Black women in the United States have historically had higher maternal mortality rates than non-Black women. This disparity has been attributed to Black women having fewer healthcare resources, lower quality of care, and underlying chronic health conditions such as hypertension, obesity, and diabetes.
In 2023, Black women's maternal death rate was slightly greater than 50 per 100,000, which is roughly 4.5 times higher than the rate for Asian women, who had the lowest maternal mortality rates in America.
Recent studies indicate that more than 80% of these maternal deaths are preventable, reflecting systemic issues in the US healthcare system, including Black women's limited access to healthcare, implicit bias within the medical field, socioeconomic status, and the impact of structural racism – all of which are social determinants of health in the United States.
Solutions proposed by policymakers include implicit bias training for healthcare providers, expanded Medicaid coverage for maternal care, and community-based support initiatives that prioritize Black maternal health. Additional steps include enhancing patient-provider communication, providing comprehensive postpartum care, and supporting midwifery and doula care, particularly in underprivileged communities.
Maternal mortality Maternal mortality is defined as a death occurring either during or within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy or its management.
Maternal death is often linked to both direct obstetric complications (such as hemorrhage or eclampsia) and indirect obstetric deaths that exacerbate pre-existing health conditions. In 2021, over 1,200 women died from pregnancy-related complications within the United States, with Black women facing a mortality rate nearly three times more than the rate for White women.
Historical context
Historical abuses in maternal care of enslaved Black women Historically, care for Black mothers was influenced by economic motives; laws and practices from chattel slavery placed profit over human dignity. In 1662, legislators in the Virginia Colony passed Partus Sequitur Ventrem which ruled that children born from enslaved people would be enslaved themselves. This created the commodification of Black offspring and made Black women more profitable, increasing the slave owners' wealth without additional cost. Systemic and institutional decisions prioritized economic means over ethical treatment of Black women. The lack of care given to women shows that their medical care was not dictated by need, but rather the economic motive to keep them alive to birth more profit.
When Britain and the United States banned the Transatlantic Slave Trade in 1807–1808, slave owners placed more value on women. White physicians were called upon to examine infertility and to investigate infant mortality. Adopting more formal medical interventions allowed the slave owners to increase power over the reproductive rights of enslaved women. However, without proper knowledge, these White physicians could not adequately care for their patients and often tortured their patients due to lack of anesthesia. Systemic neglect and abuse caused Black mothers to suffer under the guise of medical supervision.
Exploitation of Black women in gynecological research Increased oversight by White physicians led to the abuse of Black mothers as these doctors sought to advance scientific knowledge and enhance their reputations during the Antebellum period. Nathan Bozeman was a surgeon gaining popularity in Alabama for his work repairing vesicovaginal fistulas. His initial patients were enslaved women who were operated on often without anesthesia, but rather morphine to help subdue them. The work of Dr. Bozeman and other physicians, such as Dr. John Marion Sims, led to a morphine addiction in many enslaved woman due to its overuse. One particular patient of Bozeman, a young woman named Kitty, was bed ridden for two months prior to her operation. She was further found to be infertile and permanently disabled due to the procedure.
The dehumanization of Black enslaved individuals has continued post enslavement. It developed into the myth that Black people were pain-resistant compared to White people – a belief upheld by Dr. Sims who described the enslaved women he abused as "stoic" and "resistant to pain". This historic mistreatment and denial of basic rights of Black women by physicians has caused disparities in Black maternal health care and trust in the medical system among the Black community. Historically, racist myths and abuse against Black women has resulted in, "implicit bias on behalf of healthcare professionals, racial and socioeconomic disparities regarding access to care, and an absence of treatment that is culturally competent".
Distrust of health institutions The historical context of institutionalized racism in the United States has had the effect of Black people having to deal with medical and scientific racism. This has made the Black community less likely to trust medical institutions and professionals due to previous exploitation and abuse. Institutionalized racism is defined as policies and practices that exist across an entire society or organization and result in and support a continued unfair advantage for some people and unfair or harmful treatment of others based on race. For many years, African Americans in medicine and healthcare have faced racial injustices. Understanding what factors contribute to the racial disparity in maternal health outcomes is critical because it can illuminate where and how to address such a complex issue and focus the scope of public health prevention programs. An article in the American Journal of Public Health describes that laws making enslavement an inheritable status increased the scrutiny of Black women and forced them into bearing children for the economic gain of their enslavers. In addition, many medical and surgical techniques were developed by exploiting the bodies of enslaved Black women. Another article written by the Association of American Medical Colleges describes how Black pain is typically written off and ignored due to medical myths. For example, "Black people's nerve endings are less sensitive than White people's" or "Black people's skin is thicker than White people's", leading to a lack of treatment and diagnosis for severe illnesses are some false sentiments that are purported.
