Pregnancy-related complications and death in the U.S. occur disproportionately in Black people, even with social protections such as higher education and income,—a health inequity that continued as maternal deaths rose overall in the first year of the COVID pandemic—but questions of exactly how and why tend to focus more on individual factors such as age, weight, pre-existing health conditions, and number of prior cesarean births. A growing body of research and thought suggests that the problem should be seen not as one of race, but of racism. Beyond factors like prenatal care access, insurance status, or chronic health conditions, inequities show up in poor quality of care provided to Black mothers and birthing people, resulting in disparate experiences of care during pregnancy, labor, birth and postpartum care.