the Age of Slavery, historian Mary Hicks documents how Black barber-surgeons in Brazil adapted West African healing traditions of bleeding and cupping. In the American South, the practice was used by white doctors and enslaved Black folks. Historian Sharla M. Fett in Working Cures: Healing, Health, and Power on Southern Slave Plantations mentions it briefly: “If a client was bedridden, the conjurer performed curing rituals at the bedside, using cupping horns, songs, and massage to withdraw the offending snakes, lizards, or other reptiles from the sick person’s body.”

I wanted more information than that, though. After a short dive through the narratives of formerly enslaved people from the Federal Writers’ Project1, I found Lucy Key’s recollection healing her rheumatism by cupping. It was also the most direct correlation to the Louisiana cup cure I found:

In another narrative, where Morris Sheppard mentioned that the plantation where he was enslaved didn’t allow the practice:

It’s worth noting that, generally, cupping, especially if it involved bloodletting, wasn’t preferred by most Southerners, according to historian Lindsey Stewart’s research in The Conjuring of America: Mojos, Mermaids, Medicine, and 400 Years of Black Women’s Magic. Still, the Louisiana Cup Cure sits in this lineage and is rooted in knowledge that predates the country in which it was practiced.

This brings us back to the reactions online.

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Cupping has been steadily gaining mainstream Western credibility for years. Gwyneth Paltrow is often credited with the practice’s original ascension in 2004, when she was photographed on a red carpet with the distinctive round bruises on her back. Twelve years later, Michael Phelps threw it back into the mainstream when he showed up to the 2016 Olympics covered in cupping marks. Some insurance plans now cover acupuncture, and TCM practitioners are licensed in most states.

Cold therapy has followed a similar trajectory. Cryotherapy chambers, where you stand in subzero temperatures for two to three minutes, have become a staple of elite athletic recovery and high-end wellness spas. Ice baths went from niche biohacking to mainstream wellness content after figures like Wim Hof and Andrew Huberman popularized a practice that is also indigenous. The basics of the science are the same as those behind a grandmother in Louisiana placing a glass of cold water on her grandson’s head.

Black ancestral medicine didn’t fail to produce knowledge. It was failed by the institutions that decide what counts as knowledge. The Louisiana Cup Cure works the way a cold compress works, the way cupping works, the way generations of Black grandmothers knew their methods worked before anyone with grant funding started to ask why.

The difference isn’t the evidence. It’s whose hands are holding the cup.

Everything you just read is free, and I want it to stay that way! But the research behind it—the clinical reviews, the sourcing, and the hours spent making sure every claim holds up—isn’t. If this issue earned your trust, a tip helps me keep earning it.

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At the beginning of October, I decided to participate in a “Project Pan,” a sustainability challenge that involves using up items I already have—such as blush, lip glosses, and body butters—before purchasing anything new. Typically, this applies to makeup and skincare, but I also decided to work on my pantry and refrigerator. This was a fun and creative challenge for me, and it was pretty successful. I saved money, didn’t waste any food, cooked some…interesting meals1, and emptied some skincare products and makeup, which gave me an excuse to buy more.

As wages stagnate, the cost of living rises, and climate disasters multiply, sustainability is the practical choice. Before it became trendy on social media, sustainability was primarily a consequence of poverty. For generations, people reused, repurposed, and stretched what they had because it was necessary. The zero-waste lifestyle that now fills social media feeds once looked like growing your own food, utilizing animal scraps, mending clothes instead of buying new ones, and saving glass jars for storage. What’s being marketed as moral virtue today was, for many, simply survival.

My family was my first introduction to the concept of sustainability. We saved glass sauce and jam jars, rubbed off the labels with warm water and Ajax dish soap, and dried them on a rack to use for drinking or storing food. Whatever recyclables weren’t kept went into the bins or were taken by Muss^⁠2 to scrap yards that pay cash on the spot based on material weight. Nana^⁠3 would always make sure Muss took her items, too, so that her mother could make a little extra cash. My grandmothers gardened, shopped at farmers’ markets, fish markets, and bought fresh, hunted meats from people they knew. Those meat scraps would be added to a pot with greens or another vegetable, allowing us to enjoy the benefits for a longer period. And, of course, I got chewed out for leaving the lights on in an empty room, as were many other children I grew up around, whose caretakers were navigating tricky socioeconomic conditions with limited resources.

Sustainability’s history, particularly in Black communities, is interstitial with the present. We can learn valuable lessons from the past to pull forward into the current day, guiding us on how to live amid economic precarity and environmental collapse.

Kenyan philosopher John S. Mbiti’s concept of time offers some insight.

Mbiti argued that African conceptions of time are anchored in the past and present, with little emphasis on a distant, abstract future. Time is not an infinite, linear horizon like in Western societies, but a lived, event-based reality made tangible through memory and ritual. The past remains ever-present, shaping identity and practice, while the future is experienced only insofar as it is imminent or embedded in communal rhythms. When you break it down, Mbiti’s theory was relatively simple: people and communities progress by following and learning from their ancestors, who paved the way for them, rather than turning their backs on lessons from past generations. It’s reminiscent of the Ghanaian principle of Sankofa or “go[ing] back and fetch[ing] it.”

Mbiti’s understanding feels urgent in this moment. Our future may depend less on technological or industrial innovation than on remembering and recovering the wisdom embedded in older ways of caring for the Earth and for one another.

Revelatory examples abound. George Washington Carver worked on developing sustainable farming practices, natural remedies, and community health initiatives, making him a pioneer in holistic science—combining agriculture, wellness, and environmental care to uplift entire communities^⁠4. The Gullah-Geechee communities practice resource circularity^⁠5 by net making with cotton to reduce waste and ensure product longevity, and by melting down metal scraps to cap them using the original West African method. They also practice quilting, sweetgrass basketry^⁠6, and making bateau boats from wood by hand so that the captain can readily repair the boats themselves.

One of the most prominent communal care models that offers wisdom is the Freedom Farm Cooperative (FFC), based in Sunflower County, Mississippi. Before the FFC was founded in 1967 by Fannie Lou Hamer to combat poverty and hunger, Sunflower County’s rates of diet-related illness were among the highest in the nation, and most of them were related to malnutrition. Wealthy white folks in Sunflower County were using starvation and limited resources as a tactic to get Black people who wanted to stay down South to join the Great Migration.

