Barbara Smith and her fraternal twin sister, Beverly, were born on November 16, 1946 in Cleveland, Ohio, to Hilda Beall Smith. Born prematurely, both twins struggled during their first months of life, though Beverly particularly struggled after contracting pneumonia. Their mother worked as a nurse's aide and later a store clerk, so the girls’ grandmother acted as their primary caretaker during their childhood, while their mother drew an income. In 1956, when Barbara and Beverly were nine, their mother died from heart complications related to childhood rheumatic fever. After their mother's death, the girls continued to live in a two-family home with their grandmother, aunts, uncles, and cousins.