Dr. Janell Green Smith’s Tragic Death Exposes Systemic Failures in Maternal Healthcare, Globally and Domestically

In 2025, the global community was shaken by the tragic news of Dr. Janell Green Smith’s death, a South Carolina midwife and fervent advocate for Black maternal health, who succumbed to complications following childbirth. Her passing, at just over 30 years old, was not merely a personal tragedy but a stark, painful reminder of the deep-seated systemic failures plaguing maternal healthcare, both within the United States and across the globe. Dr. Green Smith, who proudly called herself a ‘Loc’d Midwife,’ dedicated her life to ensuring safer birthing experiences, particularly for Black women, a demographic disproportionately affected by maternal mortality.

The American College of Nurse-Midwives (ACNM) swiftly issued a statement, calling Dr. Green Smith’s death a “profound failure of the systems meant to protect birthing people.” The statement unequivocally highlighted the unacceptable reality that “a Black midwife and maternal health expert died after giving birth in the United States.” It underscored a persistent and well-documented truth: Black women, irrespective of their education, income, or professional expertise, face significantly higher risks during pregnancy and childbirth due to systemic racism and inherent failures in care. This tragic irony, where an expert in maternal health could not escape the very risks she fought to mitigate for others, reverberated deeply.

A Life Dedicated to Care and Advocacy

Dr. Janell Green Smith became a certified midwife in 2021, culminating her dedication with a Doctor of Nursing Practice (DNP) degree in 2024. Her journey was not without its profound personal challenges. She openly shared on Instagram how the death of her mother in 2023 nearly derailed her pursuit of the DNP, leading her to withdraw from the program before re-enrolling the following year. Her resilience shone through in her reflection: “Moral of the story: The strength He gives in the storms of life is sufficient to carry you through any hurt if you allow it.” Beyond her professional calling, Dr. Green Smith was also a talented photographer, humorously labeling herself a “Certified Nurse Midwife catching babies & angles,” capturing life’s precious moments from engagement shoots to family portraits. Her multifaceted life, brimming with passion and purpose, makes her loss all the more poignant.

Her advocacy extended to partnerships with organizations like the Hive Impact Fund, a nonprofit and app providing resources for parents during early childhood, especially during Black Maternal Health Week. Her efforts were part of a broader movement to address the alarming disparities in maternal health outcomes, where maternal death rates among Black women are three times higher than those among white women, as noted by organizations like the Southern Birth Justice Network.

The Critical Role and Perilous State of Freestanding Birth Centers

Dr. Green Smith’s story is inextricably linked to the broader crisis in maternal healthcare infrastructure. Across the United States, hospital labor and delivery units are closing at an alarming rate, with over two dozen shuttering in 2025 alone. This creates vast “maternity care deserts,” leaving many communities, particularly rural and underserved ones, without adequate access to essential birthing services. Freestanding birth centers, unattached to hospitals and offering a more homelike, less medicalized environment, could be a vital solution. They employ midwives, focus on low-risk pregnancies, and often partner with hospitals for specialized care when needed. For many Black and Indigenous communities, these centers offer a crucial alternative to traditional medical settings where they often report feeling marginalized, dismissed, or unsafe.

However, these crucial facilities are themselves struggling to survive. According to the American Association of Birth Centers, roughly two dozen centers have closed since 2023, bringing the national total down to around 395. They face immense financial pressures, including insurer payments that often don’t cover the full cost of care, and rising malpractice premiums. Regulatory hurdles are equally formidable. States often impose arcane rules, such as requiring a “certificate of need” before opening, which can be challenged by rival hospitals viewing birth centers as competition. Dr. Heather Skanes, an OB-GYN who opened Alabama’s first freestanding birth center in Birmingham in 2022 to serve a majority-Black neighborhood, was ordered to shut down just six months later for operating an “unlicensed hospital.” Similar stories abound, from Pennsylvania’s Lifecycle Wellness and Birth Center closing after 47 years to New Mexico’s longest-operating center ceasing deliveries in December 2025.