But Hamer understood that food justice, health equity, and political power are inextricably linked. Being self-sufficient would enable Black communities to resist disenfranchisement more effectively. To work toward a future where Black people could choose to stay in the South, the FFC provided housing, helped individuals obtain mortgages, and offered financial support to enable them to pay their rent or mortgages. It also provided healthcare, employment, education, economic resources for small business owners, and access to healthy, nutritious foods. It housed one of the first Head Starts in Mississippi. There was a “pig bank” that allowed families to generate income by raising pigs or butchering the meat to feed their families. It was^⁠, as Monica White wrote:

…an alternative to the second wave of northern migration—the departure from the rural South for northern cities and work in the manufacturing industry. FFC represented an opportunity to stay in the South, live off of the land, and create a healthy community based upon building an alternative food system as a cooperative and collective effort. It was in keeping with Hamer’s perspective that if she had a pig and a garden, “she might be harassed and physically harmed but at least she would not starve to death.”7

The FFC had almost 700 acres of land and farmed a variety of crops, including kale, turnips, corn, okra, sweet potatoes, tomatoes, and butter beans. According to White’s research, more than 1,600 families were fed by the FFC in 1972. Unfortunately, due to a lack of institutional backing, the co-op couldn’t sustain itself once donations began to wane and was fully dissolved by 1976.

I’m not telling you to go out and start a farm, although that would be really dope. The lesson, however, is that sustainability, like most things in the health and wellness sphere, has historically been a communal and justice-oriented pursuit rather than an individual endeavor. Taken together, these stories are blueprints. The question, then, is how we turn that wisdom into action.

Recognize and honor the knowledge that already exists. If you have elders to discuss their sustainability practices with, sit down and have a conversation with them. Documenting those practices and then teaching them will remove the luxurious lens sometimes applied to sustainability. We don’t have to spend $20 on a single reusable silicone storage bag; we can repair, repurpose, or rethink what’s already in our homes—such as hemming a torn seam, reupholstering an old chair, or learning to make something last instead of replacing it.

Take the opportunity to be sustainable in community when it presents itself. That might look like planting herbs in a community garden, donating your old books to a public bookcase/Little Free Library, or contributing to a local food pantry. It could also mean swapping clothes with friends, organizing or participating in a mutual-aid drive, or volunteering to drop off your neighbors’ compost.

Get political. Personal ethics aren’t enough to address systemic harm, and pushing for policies that make sustainable living accessible to everyone will be key. There are a plethora of options here. You can organize around food justice, support land-back initiatives, or join a co-op. Voting with intention, attending city council meetings, and amplifying the work of grassroots organizers are all extensions of sustainability. The systems that harm the planet are the same ones that harm people; the work toward climate, health, and economic justice is inseparable.

Technological innovation isn’t the end-all, be-all. Environmental stewardship is as crucial as investing in solar panels and wind technology.

Historical legacies of sustainability beg us to push the limits of our creativity. They require that our imaginations and paths forward be rooted in the memory of what sustained those before us. The past is not something we’ve outgrown, but rather something we return to for guidance, like soil that still holds seeds. As climate disasters accelerate and economic precarity deepens, the lesson is not to innovate our way out, but to remember our way through.

A Deeper Look At My Project Pan

I wasn’t going to do a post based on my Project Pan without sharing more info about it! Here are a few things I did, emptied, and learned during this challenge.

I made a batch of what I’m calling “Scrappy Wellness Shots”: I blended up some fresh ginger root, and the meat of a few oranges and lemons a friend left me when she moved out of her apartment last week. I juiced them using a nut milk bag and then froze the liquid in ice cube trays. Now in the mornings, I pop one into a cup of hot water with honey and a dose of creatine. This concoction is anti-inflammatory, supports the immune system, and aids in digestion.

My October Empties

Garnier Fruitis Micellar Water: Honestly, this isn’t my favorite. I’m a Bioderma enthusiast, but I picked up the Garnier one day because the Bioderma was sold out at my CVS. It’s fine. It works well enough. It’s affordable. I used all of it, begrudingly. I did not repurchase.

Dieux Ethereal Makeup Removing Concentrated Cleansing Oil: I’ve tried many cleansing oils, but this one is among my favorites. While I don’t like that it doesn’t emulsify as well as, say, the Clinique Take The Day Off Balm (my OG), I do love that Dieux’s formula doesn’t tug at my skin like many oil cleansers do. It’s very gentle and soft, almost—and I didn’t know that a cleanser could be soft. I repurchased it.

Topicals Faded Serum (Unscented): I have so much post-inflammatory hyperpigmentation and dark spots that I struggle to see if a product is actually working—but the Topicals has made a dramatic change in the texture and composition of my skin. It uses a combo of tranexamic acid (reduces melanin production), niacinamide (brightens dull skin), azelaic acid (fights acne and evens skin tone), kojic acid (inhibits tyrosinase, an enzyme involved in melanin production, to lighten hyperpigmentation), and melatonin (acts as an antioxidant to repair UV damage) to reduce the medley of issues that causes skin, espeically skin of color, to hyperpigment. I love it. I obviously repurchased it.

Bob’s Red Mill Farro: I love farro. It’s high in fiber and protein—a win-win for me. I repurchased.

Ilia Multi-Stick Cream Blush + Lip Tint in Tenderly: I actually do like this, and I enjoyed using it. In a way, the color reminded me of Orgasm by NARS—an iconic tint that I always have in my makeup kit. But when I bought the Ilia eons ago, it wasn’t $36. And it isn’t NARS, so to me it’s not worth the price hike. I did not repurchase. Instead, I grabbed a rhode Pocket Blush in Toasted Teddy. I didn’t believe the hype behind the brand because TikTok tends to overhype things, but I gotta give Hailey Bieber her 10s. I’ve tried several products at Sephora before they dropped that distasteful holiday ad and bought a lip tint. The products are, in fact, amazing. I’m going to try the mini Glazing Milk once I run out of my Cyklar Milky Essence.

Barebells Protein Bars: I run through these like a hog runs through mud. Of course, I repurchased them. I’m on the hunt for the peppermint bark flavor right now.

Howdy,

September was a busy month for the Library. We’ve added 13 new materials—many in part to submissions! How exciting! I love that this project is so communal, which I wanted, and seeing that manifesting makes me very happy.

Okay. Let’s explore the shelves.

