September 2000, Atlanta. I had just celebrated my 23rd birthday. After a summer spent cashiering at Whole Foods for $8.25 an hour, and with my senior year at Spelman College about to start, I was already stress-planning my schedule. For a moment, though, all that worry came to a pause. I stood in my cramped apartment bathroom, heart racing, and called Shawn in to join me. Together we stared at the pregnancy test strip. Though deep down I already knew the result—my cycle ran like clockwork—I still held my breath until the second pink line appeared.

When I entered the campus gates that fall semester, I carried more than a baby. Hitched to me was also the burden of a degrading narrative about what it meant to be young, pregnant, and Black. At the time, the inflamed rhetoric of “babies having babies” was heavy in the air, and though I wasn’t a teenager, I was much younger than most college-educated women who decide to become mothers. According to the stereotypes, I was lazy, promiscuous, and irresponsible—an image that Spelman, an institution known as a bastion of Black middle-class respectability, had been trying for over a century to distance itself from.

The previous year, while digging through archives for a junior term paper, I had come across a 1989 Time interview with Toni Morrison in which she was asked whether the “crisis” of teenage pregnancy was shutting down opportunity for young women: “You don’t feel these girls will never know whether they could have been teachers?” Morrison replied:

They can be teachers. They can be brain surgeons. We have to help them become brain surgeons. That’s my job. I want to take them all in my arms and say, Your baby is beautiful and so are you and, honey, you can do it. And when you do, call me—I will take care of your baby. That’s the attitude you have to have about human life … I don’t think anybody cares about unwed mothers unless they’re Black—or poor. The question is not morality, the question is money. That’s what we’re upset about.

Almost a decade after the interview, sociologist Kristin Luker published Dubious Conceptions: The Politics of Teenage Pregnancy, offering a powerful refutation of what politicians and pundits called the “epidemic of early childbearing.” Luker demonstrated that, contrary to the racist depictions of teenage mothers as Black girls, most were actually white and, at 18 and 19 years old, were legal adults. Luker’s data also suggested that early childbearing was an indicator of poverty and social ills rather than a cause, and that postponing childbearing did not magically change those conditions. So, instead of stigmatizing and punishing young people for having children before they are economically independent, Americans should demand programs that expand education and job opportunities for impoverished youth. (Later, in graduate school at the University of California, Berkeley, I would become a student of Luker’s—digesting the data after already having lived the story.)

As a pregnant undergraduate, I didn’t have Luker’s statistics at hand. But I knew intuitively that reproduction by those who are white, wealthy, and able-bodied is smiled upon by many people who adhere to a eugenically stained view of the world—policy makers and pundits, medical professionals, and religious zealots among them—while babies of color, those born to poor families, and those with disabilities are often seen as burdens. Eventually, I would learn that cultural anxieties about “excess fertility” among nonwhite populations and about the declining birth rate of white populations are two sides of the same coin. No amount of moralizing about “babies having babies” could hide the underlying disdain directed toward those who didn’t come from “superior stock.”

The first time I stopped by the student health clinic to ask whether my health insurance plan covered pregnancy-related care, a Black woman behind the desk noted with slight irritation, barely looking at me, that, yes, it was covered, “like any other illness.” Pregnancy, but especially Black pregnancy, was a disorder that required medical intervention. I realized that even at an institution created for Black women, I couldn’t expect care, concern, or congratulations. And although the receptionist’s words still ring in my ears, what’s far more worrisome are the disastrous effects when those in power pathologize Black reproduction.

The real “crisis” of Black pregnancy is not youth or poverty or unpreparedness; it’s death. Black women in the United States are three to four times more likely to die during pregnancy and childbirth than white women. This rate does not vary by income or education. Black college-educated women have a higher infant mortality rate than white women who never graduate high school. Black women are also 2.5 times more likely to deliver their babies preterm than white women.

Some observers attribute the higher rate of maternal mortality and preterm birth among Black women to higher rates of obesity, diabetes, and other risk factors. But as Elliot Main, a clinical professor of obstetrics and gynecology at Stanford, says, the focus should turn to the treatment of Black women by hospital staff: “Are they listened to? Are they included as part of the team?” Too often, medical professionals discount the concerns of Black women, downplay their needs, and regard them as unfit mothers. Hospital staff callously interrogate their sexual histories and send them home with symptoms that turn out to be serious. The experience for Black LGBTQIA+ patients and people with disabilities can be even more alienating and hazardous. Taken together, this is what medical anthropologist Dána-Ain Davis terms “obstetric racism.”

In the PBS documentary Unnatural Causes, neonatologist Richard David put it this way: “There’s something about growing up as a Black female in the United States that is not good for your childbearing health. I don’t know how else to summarize it.” Even this, though, misattributes the source of harm; the problem is not growing up Black and female, but growing up in a racist and sexist society. Racism, not race, is the risk factor.