The majority of midwives in this period are Black, Indigenous, and immigrant women. Block (2020) writes: "At first states outlawed 'abortion' partly as a means of limiting midwives’ practice. Then state after state erected statutory barriers for midwives, first by licensing and supervising existing midwives and later by denying licenses in all but a handful of states." This will continue over the next century and a half, until by the 1960s, midwives and birth workers will be much less visible and will be widely vilified by institutional medicine.