✨ My Fave Finds

Healing from Hurricane Katrina, 20 Years Later

I enjoyed this story—works pertaining to Hurricane Katrina’s aftermath were missing from the Library, and that omission was glaring to me. In this piece, author Dominique Fluker explores how Hurricane Katrina survivors are coping with mental health challenges like PTSD, depression, anxiety, and grief 20 years later. The story also looks at how the broader lack of access to mental health care in Black communities has compounded the trauma of the disaster.

read the full story

Five Articles from Negro Digest/Black World

Negro Digest was a groundbreaking Black American publication founded in 1942 by John H. Johnson, the visionary behind Ebony and Jet magazines. Modeled after the Reader’s Digest, it began as a platform to highlight the achievements, perspectives, and cultural contributions of Black Americans during a time when mainstream media largely ignored them. In 1970, the magazine was renamed Black World, marking a shift toward a more radical and Pan-Africanist editorial tone. Under the influential editorship of Hoyt W. Fuller, Black World became a key voice of the Black Arts Movement, publishing essays, poetry, and critical writings by significant figures such as Amiri Baraka, Gwendolyn Brooks, and Sonia Sanchez. It served as both a cultural archive and a forum for political thought, reflecting the evolving consciousness of the African diaspora. Though it ceased publication in 1976, Negro Digest / Black World remains an essential artifact of Black literary and intellectual history.

These are the oldest materials featured in the library, and while reading through them, I was fascinated by how our elders and ancestors discussed well-being. One piece, called In Defense of Chittlins (April 1950), uses a dish often admonished for consisting of pig intestines as a way to argue that there is no “Negro diet”—just a “nutritionally adequate” Southern diet—which, in turn, subverts claims that poor dietary choices are what lead to adverse health outcomes among Black Americans. It also notes that chitlins and other organ meats contain essential vitamins. Another, entitled Folks Do Get Born (August 1946), chronicles the work of granny midwives and the systemic influences preventing more from picking up the profession.

The remaining pieces include:

Dr. George Washington Carver (July 1944): George Washington Carver’s legacy goes far beyond peanuts. His work in sustainable farming, natural remedies, and community health made him a pioneer in holistic science—blending agriculture, wellness, and environmental care to uplift entire communities.

My Africa (August 1946): Mbonu Ojike offers a vivid, first‑person account of his life in southeast Nigeria that blends autobiography with a sharp critique. He defends indigenous culture and argues for dignity and cultural self‐respect. In this excerpt, the focus is on food culture in Nigeria.

One Half the People (November 1949): A story about an Ivory Coast medicine man who combined the ancient wisdom of African traditional medicine—which included a deep knowledge of herbs and medicinal uses for dirt—with modern practices to combat tuberculosis and other diseases present in the populations he served.

📚 More New Additions

Radical Self-Care, explained by Angela Davis

Fun fact: The Black Panthers popularized the concept of taking care of oneself as a way of taking care of one’s community and turned it into action.

Academic Articles

“A Kind of Restoration”: Psychogeographies of Healing in Toni Morrison’s Home (August 2014)

The Restorative Power of Sound: A Case for Communal Catharsis in Toni Morrison’s Beloved (April 2007)

News Articles

This New App Connects Women Of Color Facing Infertility — And Builds Hope Along The Way

Black Girl Wellness: A New Cultural Renaissance

How ESSENCE And Black Women Are Prioritizing Pleasure

Motherhood On Rikers Island: Inside The Jail’s Doula Program For Incarcerated Moms

🌿 This Month’s Long Read

Gloria T. Hull wrote, in my opinion, the best analysis of The Salt Eaters:

Reasons for studying the novel are weighty. It is a daringly brilliant work which accomplishes even better for the 1980s what Native Son did for the 1940s, Invisible Man for the 1950s, or Song of Solomon for the 1970s: it fixes our present and challenges the way to the future. Reading it deeply should result in personal transformation; teaching it well can be a political act. However, Toni Cade Bambara has not made our job easy (because our job is not easy). Salt is long, intricately written, trickily structured, full of learning, heavy with wisdom-is, altogether, what critics mean by a ‘large’ book.

It is a challenging read, but this book also changed my life and my way of thinking about the labor that goes into protecting myself and my well-being. When you’re pulled in multiple directions, as Velma Henry, the protagonist, was for most of her life, you must accept that achieving and maintaining wellness will be hard work. Instead of writing a summary of The Salt Eaters, which is what I would usually do, I wanted to share resources that helped me work through the ideas presented by Toni Cade Bambara when I first read the book—including Hull’s piece What It Is I Think She’s Doing Anyhow: A Reading of Toni Cade Bambara’s The Salt Eaters (PDF, pgs. 185-202)

The Weight in Being Well: The Salt Eaters and the Genius of Toni Cade Bambara

“Are You Sure, Sweetheart, That You Want to Be Well?”: The Politics of Mental Health and Long-Suffering in Toni Cade Bambara’s The Salt Eaters

That’s all for this month, gang. See you soon.

— Juju

Dear friends,

I’m thrilled to welcome you to the first edition of the Library of Black Wellness Newsletter, an extension of the living archive dedicated to creative works that have shaped, preserved, and expanded Black wellness across generations. Each monthly issue will spotlight new additions to the library, highlight my favorite finds, and feature one monthly long read, typically a book, that I believe belongs at the heart of our conversations on Black wellness. Along the way, I’ll share insights, reflections, and stories about why these works matter and how they continue to guide us.

📚 New Additions

Liberating Abortion

Co-authored by Renee Bracey Sherman and Regina Mahone, this book delves into the lives of hidden historical figures and examines the complex interplay between race, class, and reproductive rights. Sherman, also known as “The Beyonce of Abortion Storytelling,” has once again humanized an issue that is so often not.

Purchase from a Black-owned bookstore

Womanly Magazine Issue No. 4: Black Maternal Health

This issue of Womanly comprehensively explores Black maternal health through personal narratives, expert interviews, and educational articles. It also shares powerful birth stories and reflections on motherhood through really beautiful photo essays.

Meet Johanna: Pilates Instructor and Wellness Diversity Advocate

This article profiles Johanna Thompson, a Pilates instructor who advocates for diversity in the wellness space. She focuses on making wellness more inclusive, particularly for women of color, and is working on eradicating elitism from Pilates—which is very much needed.

✨ My Fave Finds

Women In The Life, Breast Cancer Memoirs By Lesbians Of Color, April 1999

As I worked to source the Library, I encountered Women in the Life magazine during one of my archive dives. This edition, uplifting the stories of women navigating breast cancer, brought me to tears. Their stories of what it meant to love and care for themselves and each other during a difficult diagnosis and healing process were moving. Our storytelling has so much power, especially when we share it broadly.

‘We live in both worlds’: how teachers of Gullah Geechee herbal medicine are cultivating tradition

I really did enjoy this one. The fact that this piece was published in such depth showcases that herbal medicine is being taken somewhat seriously as a legitimate wellness practice after being stigmatized historically. At its crux, the article focuses on how a new generation actively works to preserve this ancestral knowledge, recognizing it as a form of self-reliance.

