Black women face an imbalance of poor maternal health outcomes in the U.S., including alarmingly disproportionate death rates due to complications during pregnancy or childbirth. Understanding maternal mortality rates among Black women requires a closer look at the ways systemic racism and sexism compound and perpetuate lethal inequalities in healthcare.
The U.S. has the worst maternal mortality rates of any developed country, and those death rates are increasing. The term “maternal mortality rate” refers to the number of maternal deaths per 100,000 live births. Maternal deaths are avoidable deaths during pregnancy and childbirth or within 42 days of termination of pregnancy, usually expressed per 100,000 live births.
In January 2020, the Centers for Disease Control and Prevention (CDC) found that the U.S. has an annual rate of 17.4 maternal deaths per 100,000 live births: About 700 pregnant women die due to complications in childbirth each year. Tragically, healthcare experts estimate that about 60% of all pregnancy-related deaths are preventable.
Maternal mortality rates are especially dismal for people of color. According to the CDC:
- Black, American Indian, and Alaska Native women are three times more likely to die from pregnancy-related causes than white women.
- Black women are more likely to experience preventable maternal death than white women.
- Disparities in pregnancy-related mortality for Black women persist across our nation; even in states with the lowest maternal mortality rates, Black women still die at three times the rate of white women.
- Black women are also twice as likely to suffer postpartum depression than white women.
Crucially, data on age and maternal mortality shows that this disparity ratio between Black women and white women increases over a lifetime. For example, Black women under the age of 20 experience maternal mortality at 1.5 times the rate of white women; for Black women between 30 and 34 years old, the maternal mortality rate jumps to 4.3 times that of white women in the same age group.
The data shows the deadly effects of racism that add undue chronic stress on women of color.
Maternal Mortality and Social Determinants of Health
In American culture, common narratives around health tend to blame the victim for poor health outcomes. Mandates to eat better, sleep longer, and get more exercise underemphasize and flatly ignore the structural conditions that make people sick to begin with.
Recent efforts to understand health disparities for Black women look instead to the social determinants of health. The CDC defines the social determinants of health as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.”
Such social determinants of health include the following:
- Education (early childhood education, language and literacy, higher education)
- Healthcare (access to primary care, health literacy)
- Economic stability (employment, food insecurity, housing instability)
- Built environment (environmental conditions, quality of housing, proximity to violence)
- Social and community context (discrimination, incarceration, civic participation, social cohesion)
Studies show that Black women are more likely to die during pregnancy and childbirth than white women, regardless of income, education, or lifestyle.
The Problem Isn’t Education Level
Level of education alone can’t safeguard women of color from maternal mortality. The CDC reports that the pregnancy-related mortality rates for Black women with a college degree are five times as high as women with a similar education.
Black non-Latina women with at least one college degree have higher maternal morbidity rates than all other women who never graduated high school, according to findings from the New York City Department of Health and Mental Hygiene.
Implicit Bias in Healthcare
Implicit racial bias continues to affect quality of care, which in turn contributes to the racial and ethnic disparities in maternal mortality, according to the CDC. For example, a national study of five pregnancy complications found that Black women and white women were equally likely to experience pregnancy complications, yet Black women had a significantly higher case fatality rate. Women of color often need to self-advocate, which can lead to delays, misdiagnoses, and neglect.
In 2020, the CDC proposed federal guidance to reduce maternal mortality rates, especially disparities in maternal mortality rates among women of color. The proposal called for hospitals and healthcare systems to implement standardized protocols so that all patients receive the same levels of care, regardless of race and gender, and identify and address implicit bias among staff and within healthcare systems.
Black women are more likely to lack access to health insurance, face greater financial barriers to care, and are less likely to get prenatal care than white women. Because of racism and sexism, Black women typically earn only 63 cents for every dollar paid to white men. Black women earn median wages of just $35,227, or $21,698 less than white men.
According to the National Partnership for Women & Families, “These lost wages mean Black women and their families have less money to support themselves and their families, and may have to choose between essential resources like housing, childcare, food, and healthcare.”
Due to a variety of health inequities, Black women are more likely to receive obstetric care in hospitals with a lower quality of care. A total of 75% of Black women give birth at hospitals that serve predominantly Black populations. According to the National Partnership for Women & Families, “Black-serving hospitals have higher rates of maternal complications than other hospitals” and perform worse on the majority of birth outcomes, such as elective deliveries, nonelective cesarean births, and maternal mortality.
Social and Community Context
The trauma of overtly racist and sexist policies in medicine persists. Dána-Ain Davis, professor of anthropology and urban studies at Queens College, City University of New York, explains, “The way that Black women have been demonized, stereotyped, violated and policed in the past, is consistent with contemporary medical interactions and operate as reminders of the past.”
Davis continues, “The repertoires of racism exist in the crevices and creases of a conversation, in the space between a comment and a pause. If doctors and nurses give dismissive looks or make a woman feel unworthy, that also constitutes a repertoire of racism.”
Community activist groups such as SisterSong have been amplifying the voices of women of color and indigenous women seeking reproductive justice for decades and continue to push for progress. Their efforts, and those of similar organizations, reflect the resilience of Black women and women of color in the face of life-threatening maternal mortality rates.
Clearly, maternal mortality is a grave injustice that disproportionately affects Black women. The root lies in structural racism and sexism and their compounding effects over time.
Weathering and Chronic Stress
Implicit racial bias in the healthcare system affects interactions between patients and medical professionals, treatment decisions, and patient adherence to recommendations. The result? Chronic stress and undue burdens on Black mothers navigating a society — including its healthcare system — that systematically silences them.
According to the “weathering” hypothesis, Black women experience earlier health deterioration than white women because of the cumulative impact of psychosocial, economic, and environmental stressors due to racism. Black Americans have the highest rates of post-traumatic stress disorder (PTSD) of all other racial and ethnic groups. Worse, Black women experience PTSD following trauma at two to three times the rate of Black men — suggesting that racism and sexism together exacerbate negative health outcomes.
Acknowledging Black women’s experiences is a crucial first step toward reducing Black maternal mortality. To address racism and sexism in the healthcare system today, medical and healthcare professionals must be willing to speak out against racism and take responsibility for their own biases.
Support Equity in Nursing and Public Health
Racism in healthcare still exists in both overt and subtle forms today. The combined effects of racism and sexism continue to affect maternal mortality rates among Black women.
Dismantling structural inequalities in healthcare requires that medical professionals, public health officials, and a diverse range of community organizers and advocates consistently work together to implement lasting public policy change.
With a commitment to diversity and justice, students at St. Catherine University learn ways to make medicine work for all. Explore St. Catherine’s nursing programs and public health programs to learn more about how students today are learning to make a difference in healthcare.