Is Black Maternal Mortality the Elephant in the Room?

What is maternal mortality?

According to the U.S. Department of Health and Human Services, “maternal mortality” refers to the ‌maternal death rate (death of a woman) from complications of pregnancy or childbirth that occur during the pregnancy or within six weeks after the pregnancy ends.

In the United States, the overall rate of maternal deaths is triple that of other wealthy countries. As shocking as that statistic is, what’s horrifying is that maternal deaths are three times higher among Black women than White. Race also plays a role in severe birth complications and infant mortality, with Black women much more likely to suffer a dangerous birth.  

Racial inequities and disparities in quality of care adversely affect ‌both the mother and child health outcomes. Although complicated births may not be fatal, they can lead to short- and long-term health problems, emotional trauma, and decreased quality of life.  

Are there racial disparities in maternal mortality

In 2021, the Centers for Disease Control and Prevention (CDC) released a report from the National Center for Health Statistics that revealed the following U.S. maternal mortality rate by race: 

• There were 1,205 maternal mortalities in 2021, a 40% increase from 2020.  

• The increase in mortalities from 2020 to 2021 for all ethnic groups studied was significant.  

• The maternal mortality rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births: 2.6 times the rate for non-Hispanic White women (26.6).

• There was a significantly higher non-Hispanic African American maternal mortality rate for women than for White and Hispanic women. 

Even when controlling for socioeconomic factors, such as education and income, racial and ethnic disparities in maternal health persisted. This is undoubtedly a health crisis. 

Historically, the increase in severe birth complications was thought to be connected with women becoming pregnant older or when suffering from conditions like diabetes, obesity, or hypertension. However, Stanford epidemiologist Professor Stephanie Leonard believes this public health explanation is outdated and “is not the driver.”  

In a study published in BMC Pregnancy and Childbirth, the Stanford research team analyzed how maternal factors such as advanced maternal age, obesity, preexisting conditions, and prior cesarean delivery contributed to severe complications.  
 
The study found that maternal morbidity (defined by the World Health Organization as “any health condition attributed to and/or complicating pregnancy and childbirth that hurts the woman’s well-being and/or functioning”) rose much faster than these individual health markers. It concluded that the pre-pregnancy health and socioeconomic factors of individual women could not explain the racial disparities.   

Do Black mothers have more pregnancy complications?

Black moms-to-be are two to three times more likely to die from pregnancy-related complications than White women, according to a CDC report. They are also more likely to be uninsured and have less access to prenatal care and postpartum care. 

Even wealthy Black mothers are more likely to face higher rates of complications. Tennis star Serena Williams had a pulmonary embolism after giving birth, yet healthcare providers did not address it at first.  

A 2016 data analysis from New York City health care system found that Black, college-educated pregnant women were more likely to face life-threatening pregnancy or childbirth complications than White moms with only a high school diploma.  

The leading pregnancy complications that disproportionately affect Black mothers include the following: 

• gestational diabetes 

• preeclampsia 

• eclampsia 

• fibroids 

• hypertension (high blood pressure) 

• cardiovascular disease 

• preterm birth 

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Preeclampsia and eclampsia are the leading causes of death for Black women, and data show that 84% of pregnancy-related deaths are preventable. 

Is the United States a dangerous place to be a newborn?

The United States seems to be a dangerous place to be a newborn, but it’s not equally risky for all. New research data from California shows that for every 100,000 births:  

• 173 of the babies born to the richest White mothers die before their first birthday.  

• 437 of the babies born to the wealthiest Black mothers die before their first birthday. 

• 350 babies born to poor White mothers die before their first birthday.  

• 653 babies born to poor Black mothers die before their first birthday and are at the highest risk.  

This is the first large study to show how the risks of childbirth vary by race and parental income. Social determinants of health have consequential effects on medical outcomes across race and ethnicity, and Black families, regardless of their socioeconomic status, are disproportionately affected.  

Some state initiatives try to improve Black maternal health

New York State Department of Health held community listening sessions where women from high-risk areas shared their stories about their birth experiences. Participants included women who had recently given birth, those who had had negative experiences of birth, family members of those who had died in childbirth, and community organizations.  
 
It was found that many felt that their healthcare providers didn’t listen to them, they were given little information about maternity, and that there was inadequate social support. Black women felt that they felt judged and disrespected and that racism affected their care.   

Why choose Dr. Rad and Los Angeles Maternal & Fetal Care?

Did you know that about 8% of pregnancies in the United States are deemed high-risk? But many other pregnancies are “at risk” and should be monitored closely for the sake of both the child’s and the woman’s health. 

Expectant mothers in Los Angeles turn to double-board certified Dr. Steve Rad, an OB/GYN with sub-specialty training in Maternal-Fetal Medicine / Perinatology. 

Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.

We are conveniently located for patients throughout Southern California and the Los Angeles area in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles. We also offer in-home prenatal care and have an obstetrics fly-in program for out-of-town patients. 

Sources 

Maternal Mortality Rates in the United States, 2021  
https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm 

Brown, C. C., Adams, C. E., & Moore, J. E. (2021). Race, medicaid coverage, and equity in maternal morbidity. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 31(3), 245–253.

https://doi.org/10.1016/j.whi.2020.12.005 Mallampati, D., Federspiel, J., Wheeler, S. M., Small, M., Hughes, B. L., Menard, K., Quist-Nelson, J., & Meng, M. L. (2022). Incidence of severe maternal morbidity by race and payer status at an academic medical system. American Journal of Obstetrics and Gynecology: Supplement, 226(1), 440. https://doi.org/10.1016/j.ajog.2021.11.731  

Howell, Elizabeth A.; Zeitlin, Jennifer (August 2017.” Seminars in Perinatology. 

B’MORE FOR HEALTHY BABIES: A Collaborative Funding Model to Reduce Infant Mortality in Baltimore 
https://assets.aecf.org/m/resourcedoc/AECF-BmoreforHealthyBabies-2018.pdf  

“PRIME PubMed | Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic”. www.unboundmedicine.com.   

Can You Hear Me?: How Implicit Bias Creates a Disparate Impact in Maternal Healthcare for Black Women, Glover, Kenya [ 34 pages, 243 to [vi]]