🌿 This Month’s Long Read

Purchase from a Black-owned bookstore

Beloved being the first book recommendation likely isn’t shocking if you know me personally. Whenever I explain the Library to people, I typically point them here because the book provides the foundation for reading dense texts about complicated topics such as healing from unthinkable traumas and “rough” choices made out of love.

Beloved is a profound exploration of life after enslavement, and what it means to be haunted by the consequences of a vicious, inhumane institution. Parts of it are difficult to read, but I encourage you to keep going.

The story centers on Sethe, who, 18 years after her escape, lives in Ohio with her daughter Denver, isolated and tormented by the ghost of the eldest child she killed instead of allowing to grow up enslaved. The malevolent spirit, which they call Beloved, eventually manifests as a mysterious young woman who appears on their doorstep. Her arrival forces Sethe to confront the devastating choices she made and work to heal from her memories. Morrison does not hold back here. As she said in an interview once, she “goes there” and asks us to come along with her as her characters work through things many of us cannot imagine.

Thank you for being here at the very beginning. I can’t wait to continue this work with you all.

With care,
Julia

At the top of this page, you’ll see a clip of Shug Avery returning to her father’s church in The Color Purple after decades of estrangement. Reverend Avery all but disowned his daughter for being a traveling blues singer and a “loose woman.” After hearing the choir in her father’s church begin singing God Is Trying To Tell You Something, Shug picks up the tune and walks toward the church, bringing her community of Blues musicians and early-Sunday morning spectators. Shug opens the church doors and stands before her father in a moment of praise and worship, where their worlds and communities merge. They lock eyes and she runs to embrace him, whispering in his ear, “See Daddy? Sinners have soul, too.”

I chose this moment to welcome you into The Library of Black Wellness because it captures the essence of this project: reconciliation, love, and healing, and how those things often happen most profoundly in community.

Visit the Library of Black Wellness

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I craved a place where our cultural memory, lived practices, and artistic expression could sit side by side because they belong together. It comes from watching pieces of our stories, our wisdom, and our art scattered across time and platforms. Some of it I’ve seen preserved in books, such as when Baby Suggs gathered Black folks in a clearing in the woods and told them to love the skin white people hated in a radical act of communal healing. Some live only in my memory, like the warm late spring day I went out into the country with my great-grandmother as a child to pick kale from her best friend’s garden. And some are currently hidden in archives that most people will never see.

The Library of Black Wellness is my way of gathering them. It’s a growing collection of books, personal essays, videos, research, and other creative works that have helped Black people survive, grieve, love, heal, and thrive across generations. Here, you’ll find Audre Lorde alongside herbalist Emma Dupree, contemporary essays beside research papers, and podcasts next to YouTube videos of our elders discussing what it means to be well—all threads in the same tapestry.

Many of the works in this archive aren’t typically shelved under “wellness.” But read closely, and you’ll find rich narratives of care, healing, and survival. Toni Morrison’s Sula is about friendship, betrayal, and autonomy, but it also shows how Black women live through grief and shape each other’s healing. Whether in essays or poetry, Audre Lorde’s writing reveals how self-care is political and how community care is liberatory. Parable of the Sower is a visionary exploration of resilience amid chaos and the radical necessity of building care networks that nurture healing and collective strength.

Nearly every work in this library returns to the collective. Black wellness has never been only an individual pursuit. It’s something we’ve always done in relationship to one another. That’s why public submissions about Black wellness across the diaspora are vital to this Library’s future—I can’t do this alone and don’t want to.

The Library of Black Wellness is a space to remember what we already know. At its core, this library exists to honor and preserve the traditions, strategies, and insights Black people have used to heal, protect, and sustain ourselves across generations. By collecting and celebrating these works, we safeguard ancestral wisdom and help build futures where rest, resistance, and joy are our birthright.

I hope you’ll wander through, share what you find, and see yourself reflected here. I hope you remember that we are our own best thing.

The Library of Black Wellness

A living, growing archive dedicated to preserving and celebrating the stories, practices, and cultural knowledge that have sustained Black wellness across generations.

By Julia Craven

Word counts are a necessary evil in media. No editor or writer I know is particularly fond of them, but we understand that word counts keep a piece from going off the rails, thus making the content more engaging and informational for readers. That said, I performed somewhat of a gut job on my last piece published at New America, which was a story about how doulas can make a world of difference for Black moms. Don’t let the language I’m using cause you to assume that I hated the end result. I love the way it turned out, and I think 1,000 words more efficiently tells the story I wanted to tell.

But the original piece was nearly 4,000 words. It offered a more nuanced, in-the-weeds look at doula care that connected the current political climate to the very real lives of doulas, the people working with them, and the educators working to get them into the workforce. I decided to share it here, in full, after updating the data to the most recent available. You should also know that I interviewed these women before Trump was elected, and, where appropriate, I have added relevant information from more recent conversations with them. Most of them, however, hadn’t changed their thoughts on anything since, as we know, Black folks and our politics transcend presidential administrations—so much so that when we speak freely to one another about a topic as long standing as caring for Black birthing people whomever is in office barely comes up, if at all.

The constant vomiting and nausea began early during Tonya Abari’s first pregnancy in 2014.

It was far beyond the typical morning sickness, which happens once or twice daily, most commonly during the first trimester. Abari was throwing up multiple times—sometimes, she took as many as 20 trips to the nearest receptacle. “There was not one day that I didn't have five or more episodes of vomiting throughout the entire [10 months of] pregnancy,” Abari, now 42, said. “I was very weak and lost a lot of nutrients, and the only thing that made me feel better was eating bread. I ate a lot of bread.”

While the bread soothed her stomach, it also caused her to gain weight, which led the midwives and obstetrician she was working with in Nashville, Tennessee, to question if the vomiting and nausea were due to her size, even though her illness predated the jump on the scale. She wasn’t offered nutrition counseling or blood tests to determine what was wrong. Toward the end of her pregnancy, her blood pressure began to fluctuate, eventually ticking upward to hypertensive levels. She doesn’t remember how high, but she knows it was well above her pre-pregnancy average of 115/65. She believes she had preeclampsia, a disorder characterized by high blood pressure and the leading cause of death in the pre- and postpartum periods for Black women, but she was never officially diagnosed. (She later found out from her doctor that her vomiting was hyperemesis gravidarum, a severe form of pregnancy-related nausea and vomiting that can lead to dehydration, weight loss, and nutritional deficiencies.)

Another complication arose once it was time to deliver her daughter. Abari went to the hospital because her amniotic sac was damaged. It wasn’t wholly ruptured, or, as is more commonly said, her water hadn’t broken. The sac was torn and slowly leaking—a complication that can potentially lead to infection if not treated. She was admitted and told she’d need an emergency C-section due to her weight. “I refused because my weight is not a determinant of whether I need a C-section or not,” she recalls. “Let me walk around. Let me see if we can move the needle. I was zero centimeters dilated. Let me do what we've been talking about according to my birth plan.”

