Black women in the U.S. die from pregnancy-related complications at two to three times the rate of white women, according to CDC data, and most of those deaths are preventable. That heightened risk holds true across income and education: the wealthiest Black Californian faces higher maternal mortality risk than the poorest white Californian. Black birthing people also face greater rates of preeclampsia, postpartum hemorrhage, blood clots, preterm birth and low birth weight. Advocates point to structural racism in health care and society—exposed by the deaths of mothers like CDC scientist Shalon Irving and by COVID-19’s racial toll—as the root cause. Policy fixes center on paid family leave, telehealth and the federal Black Maternal Health Momnibus Act of 2021. The U.S. has no national paid-leave guarantee; Black women are less likely than white women to have paid leave and return to work too soon after birth. Thirteen states plus DC have their own paid-leave laws, and studies link job-protected leave to better outcomes for moms and babies. Telehealth expansions under the CARES Act and extended by the 2022 omnibus have narrowed racial gaps in postpartum visits. The Momnibus, introduced by Rep. Lauren Underwood and the Black Maternal Health Caucus, bundles 12 bills addressing social determinants, workforce diversity, data collection and more. So far only the Protecting Moms Who Served Act has become law. Medicine’s training and practice also need reform. The 1910 Flexner Report, backed by the AMA, shuttered all but two historically Black medical schools, creating today’s shortage of Black physicians. Meanwhile, traditional Black midwives—“granny midwives”—handled half of U.S. births in the early 1900s before being sidelined; by 1975 they attended fewer than 1 percent of deliveries. Advocates call for cultural humility training, support for community-based birth workers and investment in a perinatal workforce that reflects the populations it serves.