- The incidence of maternal mortality, either during childbirth or during the postpartum period is increasing in the U.S., especially among black women.
- Differences in education, access to quality healthcare, and financial resources contribute to but do not explain the racial disparities in pregnancy and childbirth mortality.
- Some of the other probable causes include biases within the medical system and basic social inequalities, as well as high rates of such complicating conditions as diabetes, obesity, heart disease and hypertension.
Although the incidence of women dying during or soon after childbirth has decreased in most industrialized areas of the world, it is increasing in the United States, particularly among black women.1 The Centers for Disease Control and Prevention (CDC) have reported that about 700 women die of pregnancy or childbirth complications in the U.S. every year, despite the efforts of hospital and community programs attempting to counteract the crisis.2
Reporting that black women are three to four times more likely to die from pregnancy-related causes than white women, the CDC largely attributes that racial difference to the increasing rate of pregnancy-related deaths over the past 20 years in the U.S., which currently has the dubious distinction of having the worst maternal death rate of any industrialized country.3
In New York, black women die at a 12 percent higher rate than other women, according to a study reported in The Journal of Maternal-Fetal & Neonatal Medicine. Taraneh Shirazian, MD, who heads up the Global Women’s Health program at NYU’s College of Global Public Health, said, “It’s extremely alarming… We actually learned that most of the women who died had received no prenatal care. These women who are underserved in the city are not seeing their physicians for multiple reasons… in a city where we have so many resources.”4
Referring to New York’s Doula Pilot program, which reimburses women for some doula services, Dr. Shirazian stressed that such applaudable interventions must be paired with education programs to be effective in preventing maternal deaths. According to her Saving Mothers nonprofit organization, as many as 75 percent of maternal deaths worldwide could be prevented with low-cost interventions.
More Than an Economic Issue
While the disparity in maternal mortality may be attributable to differences in education, financial stability or availability of high quality medical care, the racial divide extends to such well-known celebrities as Beyoncé and Serena Williams, both of whom experienced high-risk complications in their pregnancy and birth experiences.5 In Williams’ case, she recognized symptoms of a pulmonary blood clot earlier than the medical staff attending her, but her concerns were initially dismissed by medical personnel, resulting in lost time before she was accurately diagnosed and treated.
According to Allison Bryant Mantha, MD, vice chair of quality, equity and safety in the obstetrics and gynecology department of Massachusetts General Hospital in Boston, “Racism affects so many things before the patient even gets to the clinical encounter… Both implicit bias and structural racism affect how women are cared for in the health care system.”6
That sentiment is echoed in statistics showing that “the disparity is not about class or level of education attainment, as even college-educated mothers who deliver in local hospitals are more likely to suffer complications in pregnancy and childbirth than white women who never graduated from high school.”7 The CDC reports that pregnancy-related mortality ratios ranged from a high of 42.4 deaths per 100,000 live births for black non-Hispanic women, to 13.0 per 100,00 for white non-Hispanic women, and 11.3 per 100,000 for Hispanic women.8
Maternal Mortality is a Multi-Faceted Problem
Part of the explanation for the increase in maternal mortality in the U.S. may lie with the increased incidence of chronic health conditions among pregnant women, including hypertension, diabetes and heart disease, any of which can increase the risks associated with pregnancy.
Other factors may include the increase in C-sections and planned inductions, both of which can escalate the chances for hemorrhages or blood clots. Similarly, the country’s high obesity rate and the trend toward having babies later in life also can increase the odds for high blood pressure and lead to complications such as preeclampsia. Preeclampsia, associated with high blood pressure, is said to be 60 per cent more common among African-American women than for other races.9
One of the most disturbing considerations for the disproportionate incidence of maternal mortality among African-American women is the chronic stress presented by the “discrimination that black women experience in the rest of their lives—the double whammy of race and gender—that may ultimately be the most significant factor in poor maternal outcomes.”10 Such chronic stress can take a physical toll on the body during pregnancy and childbirth.
Termed “weathering” by Arline Geronimus, a professor at the University of Michigan School of Public Health, that chronic stress can effectively “age” the body such that complications frequently seen for older white women in their 40s might be seen in black women a decade younger.
1 Bondy H. ‘Extremely alarming’: New report addresses maternal mortality in the U.S. NBC News Jan. 2, 2020.
2 Why Are Black Women At Such High Risk Of Dying From Pregnancy Complications? American Heart Association News Feb. 20, 2019.
4 Bondy H. ‘Extremely alarming’: New report addresses maternal mortality in the U.S. NBC News Jan. 2, 2020.
5 See Footnote 2.
7 Why is the Death Rate so High for Black Women in Pregnancy and Childbirth in the U.S.? Paulson & Nace, attorneys at law.
8 Division of Reproductive Health. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention Oct. 10, 2019.
9 LoBue V. Why Do So Many Mothers Still Die in Childbirth? Psychology Today Jan 14, 2019.
10 Martin N. Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why. NPR Dec 7, 2017.