August 4, 2023 • By Mayo Clinic Press Editors
There’s a maternal mortality crisis in the U.S. Each year, tens of thousands of American women experience life-threatening pregnancy and postpartum complications. Between 2000 and 2020, the rate of U.S. maternal deaths skyrocketed by 78%.
While there are differences in the official definitions of terms like maternal and pregnancy-related mortality, generally speaking, when a mother dies due to a pregnancy-related complication during or after her pregnancy, this is referred to as maternal mortality.
While maternal mortality affects all kinds of women, non-Hispanic Black women are most at risk. The rise in maternal deaths of Black mothers is a significant factor in this escalating crisis. Even healthy women — such as decorated U.S. Olympic sprinter Tori Bowie — can die from complications of childbirth.
According to Mayo Clinic’s Demilade Adedinsewo, M.B., Ch.B., M.P.H., the Black maternal mortality rate has caught the attention of people in positions of power who have committed to addressing the issue.
“[The maternal mortality rate] has raised concerns in the health care community, government agencies, academic institutions, health care organizations and funding agencies,” she says.
Maternal mortality rates: Black vs. white in the U.S.
Based on most recent estimates, non-Hispanic Black women are 2.6 times more likely to die from pregnancy-related complications than white women. For Black women 25 and older, pregnancy-related mortality is about four times higher than it is for white women of similar ages, according to data from 2007 to 2016.
The maternal mortality rate for Black mothers doesn’t improve with socioeconomic status or educational level. For example, data from 2007 to 2016 show that among women with a college degree or higher, the pregnancy-related mortality ratio was five times higher for Black mothers compared with white mothers.
Black maternal mortality by state
There are several reasons maternal mortality varies in different states or regions. For example:
- Guidelines for caring for expectant mothers vary between states and often reflect social and political factors in each state.
- Mothers in rural areas are almost twice as likely as mothers in urban areas to experience maternal mortality, so states with larger rural populations are often at risk.
- States with higher percentages of at-risk populations, such as Black mothers, may have higher mortality rates.
Because several states do not report Black maternal mortality rates, it’s difficult to compare states accurately. However, the CDC does publish maternal mortality rates for all mothers. According to the latest numbers, Arkansas, Mississippi, Tennessee, Alabama and Louisiana are the states with the highest maternal mortality rates.
Like Black mothers, Native American and Alaska Native mothers have a historically higher risk of maternal mortality. As of 2019, their pregnancy-related mortality rate was about twice as high as white mothers.
Why are Black maternal mortality rates high?
When asked why Black maternal mortality rates are so high, Dr. Adedinsewo says, “There is no known singular reason to explain it. Multiple factors are believed to contribute to racial disparities in maternal mortality.”
“(These include) access to quality and affordable health care, limited postpartum care that typically ends at six weeks following delivery, delayed recognition of risk and complications, systemic discrimination, and implicit bias,” she says.
Several health conditions that disproportionately affect Black mothers may contribute to their maternal mortality risk, including:
- Chronic heart disease.
- Hypertension.
- Obesity.
- Diabetes.
Societal stress, insurance status, unhealthy eating, lack of physical activity and limited access to prenatal education also may contribute to the crisis.
How to reduce Black maternal mortality rates
Dr. Adedinsewo suggests four ways to help prevent pregnancy-related complications and deaths of Black mothers:
- Family and friends need to support and advocate for women who are pregnant or recently postpartum. Listen to their concerns and encourage them to seek medical help.
- Pregnant and postpartum women need to be aware of potential risks during pregnancy and after delivery. For example, it’s important that they watch for urgent maternal warning signs and seek medical help without delay when signs appear.
- Health care professionals need to listen to patients’ concerns and educate patients regarding warning signs and their individual risk.
- Health researchers need to investigate maternal health topics to learn more about risk factors and potential interventions to reduce maternal mortality. This research is especially important given that women — particularly pregnant women — are often excluded from clinical research studies.
What is the U.S. health care system doing to decrease Black maternal mortality rates?
There are many initiatives in the government and health care organizations targeted at bringing Black maternal mortality rates down.
Dr. Adedinsewo points out several areas of progress, including:
- The Black Maternal Momnibus Act of 2021, introduced by Congress to address the maternal health crisis in the country. It includes 13 separate actions to help Black mothers, from housing and transportation programs to digital tools that improve health outcomes in underserved areas. As of 2023, the legislation is still working its way through Congress.
- At least 30 states have expanded Medicaid postpartum care coverage to address maternal mortality and ensure access to care after the traditional six-week postpartum visit.
- Ongoing research studies supported by organizations such as the American Heart Association (AHA) and the National Institutes of Health (NIH).
Health care organizations also are making positive changes. For example, Black communities have a long tradition of midwives. Incorporating doulas and midwives during care can help mothers navigate the health care system, lessen the discrimination in the health care system and connect families to social services.[3] Additionally,many hospitals, health care organizations and medical schools are implementing implicit bias training programs to promote culturally sensitive care.
What are some resources Black mothers can turn to for maternal health?
“The CDC Hear Her campaign has a lot of useful information for Black mothers,” says Dr. Adedinsewo.
She adds that the “Hear Her” website also includes information on warning signs and specific conditions that occur during pregnancy, other organizations focused specifically on Black maternal health, and a variety of other resources.
Dr. Adedinsewo also recommends these resources for Black mothers:
- We Are the Faces of Black Maternal Health
- Black Mamas Matter Alliance (BMMA)
- National Birth Equity Collaborative
- Preeclampsia.org
- Peripartum Cardiomyopathy Registry
- Let’s talk PPCM (Peripartum Cardiomyopathy)
Article Link: Why are Black maternal mortality rates so high? – Mayo Clinic Press