Black Maternal Mortality Rates Are a Public Health Crisis: Here’s Why and What’s Being Done to Address It

Disparities in health outcomes — especially those that negatively impact Black people — have been present in the United States since its inception. But back then, the root causes were much less ambiguous when the economy was based on slavery and the devaluation of non-white lives. 

Despite advances in prenatal and obstetrical care, the wide gaps in maternal mortality rates have persisted into the present day. Although it’s long overdue, how to address these disparities has become an area of focus.  

Keep reading to learn more about this important topic.

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Why do pregnant people die at all?

The World Health Organization (WHO) defines maternal mortality as any non-accidental pregnancy-related death that occurs during pregnancy or within 42 days of the end of a pregnancy. 

Compared to other countries, the U.S. has the highest maternal mortality rate in the developed world and is the only country where the maternal mortality risk has gone up in recent years. What’s more, 2 out of every 3 pregnancy-related deaths every year are considered to be preventable.

The history of maternal mortality

Historically, pregnancy and birth-related issues were one of the leading causes of mortality in women of childbearing age around the world.

Before the modern medical era, the risk of otherwise healthy people dying during pregnancy and childbirth was significant. Infections, bleeding, seizures, and complications from procedures performed to end pregnancies were often the cause.  

Although cesarean sections (C-sections) have been performed for centuries, it was historically an attempt to save the baby when the mother was not expected to survive the delivery. In other words, the procedure originally was not meant to save the mother’s life. Early techniques contributed to high maternal mortality rates during this time, with mothers often dying from bleeding or infection.

Even though we’ve seen significant advancements in medical procedures over time, it’s important to note that significant changes take place in the body during pregnancy. And although it usually ends well, many of the risks that have existed in the past are still a concern today. 

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The modern-day causes of maternal mortality

The top causes of maternal mortality today overlap somewhat with causes in the past. According to the Centers for Disease Control and Prevention (CDC), the top five causes of maternal mortality in the U.S. are: 

• Cardiovascular conditions (including seizures from high blood pressure called eclampsia), 15.5%

• Infection,12.7%

• Heart muscle disease (cardiomyopathy), 11.5%

• Bleeding (hemorrhage), 10.7%

• Blood clots in the lungs (thrombotic pulmonary embolism) or other parts of the body, 9.6%

Some of these conditions, like those related to high blood pressure, can be picked up in routine prenatal screening where treatment can start before more serious problems develop. 

Also, when a pregnant person and their care team work together to look for subtle signs of problems like infections, it doesn’t have to get to the point where a life is at risk. These are some of the more preventable deaths.

What is the incidence of maternal mortality in Black women compared to other races?

The dire reality is that Black women have a maternal mortality rate that is 3 to 4 times the rate of white women in the U.S. They also have a higher incidence of cardiomyopathy (heart muscle disease), thrombotic pulmonary embolism, and pregnancy-related high blood pressure disorders when compared with white women. Some of this can be linked to inadequate prenatal care and insurance coverage. 

It’s worth noting that these disparities still exist when you eliminate the impact of education. In fact, studies show that highly-educated Black women are still at a much higher risk. For example, a college-educated Black woman is still five times as likely to die as a result of a pregnancy-related cause when compared with a similarly educated white woman.

Similar trends are seen in Alaskan Natives and Native Americans who become pregnant in the U.S. Their maternal mortality rate is also 2 to 3 times that of the non-Hispanic white population.

And it’s important to note that the mortality disparity also extends to infants, with Black babies twice as likely to die compared to white babies. They’re also about 4 times more likely to die from low birth weight complications.

What do experts believe are the causes of these disparities?

There is no biological basis for race, so the disparities we see can be traced to resources, racial trauma, and the cumulative impact of structural racism. Let’s review a few ways these factors can contribute to maternal outcome disparities. 

Structural racism

Black women are more likely to live in areas with higher pollution rates, resulting from the historic practice of redlining. Redlining was a previous mortgage lending practice — which has since been banned — that resulted in the concentration of Black homeowners in certain disadvantaged areas of a community. 

In other words, redlining’s effects are still impacting Black communities today, putting Black women at higher risk for pregnancy complications. 

What’s more, living in these high-pollution areas makes expectant mothers 42% more likely to have a child who is stillborn. It also raises the risk of lower birth weights. This means that not only is the mother being impacted, but their unborn baby is as well. Because of this, these children are more likely to develop chronic conditions (e.g., diabetes and heart disease) that put their own maternal outcomes at risk — causing the cycle to continue.

Additionally, there are a number of complications that can happen during pregnancy — that can harm the mother, unborn baby, or both — so access to prenatal care is critical in identifying and managing them early. In fact, prenatal care has also been shown to lower the infant mortality rate.

However, research shows that Black women are likely to be further into pregnancy before receiving prenatal care. This could be related to challenges around insurance, transportation, and access to family planning tools.