In Georgia, nurse Katie Chubb championed legislation in 2024 to exempt birth centers from the certificate of need process, only to face another roadblock: hospitals’ refusal to sign transfer agreements for emergencies. “We’re seeing women giving birth in hospital hallways or at home unassisted, because there’s no in-between option like a birth center,” Chubb lamented. This underscores a systemic issue where some hospitals perceive birth centers as a threat to their revenue, despite the overwhelming need for more accessible maternal care options. Even in states like California, which moved to streamline licensure in 2025 after 19 closures between 2020 and 2024, the path remains challenging.

Global Maternal Health Crisis: Aid Cuts and Reversals of Progress

The challenges highlighted by Dr. Green Smith’s death and the struggles of birth centers are mirrored, and often amplified, on a global scale. Postpartum hemorrhage, or excessive bleeding after childbirth, remains the leading cause of maternal deaths worldwide. Professor Arri Coomarasamy and the University of Birmingham spearheaded research that led to a breakthrough in 2023: a combination of better diagnosis (using blood-collection drapes) and simultaneous administration of effective treatments (oxytocin, tranexamic acid, IV fluids) could reduce severe bleeding, surgeries, and deaths by 60 percent. This “extraordinary finding in modern medicine” offered a tangible solution to a devastating problem.

However, the rollout of these life-saving interventions has been severely hampered by political decisions. Following the Trump administration’s slashing of foreign aid at the start of 2025, key US-funded programs like Momentum Country and Global Leadership, which aimed to bring this knowledge and equipment to patients, were curtailed in more than 10 of the roughly 25 countries where they operated. The Independent reported that these cuts disproportionately affected some of the poorest nations with the highest maternal mortality rates. Professor Coomarasamy, now at Oxford, stated, “There is no doubt in my mind that the cuts have massively impacted the rollout… which are life-saving.”

The consequences are already evident in countries like Malawi, where nurse Victoria Mzungu attests to the effectiveness of the new training, yet now lacks access to crucial drugs and equipment due to funding cuts. Outreach programs designed to reach remote communities have been canceled, leading to a drop in antenatal visits and a rise in cases of excessive bleeding. An audit report seen by The Independent even found a woman who died from hemorrhage could have survived if the cuts had not created gaps in knowledge and equipment. Another US-funded initiative by WaterAid, ensuring clean water and sanitation in maternity wards, was also stopped, leading to a fall in women attending clinics due to unhygienic conditions. “I feel like we’re going back 20 years,” lamented Cherrie Evans, a postpartum hemorrhage expert, highlighting the dire impact of these policy shifts on fragile health systems.

Struggles, Solutions, and the Path Forward

The fight for equitable maternal healthcare is ongoing, both domestically and internationally. In the US, advocates continue to push for policy changes, such as fair reimbursement rates for birth centers and legislation to enforce pay parity with hospitals for similar services. Proposed federal bills in 2024 aimed to introduce “standby capacity payments” for birth centers, acknowledging their role in filling care gaps. State grants also offer some relief, but a sustained, systemic approach is needed.

The Alabama lawsuit, where Dr. Skanes and others successfully challenged the state’s attempt to regulate birth centers as hospitals, offers a glimmer of hope, though the case remains ongoing. These legal and legislative battles are crucial for ensuring that birth centers can thrive as appealing alternatives for low-risk pregnancies, especially for communities historically underserved and mistreated by traditional healthcare.

Dr. Janell Green Smith’s untimely death serves as a profound and urgent call to action. It forces us to confront the uncomfortable truth that even those dedicated to healing and advocacy are not immune to the systemic failures embedded within our healthcare systems. Her story, alongside the struggles of birth centers and the impact of international aid cuts, paints a grim picture of a global maternal health crisis exacerbated by policy decisions and entrenched inequities. Addressing these challenges requires more than just acknowledging the problem; it demands a concerted, sustained effort to dismantle systemic racism in healthcare, reform regulatory hurdles, ensure equitable funding, and prioritize life-saving interventions for all birthing people, regardless of their location or socioeconomic status. Failure to do so not only dishonors Dr. Green Smith’s legacy but condemns countless others to preventable suffering and death.