Further exacerbating this mistrust in the ongoing lack of representation and culturally competent care within the healthcare system. Black patients frequently report feeling alienated or ignored when interacting with predominantly White medical staff who may lack the cultural context necessary to understand their concerns fully. Black women are often less likely to receive adequate explanations or follow-up care for symptoms, a trend liked to implicit biases within medical settings. For instance, Black women suffering from severe pregnancy-related complications such as preeclampsia are frequently dismissed or not taken seriously, resulting in higher rates of mortality.
The Tuskegee Syphilis Study occurred from 1932 until 1972, where 600 economically disadvantaged African American men were unknowingly used by researchers to track the progression of syphilis. It resulted in subjects going blind, insane, or experiencing other severe health problems. This event served as evidence to the Black community that the medical community was untrustworthy.
An additional example of Black bodies being exploited is Henrietta Lacks, a Black woman who had samples taken of her cancerous cells without her knowledge. This tissue was given to researcher George Gey. It was found that Lacks' cells have a remarkable capability to survive and reproduce. For years after her death, scientists continued to use her cells, released her name, and released medical records to the media without her family's consent. The battle of Henrietta's bodily rights is not over yet though. On October 4, 2021, the Lacks' estate announced that they will be suing the biotechnology company named Thermo Fisher Scientific Inc., who says they have the intellectual rights of the HeLa cells. Lawyers for Henrietta's surviving family say the biotechnology company has continued to profit off the cells well after the origins of the HeLa cell line became well known. "The exploitation of Henrietta Lacks represents the unfortunately common struggle experienced by Black people throughout history," the suit says. This enduring legacy of mistrust has carried into modern times, leaving Black women with ongoing skepticism toward their medical providers.
Policy and healthcare system failures impacting Black maternal health
Despite awareness of racial disparities in maternal health outcomes, recent policy and healthcare systems have hindered efforts to reduce Black maternal mortality. Many healthcare policies fail to address the unique challenges Black women face. For example, Medicaid, which funds 42% of births in the United States, often limits postpartum coverage to just 60 days in many states. This cutoff affects all mothers relying on Medicaid, but it disproportionately impacts Black women, who are more likely to depend on Medicaid due to socioeconomic disparities often resulting from systemic biases and historical oppressions such as redlining. Research shows that a significant number of pregnancy-related deaths occur up to a year after childbirth, with Black mothers facing higher rates of postpartum complications. Efforts to extend Medicaid coverage have been met with resistance or have only been adopted in some states, leading to inconsistent support that disproportionately affects Black mothers in low-income communities.
Medicaid's postpartum coverage limitations are harmful given the elevated health risks Black women face in the months following childbirth. Conditions such as postpartum depression, hypertension, and infections often require medical attention beyond the 60-day coverage period. Without consistent postpartum care, Black mothers are at risk for life-threatening complications. Efforts to extend Medicaid coverage have been met with varying levels of resistance, with some state opting out entirely, which leaves Black mothers without the necessary resources to manage postpartum health challenges.
Moreover, implicit biases training programs for healthcare providers have mixed results. Though training is designed to reduce racial bias in patient interactions, studies indicate that one-time training sessions may not effectively change deep-rooted biases. A study from the Journal of Racial and Ethnic Health Disparities found that implicit bias training alone does not significantly reduce instances of discriminatory practices unless followed by continued education and institutional accountability measures.
Legislation such as the Black Maternal Health Momnibus Act in 2021 aimed to address these systemic issues by proposing measures to improve data collection on maternal mortality, fund community-based maternal health programs, and increase access to mental health resources for Black mothers. However, much of the act remains stalled in Congress, highlighting the political barriers to implementing changes that could improve Black maternal health outcomes. Federal mandates to improve maternal healthcare are essential for closing these gaps, yet state-level inconsistencies continue to create disparities in care accessibility. While some states have adopted components of the Momnibus Act, lack of national enforcement results in uneven access to maternal health services, affecting mothers in underrepresented areas.
Causes
Access to maternal care