How to Address the Serious Issue of Black Maternal Mortality

How to Address the Serious Issue of Black Maternal Mortality

In 2017 the United States and the Dominican Republic were the only two countries to post increases in their maternal mortality rates. The US has, in fact, the highest rate of deaths related to pregnancy and childbearing of any developed nation.

As other nations’ rates of childbirth deaths among mothers went down, in the US it rose to 17.3 maternal deaths per 100,000 live births in 2017 from 7.2 deaths per 100,000 live births in 1987. This translates to about 700 women in the US dying every year as a consequence of pregnancy or medical complications related to pregnancy.

To compare, here are the 2019 maternal mortality rates per 100,000 live births for several other industrialized countries chosen at random: Canada (7.5), France (7.6), Hungary (11.2), Portugal (11.5), Korea (9.9).

Additionally, about 50,000 American women develop life-threatening complications associated with their pregnancies. The most frequent causes of maternal death overall, from the years 2011 to 2017, were stroke and cardiovascular disease.

The CDC points out that about two-thirds of maternal deaths are preventable.

Black women experience the worst outcomes

The maternal death rate for Black women is even more troubling, at 44 per 100,000 pregnancies in 2019. That’s more than double the rate among White women. It’s also three times the rate among Hispanic women. In stark terms, a Black woman with a four-year college degree is about 60 percent more at risk of dying in childbirth or postpartum than a Hispanic woman or a non-Hispanic White woman who never finished high school. Differences in income, lifestyle, and other factors are just as irrelevant to the maternal death rate among Black women.

Dangerous conditions prevalent among Black pregnant women include eclampsia, preeclampsia, and embolism.

Systemic suffering

Factors accounting for disparities in outcomes between Black women and other groups in the US include pre-existing chronic health conditions, but several social conditions are also involved.

According to the CDC, lower quality of health care, implicit bias among some healthcare providers, and systemic racism are among the social determinants that raise Black women’s risk substantially. These kinds of social factors have demonstrated a long history of making Black Americans sicker, keeping them from receiving high-quality care, and causing, in many cases, premature deaths out of all proportion to those experienced by other groups.

Dangerous disparities for babies

Also disturbingly, Black babies—along with Indigenous infants—are about two times as likely to die within their first year of life than White babies. This mortality disparity is more pronounced than during the days of slavery right before the Civil War.

While it’s true that medical advances over the last 170 years have vastly improved health outcomes for mothers and babies of all ethnicities, what we are looking at here is the size of the gap.

Scholars estimate that the infant mortality rate among Black children in 1850 was approximately 340 out of every 1,000; for White children, it was about 217 per every 1,000. The CDC’s statistics for 2016 record Black infant mortality rates at 11.4 per 1,000, and White infant mortality rates at 4.9 for every 1,000. Doing the math, we can see that in 1850 Black babies were 1.6 times more likely to die during infancy than White babies. In 2016 they were 2.3 times as likely to die.

Professionals and advocates confront the issue

In 2021 the American Medical Association presented a statement addressing the crisis in Black maternal health to the Committee on Oversight and Reform in the US House of Representatives. Acknowledging historic medical racism and continuing structural inequalities in healthcare, the AMA has found strong evidence for a “weathering” effect on the body when people experience consistent racism, discrimination, and disrespect. In addition, accumulations of adverse childhood experiences due to discrimination, including those experienced in utero, lead to chronic underlying conditions in later life.

Black Maternal Health Week (BMHW), held in the US every year in mid-April, serves as a means of promoting greater awareness, activism, and a sense of community around these issues. Sponsored by the Black Mamas Matter Alliance, BMHW aims to elevate our national discourse around the wellbeing of Black American mothers and infants, as well as to drive forward research and innovative healthcare programs.

The path to a better future starts here

According to the AMA and a broad spectrum of other healthcare organizations and advocates, there are concrete steps we as a nation can take to start improving health outcomes for Black women and their babies:

Work to build out a diverse workforce in the medical field.

Recruiting, training, and hiring more professionals of color will produce demonstrable gains in health for Black mothers, children, and people of all ages. Research studies confirm that being treated by Black providers tends to improve timeliness and quality of care for Black patients. And all medical students do better when they have the opportunity to learn from professionals of color as part of their work to better understand underserved communities.

Listen to Black women.

History teaches us that, too often, the voices of Black women speaking up to describe their experiences of health, disease, and pain have gone unheeded by White professionals entrusted with their care. Even tennis superstar Serena Williams came close to dying after giving birth to her daughter when hospital staff initially brushed aside her complaints about what turned out to be a serious blood clot. Additionally, we as a culture can start listening more to the experiences of Black midwives and other non-institutional care providers.

Acknowledge as a society that systemic, cultural, and person-to-person racism poses a significant threat to public health generally.

It drives a wedge between people seeking health care and the professionals and services that could help them. As such, it results in an enormous drain on resources and inflicts lifelong preventable health complications that limit individuals’ earning power and productivity. And for too many Black women and their infants, this type of racism kills.