After 56 hours of labor, Abari got the C-section. Her heart rate dropped after, another potential sign of preeclampsia, and so did her newborn daughter’s. Abari’s first pregnancy and birthing experience were a nightmare.

“I felt like I was not heard. I felt like there was a lot of bias during the entire process,” said Abari. “The first birth was so traumatic that I felt that I didn't want to have any more children after that.”

Six years later, Abari and her husband decided to have another child. While planning the baby’s birth, they were adamant about having a birth team that could actually see and hear them, people who could navigate the complex relationship Black birthing people have with clinicians who often disregard and ignore Black patients. She also wanted to reclaim her autonomy and power within the birthing experience.

Abari met Tanzye Hill, a doula and owner of Birth Manifesta, an organization that offers full-spectrum doula support to birthing people and focuses on reducing rates of Black maternal and infant mortality, in Nashville, and they became friends. When Abari found out she was pregnant, Hill was the first person she went to, and she helped Abari by looking for a Black care team that would respect her wishes, and adding a doula was key.

What differentiates doulas professionally from obstetricians, nurses, or midwives is that they don’t have clinical duties or give medical advice. Instead, doulas fill in gaps that overworked clinicians often can’t or won’t in the birthing person's care. This includes emotional and physical well-being support to their patients during pregnancy, labor, birth, and postpartum. They supplement knowledge gaps between clinicians who don’t explain complicated medical knowledge well to patients and the birthing parent.

Across all causes of maternal mortality, Black birthing persons experienced 49.5 deaths per 100,000 live births in 2022—nearly three times the rate for their white (19) and Hispanic (16.9) counterparts, respectively, and almost four times as often as birthing persons of Asian descent (13.2). Sixty-five percent of pregnancy-related deaths happen in the 365 days after delivery, according to a report from the Centers for Disease Control (CDC). Death by suicide is the leading cause. Between 29 and 44 percent of Black women exhibit symptoms of postpartum depression, but many are not diagnosed or directed to mental health care. The CDC estimates that 80 percent of these deaths were preventable.

Doulas also catch other complications in the early stages and encourage the birthing person to receive life-saving care. They teach parents the skills needed to care for a newborn, like changing diapers and soothing, and they assist with housework and other chores to take the burden off new parents. Despite evidence showing that doula care could significantly reduce the U.S. maternal mortality rate, doula care is underutilized. A study in the American Journal of Managed Care found that Black women are more likely to desire doula care than their white counterparts.

‘The Buck Doesn’t Stop with Giving Birth’

Community-based doulas are especially adept at providing culturally competent care, which is what Abari was seeking, to those most susceptible to adverse birthing outcomes. Think of a doula as a birthing parent’s caregiver, helping parents, their children, and their communities thrive by reshaping the birthing experience and empowering parents to take control.

“In our history, communities have always had what we call now doulas,” said Myriam Webb, a longtime doula. “They didn't have a formal title. They were community members who would come by and drop off food, or help you with the baby, or they would attend the birth and help you with the labor.”

While many people think of doulas as additions to the birthing process, they play a crucial role during postpartum, providing vital emotional, physical, and informational support to new parents. Doulas can offer new moms a safe space to navigate their postpartum emotional ups and downs and alleviate the feelings of overwhelm and isolation new parents often feel. They’re also trained to recognize when postpartum depression has taken root and can refer families to critical mental health services.

After attending her first couple of births, Takeallah Rivera, a longtime doula based in Memphis, realized that the postpartum period needed more attention.

“I saw that the birth aspect as it pertains to being a doula was very saturated,” she said. “And I noticed the very critical postpartum period was being neglected, which is where Black women tend to suffer even more. [But] the buck doesn't stop with giving birth.”

“Usually, with a postpartum client, I'm there maybe a night or two to help mom prepare meals, making tea, tending to the other children she may have,” said Rivera, who also works as a postpartum counselor with the National Maternal Mental Health hotline. “I also focus heavily on the mental health aspect, so getting moms connected to resources for postpartum mental health supports, therapists, psychologists, online support groups, anything that would foster their wellbeing during the postpartum period.”

Covering Doula Care Under Medicaid and Private Insurance Could Expand Access

In December 2023, De Ajanae Gunn contacted Black Infant Health, a health equity program that provides resources to pre- and postpartum Black birthing persons toward the end of her pregnancy. She wanted to know what resources were available to her as she approached her due date. They pointed her to United and Guided, a Sacramento, California-based organization offering various services, including doula care. “My baby, during birth, his heart rate kept dropping, so I had to have an emergency C-section,” said Gunn, a 36-year-old child care provider. “It was very tough because I wanted to have a very holistic birth. I wanted to have a water birth, but it just didn't work out.”

Although her doula wasn’t there in person for the birth—she was sick and attended via Zoom—she helped Gunn navigate the postpartum period mood swings, offered breastfeeding support, and was an active listening ear.

Accessing the doulas who helped Gunn through a challenging birth and postpartum period would not have been possible were it not for Medi-Cal, California’s Medicaid program, which offers doula services to any pregnant person who wants one up to one year after pregnancy. As of June 2025, 24 states and the District of Columbia actively cover doula services for people on Medicaid, according to data from the National Health Law Program’s Doula Medicaid Project. Eight additional states are implementing doula coverage under Medicaid, and 15 others have programs adjacent to Medicaid coverage for doulas, such as pilot programs or exploratory efforts. But research shows that Medicaid expansion, even when it doesn’t include doula care, is crucial to reducing Black maternal mortality.

“Having a support person is very important, especially while you're going through pregnancy,” said Gunn. “With everything going on in healthcare and how systems are already not for us, it is important that we do have that support.”

Nearly 40 percent of births are covered by Medicaid, with this figure rising to 65 percent for Black birthing people. Disruptions in postpartum health coverage, particularly among Medicaid enrollees, are a persistent issue in preventing access to necessary care during this critical time, which is why expansion is associated with lower rates of maternal mortality. The American Rescue Plan Act of 2021 introduced a provision that allows states to extend Medicaid postpartum coverage from 60 days to 12 months through a state plan amendment. As of January 2025, 49 states and the District of Columbia have implemented 12-month Medicaid postpartum coverage, and Wisconsin has implemented limited coverage for up to 90 days.

