Obstetric Racism and Ableism: A Narrative Review of Barriers to Obstetric Care and Maternal Health Outcomes for Black Disabled Women

Introduction: Black disabled women face disproportionality high rates of maternal morbidity and mortality in the United States. This review synthesizes academic and community perspectives to assess how ableism and racism shape obstetric care and maternal health outcomes, identifying gaps for policy and practice reform. Methods: Using an intersectional ecological framework, we conducted a narrative review of peer-reviewed and gray literature on how racism and ableism shape obstetric care for Black disabled women. We searched PubMed, Google Scholar, and targeted sources for studies published in the last 25 years that addressed maternal health outcomes, barriers, or structural racism and ableism. Included sources encompassed qualitative studies, epidemiologic analyses, community reports, and policy analyses that examined barriers across the obstetric care continuum. Results: One hundred and fifteen sources were included in this review. Barriers to obstetric care for Black disabled women include: (1) maternal care deserts and inaccessible facilities; (2) inadequate preconception and prenatal care; (3) provider bias, surveillance, and reproductive coercion; (4) gaps in provider knowledge and training on disability and culturally congruent care; and (5) policy failures, such as weak disability rights enforcement, Medicaid nonexpansion, restrictive reproductive laws, and absent intersectional data. These barriers are rooted in racism and ableism, which intersect to cause care delays and denials, fuel mistrust, and increase risks of severe maternal morbidity and mortality. Discussion: Obstetric inequities for Black disabled women are rooted in the intersecting structures of racism and ableism that shape policy, access to care, and clinical culture. Yet, this intersection remains underexamined in research, leaving critical gaps in knowledge and action. Closing these gaps requires intersectional, community-led research and policy reforms—expanding Medicaid, enforcing accessibility, mandating provider training, collecting intersectional data, and investing in inclusive care grounded in disability and racial justice.