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Black Maternal Health in the U.S.

June 20, 2023

The United States is one of the wealthiest countries in the world, yet its maternal mortality rates are shockingly high, particularly for Black mothers. According to the Centers for Disease Control and Prevention (CDC), Black mothers are three to four times more likely to die from pregnancy-related complications than white mothers. This disparity exists regardless of education or income level and affects mothers across the country, from cities to rural areas.

The causes of Black maternal health disparities are complex and multilayered, ranging from inadequate access to health care and discriminatory treatment by healthcare providers to systemic racism. Individuals who want to help ensure fair treatment in health care can build foundational public health knowledge, including race- and gender-based health disparities. 

What Is Maternal Health?

Maternal health refers to the health of people during pregnancy, childbirth, and the postpartum period. It includes the physical, emotional, and social well-being of mothers as well as the health and survival of their infants. It is a crucial aspect of public health that affects the health of mothers and their children, and by extension, community health.

Good maternal health requires access to comprehensive and quality health care, including:

  • Prenatal care 
  • Skilled birth attendants such as doctors, nurses, or doulas
  • Emergency obstetric care
  • Postnatal care
  • Proper nutrition
  • Clean water
  • Safe and sanitary conditions 
  • Access to education and information about maternal and child health

Maternal health outcomes vary widely around the world, with high rates of maternal mortality and morbidity particularly affecting low-income and marginalized communities. Maternal health disparities also exist within countries, with mothers from certain racial and ethnic groups, as well as those living in poverty or rural areas, experiencing higher rates of maternal mortality and morbidity. Improving maternal health is a critical component of achieving global health and development goals.

Racial Disparities in Maternal Mortality 

The Kaiser Family Foundation (KFF) provides a comprehensive overview of the racial disparities in maternal mortality and infant health in the United States. Key statistics highlighted in the KFF November 2022 article include the following:

  • Black mothers are three to four times more likely to die from pregnancy-related complications than white mothers.
  • Black infants are more than twice as likely as white infants to die before their first birthday.
  • Indigenous mothers and Alaska Native mothers also experience higher rates of maternal mortality than white mothers.
  • Maternal mortality rates have been increasing in the United States, with Black mothers experiencing the highest rates.
  • Black and Indigenous mothers are more likely to experience preterm birth and low birth weight infants.
  • Black mothers are more likely to experience pregnancy-related complications, such as preeclampsia and eclampsia.
  • Black mothers are less likely to receive prenatal care in the first trimester of pregnancy.
  • Discrimination and bias in health care can contribute to these disparities, as well as factors such as poverty, inadequate access to health care, and chronic stress.

The KFF article emphasizes the urgent need for action to address these disparities, including policy changes to improve access to health care and reduce systemic racism and bias in health care, which could significantly improve Black maternal health outcomes.

Maternal Mortality Rate by Race               

The national maternal mortality rate in the United States was 32.9 deaths per 100,000 live births in 2021, according to the 2021 National Vital Statistics System reported by the Centers for Disease Control and Prevention (CDC). In terms of maternal mortality rates by race, the CDC data shows that Black mothers’ mortality rate is highest, at 40.8 deaths per 100,000 live births. That’s more than double the rate for white mothers, which was 12.7 deaths per 100,000 live births. 

Indigenous mothers and Alaska Native mothers also experience higher rates of maternal mortality than white mothers, with a rate of 29.7 deaths per 100,000 live births. Asian/Pacific Islander mothers experience slightly higher rates of maternal mortality than white mothers, with 13.5 deaths per 100,000 live births.

Hispanic mothers have lower maternal mortality rates than both Black and white mothers, with rates of 11.5 deaths per 100,000 live births. 

Understanding the Black Maternal Mortality Rate              

The high rate of maternal mortality among Black mothers in the United States is the result of a complex interplay of social, economic, and health factors, including racism and systemic discrimination (factors described collectively as the social determinants of health). 

Here are some of the key reasons why the Black maternal mortality rate is so high:

  1. Racism causes chronic stress: Racism and discrimination can lead to chronic stress, which can have negative effects on maternal health and pregnancy outcomes such as preterm birth and higher rates of perinatal depression, according to the Kaiser Family Foundation.
  2. Existing health disparities: Black women are more likely to experience chronic health conditions such as hypertension, diabetes, and obesity, which can increase the risk of pregnancy complications; Black mothers are more likely to experience pregnancy complications such as preeclampsia, hemorrhage, and infection, which can result in maternal mortality.
  3. Limited access to prenatal care: Black mothers are more likely to lack access to prenatal care or to receive inadequate care — due to financial constraints, a lack of transportation, and explicit discrimination, according to a 2022 obstetrics and gynecology paper published in JAMA Open Network — which can lead to undiagnosed or poorly managed health conditions during pregnancy.
  4. Lack of cultural competence among healthcare providers: Some healthcare providers may not be trained to provide culturally competent care to Black individuals, leading to misunderstandings, misdiagnoses, and inadequate treatment.