Private insurance plays a role, too. The risk of maternal mortality for Black birthing persons is not bound by socioeconomic lines—wealthy Black mothers and their infants are still more likely to have an adverse outcome during the perinatal period. The coverage of doula services by private insurance varies across the country, depending on state regulations and individual insurance plans. Rhode Island became the first state to mandate that private health insurance plans cover doula services in 2021. Elsewhere, it’s less direct. California is encouraging private insurers to cover doula care. Lawmakers in Indiana introduced a bill in 2021 requiring state employee health plans to cover doula care, but it failed. Massachusetts and New York lawmakers are considering bills that would mandate all health plans to cover doulas. A bill in Virginia failed.

Research suggests doctors may be more likely to recommend doulas to their patients if Medicaid and private insurance cover their services. A doula in Rhode Island told the Women’s Bureau of the U.S. Department of Labor that since Medicaid and private insurance started covering their services, they’ve seen increased requests, especially from high-risk clients, because doctors are encouraging these patients to work with a doula.

However, following the 2024 election, the ability of millions to keep this critical coverage could depend on politics.

In May, House Republicans pushed through a budget reconciliation bill that would cut Medicaid by more than $800 billion over the next decade. Black women across the country would be left more vulnerable if Medicaid funding is slashed. Fewer providers amid an ongoing shortage, hospital closures, and the erosion of essential programs—like home visiting services—would exacerbate already staggering disparities in maternal and infant health.

Insurance isn’t a perfect solution. Medicaid doesn’t have the best reputation for paying providers. Plus, the payment rates are low and may not include the entire scope of a doula’s services. There’s also a significant administrative burden associated with insurance reimbursement—hours of paperwork, thoroughly logging hours, and filing precise claims to avoid an expensive medical audit. But having no option for people to afford doula care isn’t ideal or sustainable, either.

In Memphis, where Rivera practices, the demand for doulas is high, but so is poverty. Nearly 25 percent of Black residents in the city live below the poverty line. “I was pregnant with my son in Memphis, and there were virtually no doulas available to me,” Rivera recalls. “The doulas that were available to me were charging anywhere from $1,000 to $1,500 for support, and I recently left a pretty abusive relationship, so I was low-income. I could not afford that.”

Now, Rivera charges a sliding scale for her services, especially within the Memphis City limits. And, usually, she won’t charge Memphis residents at all. “Within the city limits is the highest rate of poverty and infant mortality, and I often do those for free,” she said.

“I have been thinking a lot recently about the future of doulas, especially Black doulas, because it's emotionally taxing, it's physically taxing—especially if you are in a red state like I am, and you're a proponent for reproductive justice as a whole,” Rivera continued. “We have a hell of a fight ahead of us for reproductive rights.”

(Editor’s note: Rivera told me in March 2025 that she has since stopped practicing as a doula in an effort to focus on taking care of herself.)

Despite GOP Desires to Slash Family-Supportive Policy, the Effort to Diversify the Perinatal Workforce Remains

That fight includes efforts to provide financial access for doula services and ensure the demographic makeup of doulas reflects the diversity of their patients. Few remedies to address the U.S. Black maternal health crisis are as directly impactful as getting more Black people into the perinatal workforce, research shows. Black patients live longer when they are cared for by Black care providers due to the reduction of implicit biases and a boost in trust, communication, and the chance that patients will adhere to medical advice when the person providing it looks like them. Currently, only 5.7 percent of physicians, 6.3 percent of nurses, eight percent of nurse practitioners, and 10 percent of doulas are Black—all of which are disproportionately low compared to the 13.7 percent of the U.S. population identifying as Black.

When Antonia Mead began overseeing Johnson C. Smith University’s (JCSU) doula and lactation program in 2017, its capacity to diversify North Carolina’s perinatal workforce was limited. Black maternal mortality was being discussed more in the news and online, and more people were discussing the benefits of doula support to birthing people. Interest in the program peaked as national conversations picked up more steam following the death of Shalon Irving, an epidemiologist at the Centers for Disease Control, from postpartum complications, becoming the focus of an in-depth ProPublica report. The story quickly went viral, shedding unprecedented national light on a crisis that has plagued Black birthing people for generations. But Mead was in a bind. She was the only full-time staff member for the program, tasked with scheduling courses, promoting them, and finding a doula to teach the students.

Mead’s reality shifted in January 2023 when the school became one of 75 projects in Mecklenburg County, North Carolina, to receive funding from the American Rescue Plan. JCSU, a historically Black college and university, was granted $943,000 to flesh out its Lactation and Doula Program. She used the funds to hire staff, invest in marketing, and increase the frequency with which the university offers the training.

“I was like a one-woman band with too many instruments—as the department chair, as the point person who would try to coordinate with our facilitator. It was all on me,” she said. “Those two things have been a blessing before God with everything I'm juggling.”

Even before receiving the funding, the course was open to anyone who wanted to take it—whether a student or a community member—with the primary target being North Carolinians. However, the school could only offer the course once or twice a year, depending on the schedule of the contracted trainers, one of whom lives in Raleigh. (Charlotte, where the university is located, is a roughly two-and-a-half hour drive one way with the usual traffic. Hitting rush hour in both cities can easily tack another hour or more onto the trip.) Marketing was also very “low budget,” Mead said, with the school depending heavily on social media.

Now, the program can appear at events and train students three times a year or once a semester, including the summer term. Funding from the American Rescue Plan has also allowed the university to fully cover the training cost and financially assist students with a portion of their total certification costs.

According to Mead, 75 students have graduated from the program, the most thus far.

That’s just step one. Becoming a certified doula is a multipronged and expensive process—and many states have some type of certification or training requirements. (They vary state-by-state and, in some states, they’re as simple as registering for a vague “certification course.”) Several organizations offer this distinction, but DONA International is the most popular. The nuts and bolts of DONA’s process begin with participating in a birth doula workshop. If a student is lucky enough to join a program like the one offered at Johnson C. Smith, the workshop will fulfill the childbirth and lactation support education requirements. If not, the student has to find additional classes. Next, the student completes two research papers and reads four books before completing a self-assessment, compiling a referral list of doulas in their community, and attending three births. The last step is submitting all materials in an application packet and uploading them to DONA International’s site, for a fee. Students have three years after participating in the training to complete all requisites.

While DONA International estimates this process costs prospective certified doulas anywhere between $600 and $1,000, Mead said $1,000 is closer to the low end. “If someone tried to do this program without our assistance, it could range anywhere from $1,200 to $3,000 for them to get their [full] training,” said Mead. “We removed that barrier, and we're able to help them move the needle closer to that certification.” JCSU’s facilitators also offer one-year mentorships to interested students working to get their certification—the university partners with local organizations to help students attend live childbirths.