Lastly, C-section rates are also higher in Black women, which raises exposure to infection and other surgical complications.

Racial trauma

The psychological toll of racism, called racial trauma, can have lasting physical and mental effects on health. This puts Black women at higher risk for conditions like chronic high blood pressure (hypertension) and dangerously high blood pressure during pregnancy that damages organs (called preeclampsia). 

Chronic stress, as is experienced with repetitive racial trauma, and hypertension, are associated with higher preeclampsia risk, one of the common causes of maternal mortality.

And not only does the stress and trauma affect the mother, but it’s suggested that the effects can be passed along in their genes and impact future generations as well.

What is being done to reduce Black maternal mortality rates? 

The Biden-Harris administration has acknowledged the disparities described above as a Black maternal health crisis. Because of this, they’ve laid out their initial plans to help address it. The main areas being addressed are as follows:

Funding initiatives

Investing in ways to lower maternal mortality and morbidity is an important part of addressing this crisis. The administration is allocating significant funding towards the following initiatives:

• Unconscious biases are the preferences and tendencies we develop over our lives without even realizing it.  Since these can sometimes lead to unequal treatment, training for healthcare professionals will be developed and implemented. 

• The Health and Human Services Office for Civil Rights funding will elevate and improve civil rights protection and advocacy.

• Pre-pregnancy and family practice services will be improved through the Title X Family Planning program.

• The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) will receive additional funding to expand and improve nutritional services. 

Waivers to extend postpartum coverage

Postpartum coverage helps to ensure people have access to healthcare services after giving birth. Previously, this coverage under Medicaid would end after 60 days postpartum. After that point, some people may not qualify for Medicaid to continue receiving care. States now have the option to extend coverage.

Illinois has been approved for a waiver to extend postpartum coverage for Medicaid-eligible women beyond 60 days, up to 1 year. All states have been invited to apply. As of June 2021, several other states have been approved or are somewhere in the process of requesting approval.

Additional funding for rural communities

The Rural Maternity and Obstetrics Management Strategies (RMOMS) program will be expanded, improving access to healthcare in rural areas.

This will be supported with an additional $12 million in awards. Applicants will be required to focus on populations that disproportionately experience inequities.

Initiatives for healthcare providers

The American College of Obstetrics and Gynecology (ACOG) has made reducing disparities and eliminating maternal mortality a priority through four main initiatives:

• The Alliance for Innovation on Maternal Health provides support for health systems to implement patient safety bundles and reduce harm.

• Optimizing Postpartum Care helps to address the critical period after birth.

• Levels of Maternal Care works towards making sure pregnancy care is delivered in the setting that meets the needs of the pregnant person with their risks of complications in mind. 

• Data collection will allow for better examination of root causes.

Since the leading cause of maternal mortality is cardiovascular problems, there is also a movement among cardiologists to be a part of the solution. 

What can Black expecting mothers do to reduce risks of pregnancy-related complications?

Changing the healthcare system to reduce pregnancy-related risks is important, but these kinds of changes can be slow to move forward. There is a lot people can do to improve their chances of a healthy pregnancy and delivery.

Be your own advocate

It’s important to be aware of the conditions that can affect a pregnancy. Ideally, consistent prenatal care that starts before pregnancy can enable healthcare providers and pregnant people to address conditions and prevent life-threatening complications. 

If you’re trying to get pregnant, tell your healthcare providers and ask them what you can do to ensure the healthiest pregnancy possible. And whether a pregnancy is planned or it’s a surprise, being as healthy as possible at all times protects your health and makes every pregnancy safer.

Knowing the difficulties Black mothers face, don’t be shy about expressing your needs and speaking up when something doesn’t feel right.

Tap into resources or support groups

There are national and local resources to provide support for pregnant people. Your healthcare provider or local health network could be great sources of information about community-based support.

The Maternal, Infant, and Early Childhood Home Visiting Program provides support during pregnancy and beyond with a focus on people who are at the highest risk of poor outcomes.

Support organizations that are working to eliminate disparities

Advocacy is an essential part of the work of changing systems. While it’s important to make sure your own pregnancy is safe, doing what you can to help others along the journey is important too. See if you can participate in the work of organizations that are helping to drive this change. A few of the groups doing this work are listed below:

• The Preeclampsia Foundation is one group that is working towards eliminating this cause of maternal mortality.

• The National Birth Equity Collaborative (NBEC) focuses on improving Black maternal and infant health through policy advocacy, research, training, and community-based work.

• The Black Mamas Matter Alliance works to change policy, drive research, advance care, and “amplify the voices of Black mamas.”

Why trust our experts?

Written by:

Khama Ennis, MD, MPH, FACEP

Dr. Ennis is a board-certified emergency physician based in western Massachusetts. She is the medical staff president and associate chief of emergency medicine at Cooley Dickinson Hospital.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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