Addressing these factors will require a comprehensive approach that includes addressing systemic racism, improving access to quality health care, and increasing cultural competence among healthcare providers.

Race and Class: Health Disparities Persist

It is important to note that racial maternal health disparities have persisted over time and are not solely attributable to differences in socioeconomic status or access to health care. Even when they earn higher salaries and gain more advanced education than their white counterparts, Black mothers experience a greater risk of maternal mortality than white mothers. 

Why? Experts say that the chronic stressors of living under racism mitigate the protective health factors that typically come with socioeconomic stability and greater education levels.

At every level of education and income, Black Americans have a lower life expectancy at age 25 than do white and Hispanic (or Latino) Americans, according to research cited by Pew Research in 2022. Additionally, Black Americans with a college degree or more education have a lower life expectancy than white and Hispanic Americans who graduated from high school. 

These racial mortality gaps also persist among highly-paid and highly-educated Black mothers. Black mothers with a college degree experience significantly higher rates of pregnancy-related mortality than mothers with similar education levels, according to the 2019 CDC data. 

The implication of this empirical research on racial health disparities is that increasing the incomes and levels of educational attainment for Black mothers is not sufficient to close the Black maternal mortality gap. Instead, racism needs to be addressed at all levels of our medical, educational, and vocational systems.

How Racism Affects Maternal Health

Racism has a significant impact on Black maternal health. The persistence of racial health inequities and disparities — even after adjusting for education and income — speaks to the urgent need to reduce racial bias and eliminate racism in all areas of our society. 

Consider some of the many ways that racism can negatively impact the health and well-being of Black mothers during pregnancy and childbirth.

1. Barriers to Healthcare Access            

One major way that racism affects maternal health is through disparities in access to health care. Black individuals are more likely to live in areas with limited access to health care facilities and providers due to historic redlining policies that pushed people of color out of wealthier neighborhoods with better healthcare access. Less access to high quality healthcare facilities can lead to delayed or inadequate prenatal care, which in turn affects maternal and infant health. 

For those who may not know, redlining was a practice of designating neighborhoods with predominantly Black or immigrant neighborhoods as “undesirable” for home loans and other financial investments in health care or business. 

While popular in the 1930s, racial redlining continues to have negative effects on communities of color. A 2021 article published in the Journal of Women’s Health noted that mothers from racial and ethnic minority groups on average give birth in lower quality hospitals and in hospitals with higher rates of severe maternal morbidity.  

Using a simulation model, the researchers found that if non-Hispanic Black mothers had their babies at the same hospitals as non-Hispanic White mothers, the Black maternal morbidity rate would decrease by 47.7 percent. This simulated estimate suggests that Black mothers continue to experience maternal mortality risks due to barriers to high quality health facilities. 

2. Racism as a Chronic Stressor          

Racism can also affect Black maternal health outcomes through the ongoing and traumatic experience of chronic stress. 

Exposure to racial discrimination can activate the body’s stress response, leading to chronic stress and inflammation, which have been linked to adverse pregnancy outcomes such as preterm birth and low birth weight. 

Black individuals are also more likely to live in poverty than white individuals and therefore experience social and economic stressors that can negatively impact maternal health, such as lack of access to healthy food, safe housing, and quality education.

Additionally, Black patients are more likely to experience racial discrimination and mistreatment from healthcare providers, which can lead to distrust of the healthcare system and reduced use of healthcare services. According to NPR, Black patients disproportionately experience instances of racial discrimination and mistreatment in healthcare contexts, including:

  • Having symptoms dismissed or disbelieved
  • Pain undertreated compared to white patients
  • Referred less frequently for specialty care compared to white patients

Given the chronic stress that racism can induce, healthcare providers must do more to treat Black individuals with dignity and respect, listening to and believing their reports of symptoms, approaching pain management and referrals equitably, and generally taking Black individuals’ health care seriously. All of these actions and attitudes can substantially improve patient outcomes in maternal health settings. 

3. Inequitable Level of Suspicion              

Black mothers are often subjected to a higher level of suspicion by healthcare providers, which can lead to delays in diagnosis and treatment and ultimately contribute to poor maternal health outcomes. This suspicion is often based on implicit biases and stereotypes that are rooted in systemic racism.

For example, healthcare providers may be more likely to assume that Black mothers are exaggerating their symptoms, seeking pain medication for drug addiction, or not following medical advice, which can lead to delays in diagnosis and treatment. Black mothers may also be subjected to unnecessary and invasive medical procedures, such as C-sections, based on healthcare providers’ biases and assumptions.

This suspicion contributes to significant disparities in maternal health outcomes between Black mothers and white mothers, including higher rates of maternal mortality and morbidity. Addressing implicit biases and structural racism in health care is essential to addressing this inequitable level of suspicion and improving maternal health outcomes for Black mothers.

This can include provider training to recognize and address implicit biases, diversifying the healthcare workforce, and improving cultural competence and communication skills.

