What's causing the Black maternal health crisis?

As a Black woman, I was terrified of maternal health statistics during my pregnancy. There were too many health disparities disproportionately impacting Black birthing people like myself. Now as a nurse practitioner who specializes in maternal health, I find myself concerned but determined.

In the words of Inas-Khalidah Mahdi of the National Birth Equity Collaborative, “Maternal disparities have little to do with race, and more to do with Black women’s experience of racism. There is nothing inherently wrong with Black women."

Being Black does not mean I am physiologically incapable of a healthy birth. Medical racism drives the Black maternal health crisis and makes victims out of healthy patients.

Maternal mortality rates in the United States are the worst compared to all other high-resource nations—approximately 700 women in the U.S. die each year due to pregnancy-related complications. And the crisis is only getting worse. The U.S. is the only high-resource country with a rising maternal mortality rate. In fact, it was recently reported that ​​the U.S. maternal mortality rate is the worst it’s ever been since 1965. One of the biggest drivers of the maternal health crisis is racism and discrimination, with Black and Indigenous women and birthing people being disproportionately affected:

• Black and Indigenous women are 2 to 3 times more likely to die from complications of pregnancy and childbirth than white women.
• Maternal death statistics persist across education levels. Black women with a college degree have a pregnancy-related maternal mortality rate that is 5.2 times higher than the rate for white women with the same education level.
• There is data showing that, after caesarian sections, Black women don’t have their pain adequately managed at the same rate as white women.
• 38 percent of women of color experience postpartum depression compared to approximately 13 to 19 percent of all postpartum women.

According to the CDC, 4 in 5 pregnancy-related deaths in the U.S. are preventable. I look at the names of beloved Black mothers who died because of alleged negligence or malpractice, Kira Johnson, April Valentine, Shamony Gibson, Amber Rose Isaac, and so many more, and I know better health care could have made a difference. We must do better.  

In this country, neither my degree nor my economic status protects me from adverse pregnancy outcomes. Instead, we must look to medical racism as the cause and the necessary target. Enough is enough. I say this knowing some clinicians may not know what to do next.

‍How can clinicians address the Black maternal health crisis?

‍Health care providers and other stakeholders must take steps to promote health equity and ensure that Black women and birthing people have access to high-quality, culturally competent care.

Here are some actions that can help:

1. Acknowledge the causes. 84% of pregnancy-related deaths are preventable—they’re caused by a lack of quality care, structural and medical racism, and implicit bias. Acknowledging these external causes takes the blame off of the patients, and it can help put efforts and resources where they will do the most good.
2. ‍Be aware of the impacts of death statistics. For a Black woman or birthing person, seeing headlines about racially-driven maternal death rates is understandably stressful. As pregnancy and childbirth can already be nerve-racking, it’s up to providers to be sensitive when relaying death statistics. Take time to discuss the emotional impact of these health disparities, and if a patient is upset or worried, be sure to validate their feelings. Disparities should be a clinician’s impetus for allyship, advocacy, and trauma-informed care.
3. ‍Address social determinants of health. Factors such as poverty, lack of resources, and housing impact an individual’s health, and play a major role in maternal health outcomes. Be sure to screen all patients for social determinants of health. For example, do they have secure transportation to and from appointments? Outside of work, try to support policies that promote economic security, access to healthy food, and safe housing.
4. ‍Advocate for access to health care services. Access to health care services is critical for promoting maternal health. Initiatives like Medicaid expansion and increased funding for community health centers and doulas can help ensure that all women and birthing people have access to the care they need. Advocate and speak to your representatives whenever possible.
5. ‍Promote culturally competent care. Health care providers must provide care that recognizes and respects the unique needs and experiences of all patients. This includes providing interpretation services, recognizing cultural differences in health beliefs and practices, and training health care providers in cultural competency. For Black women and birthing people, partnering with culturally competent doulas has been shown to improve outcomes for patients and their babies.
6. ‍Improve quality of care. Quality perinatal care for women and birthing people can help prevent complications and improve outcomes. This includes improving screening and treatment for conditions like gestational diabetes and postpartum depression, and promoting evidence-based practices for prenatal and postpartum care.
7. ‍Address implicit bias and become an ally. Implicit bias can impact the quality of perinatal care women and birthing people receive. Bias can result in minimizing or failing to listen to the concerns of Black patients—even when unintentional, it leads to serious complications. Since implicit bias is often hard to self-identify, it should be addressed through training and education, as well as an ongoing practice of introspection and allyship.
8. ‍Use trauma-informed care. Recognize that historically underserved patients have worse outcomes than their white, cisgender, and able-bodied counterparts. Exhibit empathy, sensitivity, and respect to mend trust with patients who may have had bad experiences.
9. ‍Center the individual needs of the patient. Patient-centered care allows for involvement in decisions and respect for preferences. In this approach it is important to honor the culture, values, perspective, and intersecting identities of every patient. For pregnant patients, it’s especially important to discuss their hopes, fears, questions, and birth plans before, during, and after labor.
10. ‍Practice continuity and prevention. Take a preventive approach. Focus on continuity, involvement of family and carers, and fast, reliable information and services that offer holistic care before an emergency. In addition, refer Black mothers and birthing people to community-based organizations that offer free or low-cost doula support, lactation counseling, physical and mental health therapy, and more to supplement primary care during all stages of reproductive health.

Ensuring access to quality, culturally competent care is key to addressing Black maternal health disparities. By raising awareness of the causes of maternal mortality rates, advocating for patients, and practicing through a culturally sensitive lens, we can improve the quality of perinatal care for Black women and birthing people.