JCSU, being an HBCU, is crucial to this effort and to increasing and diversifying the perinatal workforce. In June 2023, the Supreme Court effectively eliminated race-conscious affirmative action in higher education, which is expected to lead to declines in the number of Black students attending college.

The effect of that expected decline on the health and well-being of Black communities is currently unknown, but history offers up a grim possibility. In 1910, Abraham Flexner released a report that led to the closure of 75 percent of U.S. medical schools. Commissioned by the Carnegie Foundation to evaluate and standardize medical education, Flexner's investigation included six Black medical schools, four of which were shut down by 1923. Although the goal was to enhance the quality of medical care—and due to a lack of access to quality secondary school education, Black students arrived at medical schools unprepared—the consequences were particularly harsh for Black communities. Researchers estimate that, had those schools not closed, 30,000 to 35,000 Black doctors would have received a medical degree in the past century. With limited acceptance of Black students into predominantly white institutions, the number of healthcare providers willing to serve Black populations significantly decreased.

Of the Black doctors currently practicing, 80 percent were educated at Meharry Medical College or Howard Medical School, the only two Black medical schools left.

“Advocacy is the thread throughout this; that's key. That's the beauty of why we're doing it. History and advocacy are connected to the history of HBCUs,” said Mead. “HBCUs existed to educate us when nobody else would. Even if we didn't attend an HBCU, we were likely educated by someone who did. So, the legacy of HBCUs and that connection of advocacy and empowerment ties into what we're doing now.”

Doula Care Saves Black Lives

Tonya Abari’s second pregnancy was much different than the first.

Abari planned to have a vaginal birth at home—a decision that turned off many potential care providers due to her age and past complications. Abari and her husband decided that their six-year-old daughter would be as active in the birthing process as a small child could be. Their care team jumped on board, including the six-year-old in appointments, giving her homework—like keeping her mom’s food journal and writing down her blood pressure readings—sharing affirmations, and bringing her coloring books. It was a stark shift from her first pregnancy already. Her former OB didn’t even allow children in the office, which Abari found nonsensical.

“We needed a care team that was understanding of us needing to have her in the room—and I mean in the room literally while I'm giving birth,” she said. “A prerequisite for us in choosing was that you have to understand that we do things as a family.”

For centuries, Black birthing traditions have included a communal element. Abari’s doula arrived on the morning of labor and delivery with an apprentice, a birth photographer to document the process, and a therapist to provide mental health support, considering the trauma experienced during her first birth experience. Her care team held her hands during contractions, sang, made a playlist of her favorite songs, and recited affirmations with her. I am strong. I am magnificent. I am capable. They decorated her bedroom with photos of her family and art. More coloring books showed up for her six-year-old daughter, and they cooked for her family.

Labor and delivery went smoothly. In November 2021, Abari and her family welcomed a healthy baby girl.

Two weeks after giving birth, Abari had excruciating leg pain. But, suffering from postpartum depression, she kept that to herself. Late one night, she shared a photo of her swollen legs with her doula and midwife. They told her to get to the hospital. There, a kind-hearted Black woman OB told Abari that she had a blood clot and was having a light stroke. She was rushed into surgery to remove the clot. Her Black OB prayed with her alongside a few nurses.

Of Abari’s care team, her doula was the one who made it to the hospital. While there, she noticed Abari had been left to “sit in her own dirt.” She went to the managerial team and the doctors, demanding they clean Abari up. She was also able to help Abari pump so that she could continue feeding her daughter, who refused formula.

At this point, when sharing her story, Abari breaks down.

“I don't know how I pumped milk, but I pumped milk in the hospital, and my doula was there picking up the milk and delivering the milk. My baby would not drink anything other than my milk,” Abari said once she had collected herself. “She made runs. She was there. She did so much, so much, so much. And, honestly, it was lifesaving.”

“The most important time was postpartum because I didn't know things could fall apart that fast,” Abari continues. “I didn't know that I needed that extra help and that extra care after I had the baby—and what helped to save my life was their care.”

Oversized round sunglasses adorn her face, a wooden crucifix hangs from her neck, and her yellow shirt dress dances in the wind as Emma Dupree walks the documentarian through her garden, sharing stories of her loved ones, community, and how her knowledge of herbalism helped heal them. This moment in Little Medicine Thing: Emma Dupree, Herbalist, alongside her seasoned North Carolina accent, provokes memories of my own great-grandmother, walking me through her flower garden, explaining each life vessel to me and how to take care of them. Many of us will likely see our own elders in Miss Dupree, a celebrated figure within the rich history of Black herbalism, who was affectionately known as "Aunt Emma" and "Little Medicine Thing."

Born on July 4, 1897, in Falkland, North Carolina, Dupree’s life was rooted in her connection to nature and using what the earth provides to heal ailments. Dupree developed an intimate understanding of medicinal plants at a young age. She spent her childhood exploring the dense forests near her home and absorbing the wisdom offered by her surroundings, often carrying a gathering sack with her during her adventures. Her innate curiosity and intuitive relationship with plants quickly grew into a passion and skill set that would later serve her entire community. Dupree’s home in Fountain, North Carolina, where she lived as an adult, eventually blossomed into a living pharmacy where she meticulously cultivated herbs such as sassafras, rabbit tobacco, maypop, mullein, white mint, double tansy, catnip, horseradish, silkweed, and many other healing herbs. She would go on to work with physicians in her community, bridging the gap between ancestral knowledge and Western medicine.

In 1984, the North Carolina Folklore Society awarded her the Brown-Hudson Award. In 1992, when she received the North Carolina Heritage Award, she solidified her legacy within the state’s cultural and historical narrative. In 2022, a historic marker was erected in her honor in Fountain. And, each year, the community celebrates "Emma Dupree Day.”

While researching this edition of You Should Know Her, I found some excellent pieces about Dupree. Instead of producing another bio, I thought it would be more powerful to share blocks of text that stood out to me and encourage you to read up more on Dupree yourself. (For those old journals, I went through the digital archives and found photos of the article for you.)

Resource Guide

Alex Albright. Emma Dupree: Fountain’s Herbalist & Healer.

Karen Baldwin (1984). Mrs. Emma Dupree: “That Little Medicine Thing.” North Carolina Folklore Journal, 32(2), 50–53.

Bill Sharpe (1997). Emma Dupree – Herbalist. North Carolina Folklore Journal, 44(1 & 2), 56–58.

