BACKGROUND:
Black midwives in the United States have long provided culturally-centered, community-rooted models of care that improve outcomes and experiences for Black birthing people. Despite their deep expertise and innovation, Black midwives and their care models remain underfunded, undervalued, and often excluded from health system leadership and scale-up efforts.

OBJECTIVES:
This qualitative study examines how Black midwifery leaders are advancing and sustaining culturally-centered models of care that address entrenched maternal health inequities, and explores barriers and opportunities to scaling these models within broader health systems.

METHODS:
We conducted in-depth, semi-structured interviews with 9 Black midwifery leaders across the United States from September 2023 to June 2025, including practicing midwives, founders and directors of Black-led midwifery practices, and leaders of professional organizations. Data were analyzed using thematic analysis informed by reproductive justice and critical race frameworks.

RESULTS:
We identified five themes in the analysis process, including Defining Black-led Community Midwifery, Double Jeopardy, Structural Factors, Burnout and Self Care, and Scaling Black Midwifery. Findings show that Black midwives are leading innovative care models that integrate clinical excellence with cultural safety, community engagement, and holistic support for birthing people and families. Participants identified key enablers of scaling these models, including community trust, mentorship networks, and Black-led professional infrastructure. At the same time, they face systemic barriers such as structural racism, limited funding streams, and exclusion from dominant policy and health system spaces.

CONCLUSIONS:
Black midwifery leadership is central to advancing equitable maternal health systems in the US. Targeted investment in Black midwives and their models of care is critical for transforming maternity care and addressing persistent racial inequities in outcomes.

KEY MESSAGE:
Scaling Black midwifery-led models of care is an essential strategy to achieve maternal health equity and must be supported by structural investments and policy change. SRHR - Preconception/contraception (including three-minute presentation competition)