Black Maternal Mortality Is Not a Mystery. It Is the Result of a System.

There is a conversation happening in medicine. Or maybe more accurately, a conversation that should have been happening for a very long time and is only now starting to get loud enough to hear.

Dr. Melissa Adrouny, OB-GYN and founder of The Village San Jose, sat down with Courtney Broderick, founder of Chief Troublemaker Co., for a frank, unfiltered conversation about Black maternal mortality, the history of how medicine deliberately pushed out the people most equipped to provide care, and what it actually means to treat a patient instead of just a diagnosis.

This is not a comfortable conversation. It is a necessary one.

Before Medicine Was a Career, It Was Community Care

Dr. Adrouny opens with a fact that most people were never taught.

As recently as the early 1900s, midwives attended approximately half of all births in the United States. In the South, Black midwives attended up to 90% of Black births.

That statistic carries a lot of weight. It means that before the modern medical system established itself as the only legitimate path to birth care, Black women were already doing the work. They were the ones showing up, building trust, and attending births in communities that the formal medical system was not serving.

Then medicine changed.

White men in medicine launched what Melissa describes as a deliberate smear campaign against midwives. They built infrastructure specifically designed to box out midwives from practicing. They colonized medicine. They colonized gynecology.

This was not an accident or an oversight. It was a choice. A strategic, organized choice to push out the people who were already caring for the most vulnerable communities and replace them with a system that centered a particular kind of practitioner and a particular kind of patient.

The consequences of that choice are still playing out today.

The Black Maternal Mortality Rate Is the Result of That History

Black maternal mortality in the United States is not a mystery. It is not an anomaly. It is the predictable result of a system that was built to exclude, and that has continued to extract value from Black women while failing to protect them.

Melissa is direct about this: the numbers are abhorrent. And she is equally direct about who needs to be louder about it.

She makes a specific point that lands hard. It is not the job of Black women to be the only ones yelling about this. The burden of raising the alarm, fighting for recognition, and demanding change cannot sit entirely on the people who are most harmed by the problem.

This is where the work of white women in medicine and healthcare advocacy matters. Not as allies in the performative sense, but as people who have access to power, platforms, and systems and who need to use them loudly and without waiting for permission.

Celebrating Black Women-Owned Businesses Without Acknowledging Why They Built Them Is Its Own Problem

The conversation shifts to something Courtney and Melissa both see clearly.

Right now, Black women are starting new businesses at the highest rates of any group in the United States. This is frequently celebrated. And it should be.

But there is a version of that celebration that skips right past the reason why.

Melissa puts it plainly: they were pushed out. Not through a lifestyle choice. Not because entrepreneurship sounded appealing. But because the system proved to them over and over again that it would not protect them. That it would extract from them until they had nothing left to give. And then it would discard them.

The celebration rings hollow if it skips that part.

This pattern is not unique to Black women. Melissa draws a parallel to what is happening now with AI disruption and the so-called millennial career crisis. She is not buying it. A broken system does not become a crisis worth addressing until it starts affecting people who look like the ones who built it. That is not a career crisis. That is the system working exactly as designed, finally catching up to everyone.

Who Gets to Belong in Medicine

Melissa returns to the history of medicine and makes a point about more than just the professionalization of the field.

Medicine did not just create standards. It decided who got to belong.

Insurance companies lobbying politicians. The American Board of Medicine determining who qualifies as a capable physician practicing evidence-based care. A system where the monopoly's goal has nothing to do with the patient and everything to do with maximizing revenue from what it treats as a product.

For Melissa, pregnancy is one area where insurance companies have a harder time denying coverage than in others. Acute need is difficult to argue against. But she knows she is operating inside a system that is not primarily oriented toward care, and she carries that awareness into every clinical decision she makes.

What Made Melissa Adrouny Know She Would Be a Good Doctor

The conversation shifts to something more personal.

Melissa talks about the compass she has carried through every level of her training. High school, college, medical school, residency. At every stage, it felt harder for her to get from one step to the next than it did for her peers. Harder in ways that were real, not imagined. Ways that traced back to a diagnosis that was not recognized for a long time.

But through all of it, she held onto one clear thing: if she could just get to the point of being a doctor, she knew she would be a good one.

Not because of how many procedures she could do. Not because of board scores or metrics.

Because she knew that what makes a doctor good is making patients feel seen. Supported. Cared for. That is ultimately what people want. That is what people need.

She quotes Patch Adams: treat a disease, you win or you lose. Treat a patient, you win every time.

That quote is what The Village San Jose is built on. It is why the space exists. It is why the people who work here do what they do.

The Village San Jose Was Built for the Gaps

The medical system was not built for everyone. That is not an opinion. It is history. The Village San Jose exists in direct response to that history, and to the very real needs of people who are navigating pregnancy, postpartum, perimenopause, and menopause in a system that often does not have the time, the training, or the incentive to slow down and actually care for them.

If you are pregnant, postpartum, or in the middle of a transition that the system keeps glossing over, you deserve a place where you are seen and supported.

That is what we built. Come find it at thevillagesanjose.com.

The views expressed in this conversation are those of Dr. Melissa Adrouny and Courtney Broderick speaking from their professional and lived experiences. This content is intended to inform and spark conversation. It is not a substitute for medical care.