There is a Black maternal health crisis in the U.S. Black women are 2.5 times more likely than white women to die in pregnancy, birth, or within six weeks after birth. They are 70% more likely to face severe disease in pregnancy due to issues ranging from kidney failure to infection.
Maternal morbidity is defined as a serious medical event whereas maternal mortality is death due to a medical event.
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Black Women Face Worse Health in Pregnancy and Beyond
Common causes of maternal mortality in the U.S. are bleeding, infection, and cardiovascular disease during pregnancy or at birth. In the postpartum period, women are most likely to die from heart conditions, such as heart attack and stroke. Pregnancy-associated deaths (death as a result of all causes, including drug overdose) rose dramatically from 2010 to 2019. (Mental health conditions can also lead to suicide and overdose.)
This pattern persists even after accounting for income and education. College-educated Black women have 1.6 times the maternal death rate as white women who never earned a high school diploma.
Why Are Black Maternal Health Disparities So High?
Many factors combine to make pregnancy and birth more dangerous for Black women. Social determinants of health, systemic racism, current and historic inequalities, and implicit bias play a significant role in maternal health disparities. Racism and inequality in society are the larger themes.
As many experts have suggested, health disparities are a direct result of racism, not race.
In fact, one study showed that Black women born in the U.S. had a 27% higher risk of preeclampsia than Black women who immigrated later in life. (Preeclampsia happens when problems in the placenta lead to increased blood pressure in pregnant women. It’s more likely when women face challenges such as diabetes, obesity, and high stress.)
Fewer opportunities and discrimination experienced in childhood and beyond shape one’s health. Black women born in America have high rates of chronic stress, which worsens all aspects of health.
In addition to facing more racism in society, Black women disproportionately face racism in the health care system as well. One survey found that about 23% of Black women said health workers mistreated them during pregnancy or birth. This finding compares to about 14% among white women.
Black women who worry about health providers ignoring them may not raise concerns about symptoms in the first place. When they do raise concerns, health providers are less likely to take them seriously.
Access to contraception also is an important factor. On average, unplanned pregnancies result in more health problems for the mom and fetus than planned pregnancies. Black women face higher rates of unintended pregnancy in the U.S. than white and Hispanic women.
Ways to Champion Black Maternal Health
Many community, health care, nonprofit, and government organizations are focusing on Black maternal health. Measures include diversifying the perinatal workforce, expanding access to health insurance, funding community health programs, and more.
At UPMC, there are a number of federal and state bills that we strongly support and believe would have a positive impact on black women throughout the Commonwealth of Pennsylvania. These pieces of legislation would reduce maternal health disparities by aligning patient, family, community, and health system resources to better support safer childbirth.
A few opportunities for legislators in Harrisburg and Washington, D.C. include:
- House Bill 1608 is sponsored by Pennsylvania Rep. Morgan Cephas and would extend Medicaid coverage to doula services and create a Doula Advisory Board.
- Many Doulas have received cultural competency training and are invaluable in providing nonmedical comfort and support to women before, during, and after childbirth.
- Studies have shown that women who receive Doula support during childbirth are less likely to need a Caesarean surgery, which occurs more often among Black women.
- Senate Bill 335 is sponsored by Sen. Judy Schwank and would extend Medicaid coverage to doula services and care.
- More than 193,000 Pennsylvanians live in maternity care deserts — which are counties with a significant lack of maternal health care. People living in maternity care deserts who are pregnant or recently gave birth face a greater risk of poor maternal and infant health outcomes, including death.
- Women have reported greater satisfaction with the birthing experience when accompanied by a doula. Recent studies also show that doula-assisted women require less medical intervention during the birth process and experience improved health outcomes for both mother and child.
“It is imperative that leaders understand and act to reverse the maternal morbidity and mortality trends that we are seeing in Pennsylvania and nationally,” says Sharee Livingston, DO, chair of obstetrics and gynecology at UPMC Lititz. “It is great to see our elected officials recognizing the importance of creating legislation to address Pennsylvania’s maternal health crisis. More importantly, it is time to show Pennsylvania families and communities that their lives matter.”
It’s also important that those working within and outside of hospitals advocate for Black women in the health system. For example, a friend (and/or doula) can go with a Black woman to her maternal health-related visit and ensure the provider addresses all concerns. A doula is a nonmedical birth assistant who acts as an advocate for the patient. Nurses, doctors, and other providers can get training to become more aware of their biases.
The number one way to prevent poor maternal health outcomes is to ensure Black women have routine, high-quality health care. This includes before pregnancy, during pregnancy, and postpartum.
Black women are encouraged to find a provider they feel they can trust and communicate with openly.
Black women also can ask their health providers about doulas, support groups, and classes in their communities. These groups can connect women to an emotional support network that helps reduce stress in pregnancy. Facilitators also share information about eating and exercising in pregnancy and when to seek health care for symptoms.
Moms are raising the future. Together, people can help Black women get the care and support they deserve.
Editor's Note: This article was originally published on , and was last reviewed on .
American Congress of Obstetricians and Gynecologists. Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010–2019. Link
American Heart Association. U.S.-born Black women at higher risk of preeclampsia than Black immigrants. Link
Centers for Disease Control and Prevention. Unintended Pregnancy. LinkCenters for Disease Control and Prevention. Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018. Link
Commonwealth Fund. Maternal Mortality in the United States: A primer. Link
Kylea Liese et al. Racial and ethnic disparities in severe maternal morbidity in the United States. Journal of Racial and Ethnic Health Disparities. Link
Stephanie Leonard et al. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Annals of Epidemiology. Link
March of Dimes. Birthing while Black: Examining America's Black Maternal Health Crisis. Link
National Partnership for Women and Families. Black women's maternal health. LinkDr. Saraswathi Vedam et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health. Link
About UPMC Magee-Womens
Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.
Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.