I Was Born In Houston, Gave Birth There, And Almost Died There
I was born and raised in Houston, Texas. It’s the city that shaped me, the place where my family built a life, and the place where I believed I would be safest bringing a child into the world. Houston is home to the world’s largest medical center and is often held up as a symbol of medical excellence and innovation. It’s also where I nearly died giving birth.
In November 2005, I walked into my OBGYN’s office for what I believed would be a routine prenatal checkup. I was close to six months pregnant, college-educated, living a solidly middle-class life, and insured twice over through both my employer and my then-husband’s employer. By every measure, I was considered low risk. I had no prior history of high blood pressure or hypertension. I attended regular prenatal visits. I had stable housing, reliable access to healthy food, paid time off, and access to specialists. I was giving birth in my hometown, surrounded by the medical institutions for which Houston is famous.
Again, I almost died.
In the weeks leading up to that appointment, my legs and feet had swollen beyond comfort, and my headaches arrived daily, heavy and unrelenting. I told myself this was pregnancy– the body stretching and adjusting under the weight of new life. I told myself the headaches were migraines, something I had lived with long before I became pregnant. But that day, my doctor took my blood pressure and immediately sent me to the hospital.
I was experiencing preeclampsia, a pregnancy-induced hypertension that can escalate quickly and become fatal without intervention. Doctors hoped bed rest would buy us time. At 25 weeks pregnant, my daughter’s organs were not fully developed, and every additional day inside my body mattered. But my blood pressure continued to rise, and with it came the risk of stroke and death.
I delivered my daughter weighing 1 pound and 1 ounce. She spent four months in the NICU, her body sustained by machines that breathed for her until she could breathe on her own. Today, she is a happy and healthy 20-year-old, and the reason I believe in miracles.
But Black women should not have to rely on miracles to survive pregnancy and childbirth.
What happened to me was not an anomaly but part of a pattern that continues to place Black birthing people in danger. Today, Harris County, Texas, which includes Houston, is one of the most dangerous places in the country for Black women to give birth. Between 2016 and 2020, Black women in Harris County died from pregnancy-related causes at a rate of 83.4 deaths per 100,000 live births, the highest recorded rate for any racial group in the nation, according to the Houston Chronicle. White women in the same county died at roughly one-quarter that rate, a disparity so severe that Harris County Public Health has named Black maternal death the county’s most urgent maternal health threat.
This local emergency mirrors a national one. In 2023, the maternal mortality rate for Black women in the United States was 50.3 deaths per 100,000 live births, compared to 14.5 for white women, according to the Centers for Disease Control and Prevention. Education and income don’t close this gap. Black women with college degrees are still significantly more likely to die from pregnancy-related causes than white or Hispanic women who did not complete high school, a pattern documented both nationally and within Harris County data.
None of this is by chance.
The CDC reports that most pregnancy-related deaths in the United States are preventable. Research consistently points not to biology, but to structural racism, chronic stress, environmental exposure, unequal access to quality care, and persistent bias within medical systems as the primary drivers of Black maternal death.
Studies have shown that many medical providers hold false beliefs about biological racial differences, which leads to Black patients’ pain being underestimated and their symptoms more likely to be dismissed or delayed in clinical settings, including during pregnancy and postpartum care. These outcomes are not about individual behavior. They are the predictable result of systems that underestimate Black women’s vulnerability while overestimating our capacity to endure harm.
If education, proximity to care, or professional expertise could guarantee survival for Black women, then Dr. Janell Green Smith would still be alive. Dr. Green Smith was a 31-year-old Black nurse-midwife, educator, and maternal health advocate who died in January 2026 from complications related to childbirth after developing severe preeclampsia. She returned to the hospital following a ruptured surgical incision and never made it home. Her death made a painful truth that’s impossible to ignore. No credential, income level, or professional title can override a healthcare system that remains indifferent to whether Black women live or die.
This is why what is happening in Houston cannot be understood solely as a healthcare failure. It is a reproductive justice crisis. Reproductive justice was created by Black women in the mid-1990s, following the 1994 International Conference on Population and Development in Cairo, by organizers who later formed SisterSong Women of Color Reproductive Justice Collective. The framework moved beyond narrow ideas of choice and access, naming the right not to have children, the right to have children, and the right to raise those children in safe and sustainable communities. At its core, reproductive justice has always been about survival.
Over time, reproductive justice has been diluted and absorbed into a mainstream reproductive rights movement long dominated by white women and white-led institutions, narrowing its focus to legal abortion access and individual choice while sidelining the structural racial and economic conditions that shape women’s lives. Scholars and advocates have warned that when reproductive politics center on “choice” without confronting race and class, they privilege those whose choices are already protected. The result is a movement that mobilizes quickly around legislation but struggles to rally around Black women’s survival, including crises like maternal mortality and postpartum care.
So what does change require? It requires investment in Black-led maternal health organizations, midwives, doulas, and community-based care models proven to save lives. It requires mandatory anti-racism and bias training for healthcare providers, not as a box to check but as a condition of practice. It requires extending postpartum care beyond six weeks and treating pregnancy as a continuum, not an event. It requires lawmakers to fund maternal health with the same urgency they bring to policing reproduction. And it requires reproductive justice movements to return to their roots by centering Black women’s survival as non-negotiable.
In Harris County, the data is unmistakable, the disparities are documented, and the losses are ongoing. What remains unresolved is whether Texas, and this country, are willing to confront the truth that Black maternal death is not an accident. It is the predictable outcome of policy choices, racial indifference, and a failure to act.
Until that changes, Houston will remain a place where giving life too often means risking death. That is a moral failure we can no longer afford to excuse.
Josie Pickens is an educator, writer, cultural critic, and abolitionist strategist and organizer. She is the director of upEND Movement, a national movement dedicated to abolishing the family policing system.
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