I pulled this paragraph out because I found it fascinating:

According to folklorist Karen Baldwin of East Carolina University, what Mrs. Dupree was born to was “a tradition of knowing about the curative and preventative uses of the natural pharmacopeia which grew along the banks of the creeks and branches and the Tar River.” As a young child she developed an unquenchable fascination with plants and their medicinal properties. She spent endless hours roaming the woods gathering leaves, bark, stems, and seeds which she collected in a sack. “The woods-gal, that’s what they called me. They’d say, here comes that little medicine thing.”

Karen Baldwin (1990). Folk Arts and Folklife in and around Pitt County: A Handbook and Resource Guide.

James K. Kirkland, Holly F. Matthews, Charles W. Sullivan III, and Karen Baldwin (1992). Herbal and Magical Medicine: Traditional Healing Today.

East Carolina University (1979). Little Medicine Thing: Emma Dupree, Herbalist. Oral History.

Alex Albright (2020). “Emma Dupree, Pitt County Herbalist.” Lecture.

Safiyyah Bazemore (2021). Black Herbalist Spotlight: Emma Dupree.

Angie Lavezzo. Emma Dupree, Folk Herbalist & Granny Woman.

Frantz Fanon: Medicine and Colonialism

If I could publish this entire chapter here, I would. (But thankfully, it is available at the link above.) This text is crucial to understanding the power dynamics between formerly colonized and enslaved people and Western medicine.

The Gist:

It is necessary to analyze, patiently and lucidly, each one of the reactions of the colonized, and every time we do not understand, we must tell ourselves that we are at the heart of the drama-that of the impossibility of finding a meeting ground in any colonial situation. For some time it was maintained that the native's reluctance to entrust himself to a European doctor was due to his attachment to his traditional medical techniques or to his dependence on the sorcerers or healers of his group. Such psychological reactions do obviously exist, and they were to be observed, not too many years ago, not only among the masses of generally advanced countries, but also among doctors themselves. Leriche has reported to us the hesitancies or the refusals of certain doctors to adopt the thermometer because they were accustomed to estimating the temperature by taking the pulse. Examples of this kind could be indefinitely multiplied. It is hardly abnormal, therefore, for individuals accustomed to practicing certain customs in the treatment of a given ailment, to adopting certain procedures when confronted with the disorder that illness constitutes, to refuse to abandon these customs and procedures because others are imposed on them, in other words because the new technique takes over completely and does not tolerate the persistence of any shred of tradition.

Here again we hear the same refrain: "If I abandon what J am in the habit of doing when my wife coughs and I authorize the European doctor to give her injections; if I find myself literally insulted and told I am a savage [this happens], because I have made scratches on the forehead of my son who has been complaining of a headache for three days; if I tell this insulter he is right and I admit that I was wrong to make those scratches which custom has taught me to do-if I do all these things I am acting, from a strictly rational point of view, in a positive way. For, as a matter of fact, my son has meningitis and it really has to be treated as a meningitis ought to be treated. But the colonial constellation is such that what should be the brotherly and tender insistence of one who wants only to help me is interpreted as a manifestation of the conqueror's arrogance and desire to humiliate."

The Nutgraf:

In a non-colonial society, the attitude of a sick man in the presence of a medical practitioner is one of confidence. The patient trusts the doctor; he puts himself in his hands. He yields his body to him. He accepts the fact that pain may be awakened or exacerbated by the physician, for the patient realizes that the intensifying of suffering in the course of examination may pave the way to peace in his body.

At no time, in a non-colonial society, does the patient mistrust his doctor. On the level of technique, of knowledge, it is clear that a certain doubt can filter into the patient's mind, but this may be due to a hesitation on the part of the doctor which modifies the original confidence. This can happen anywhere. But it is obvious that certain circumstances can appreciably change the doctor-patient relationship.

Journal Article: Getting to the Root of US Healthcare Injustices through Morrison’s Root Workers

The Gist:

Beginning with M’Dear, the formidable old woman who is fetched to cure Cholly’s Aunt Jimmy in Morrison’s first book, The Bluest Eye (1970), I examine portraits of several Hoodoo practitioners, naturopaths, and midwives in the Nobel Laureate’s other work, most prominently Ajax’s mother in Sula (1973)—initially labelled as “an evil conjure woman” (126)—and Pilate Dead in Song of Solomon (1977), who guides Milkman’s adulthood journey and his passage into the living world by using ethnobotanical knowledge and pluralistic modalities—also known as “roots”—to enable his conception and birth. As many literary critics have asserted, Morrison crafts these characters to convey the strength and longevity of African folk traditions and the fortitude of women, to undermine patriarchal notions about gender and femininity and Western conceptions of conjure as inherently evil, and to communicate the power of the elderly. Just as the coronavirus crisis beginning in 2020 has revealed profound racial and socioeconomic gaps in the configuration of US healthcare, and the footage of George Floyd’s murder instigated yet another round of anti-racism protests against Black and brown people’s brutalization by those sworn “to serve and protect,” analysis of Morrison’s folk-healers also serves to expose many of the structural injustices that hinder African American success in areas all around the country: disparities in employment and income, education, housing, protection under the law, and, especially, medical care.

Read more

Sprinkling salt across the door frame. Stitching ancestral symbols into quilt squares. Using herbs and roots to heal common ailments. Placing a bay leaf and a $20 bill in your wallet to attract money. Using the color blue to ward off bad juju. That’s all hoodoo.

Hoodoo, or rootwork, refers to using herbs, roots, and other natural objects for spiritual and medicinal purposes. It’s a spiritual practice deeply aligned with using the earth to heal and protect oneself and one’s community through striking spiritual balance or connecting with one's ancestors through worship. (This is not to be confused with voodoo, a distinctly different practice.) And, like many things rooted in Blackness, hoodoo has long been misconstrued as demonic despite being a healing and protective practice at its core that was cultivated in Black churches. Hoodoo makes people uncomfortable due to the demonization of the practice, but it is a critical piece of Black medical history and an ancestral wellness practice. It is a modality worth learning about in-depth and without being judgmental. 

FWIW, there’s a lot of debate surrounding whether hoodoo is a closed practice/community, meaning the only people who can participate in hoodoo are those who were born into or underwent an initiation. Closed practices and communities are very common within divination. My advice is, regardless of the debate, if you’re not Black, just read the links and keep pushing.

Instead of writing an explainer, I left that to those immersed in hoodoo as practitioners or historians. 

Take care. 

An Introduction to Hoodoo

Uncovering the Power of Hoodoo: An Ancestral Journey

Mojo workin': the old African American Hoodoo system

Black Magic Matters: Hoodoo as Ancestral Religion

Hoodoo: Black Magic or Healing Art?

Digital Loa and Faith You Can Taste: Hoodoo in the American Imagination

Louisiana Superstitions

Hoodoo Heritage: A Brief History Of American Folk Religion