Addressing Racism at Systemic Levels              

To address maternal health disparities, societal racism and its impact on maternal health outcomes needs to be addressed. This includes addressing structural and institutional racism in health care and society at large, increasing access to high-quality health care for Black individuals, and addressing the social determinants of health that contribute to disparities in maternal health outcomes.

The Role of Black Maternal Health Organizations

Black maternal health organizations play an important role in addressing the health disparities and equity gaps that Black mothers face. Here are some ways that these organizations are working to improve Black maternal health outcomes:

  • Advocacy: Black maternal health organizations advocate for policy changes that will improve access to quality health care for Black mothers. This includes advocating for increased funding for maternal health care, improving healthcare provider training to address implicit bias, and addressing systemic racism in health care.
  • Education: Black maternal health organizations provide education and resources to Black mothers to help them make informed decisions about their health care. This includes information on how to access quality prenatal care, how to navigate the health care system, and how to advocate for their own health needs.
  • Research: Black maternal health organizations conduct research to better understand the causes of maternal health disparities among Black mothers and identify effective interventions to address these disparities.
  • Community engagement: Black maternal health organizations engage with Black communities to build trust and promote awareness of maternal health issues. This includes partnering with community organizations and leaders, hosting events and workshops, and providing culturally competent care.
  • Support: Black maternal health organizations provide support and resources to Black mothers who are experiencing pregnancy-related complications or maternal mortality. This includes connecting mothers with healthcare providers, providing emotional support, and helping families navigate the health care system.

Black maternal health organizations are working to address the root causes of racial maternal health disparities and ensure that Black mothers have access to quality health care and the support they need to have healthy pregnancies and births.

Organizations for Black Maternal Health

Efforts to address maternal mortality among Black mothers include policy changes to increase access to quality health care, improving healthcare provider training to address implicit bias and racism, and community-based interventions such as doula care and group prenatal care.

There are several organizations in the United States that are dedicated to addressing Black maternal health and maternal mortality in the United States:

Black Mamas Matter Alliance           

Black Mamas Matter is a national organization that advocates for policy changes and provides resources to improve Black maternal health outcomes. They also host an annual conference focused on Black maternal health.

National Birth Equity Collaborative               

This organization works to reduce racial and ethnic disparities in birth outcomes, with a focus on Black mothers and families. They provide technical assistance and training to healthcare providers and advocate for policy changes to improve Black maternal health.


SisterSong is a reproductive justice organization that focuses on the health and well-being of women of color. They advocate for policies and programs that address health disparities and support Black maternal health.

National Black Doula Association               

The National Black Doula Association is an organization that trains and supports Black doulas, who provide emotional and physical support to pregnant people and their families. They also advocate for policies that promote access to doula care and improve Black maternal health outcomes.

March of Dimes             

This organization focuses on improving maternal and child health outcomes, including reducing maternal mortality rates. They work to promote equity in maternal health care and provide resources to families and healthcare providers.

Healthy Start               

This federal program works to improve maternal and child health outcomes in communities with high rates of infant mortality. They provide support to families, including prenatal and postpartum care, and work to address the social determinants of health that contribute to health disparities.

Hear Her Campaign               

Hear Her is a campaign run by the CDC designed to raise awareness of urgent warning signs during and after pregnancy. The mission of the campaign is to educate pregnant people, families, and support systems on how to detect pregnancy complications and teach the skills to raise concerns to health professionals.

These are just a few examples of organizations and campaigns working to address Black maternal health and maternal mortality. Many others, national and local, are also doing important work in this area.

Shape an Equitable Future With an Online DrPH in Leadership, Advocacy, and Equity 

Individuals who aspire to become leaders in advancing Black maternal health can prepare for high-level public health roles in government, NGOs, and maternal health advocacy groups by earning an advanced degree. 

Tulane University, the first school of public health in the U.S., offers an Online DrPH in Leadership, Advocacy, and Equity for ambitious professionals who want to enact change and build equitable communities. Students can obtain the expertise and hands-on training to embark on a career path matching their passion for public health and equity.  

Explore Tulane’s DrPH and discover how it can equip you to become an equitable leader in maternal health or another field. 

Recommended Readings

DrPH vs. PhD: What’s the Difference?

The Role of Leadership in Public Health Advocacy

Effective Leadership in Public Health: Essential Skills


American Heart Association, Why Black Women are Less Likely to Survive Pregnancy

American Journal of Public Health, “Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016-2017”

American Journal of Public Health, “Toward a New Strategic Public Health Science for Policy, Practice, Impact, and Health Equity”

Black Mamas Matter Alliance, 2023 Black Maternal Health Week

Black Mamas Matter, Issue Brief 2022: Black Maternal Health 

Centers for Disease Control and Prevention, Hear Her Campaign

Centers for Disease Control and Prevention, Maternal Mortality Rates in the United States, 2021 

Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality

JAMA Open Network, “Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study”

KFF, Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them

Black Maternal Health Week Will Be Observed April 11–17 

National Public Radio, “Trying to Avoid Racist Health Care, Black Women Seek Out Black Obstetricians 

Pew Research Center, Black Americans’ Views about Health Disparities”