Black maternal mortality: a human rights crisis

America’s Black maternal mortality crisis is just one chapter of the long, complex history of abuse, neglect, and control of Black women’s bodies. According to the CDC, Black women in the United States are roughly three times more likely to die in childbirth than white women. A Commonwealth Fund study ranked the United States last among all developed countries in its ability to provide quality maternity care, with a relative undersupply of providers and lack of postnatal support. When looking only at the experiences of Black women, we see that they face a risk of pregnancy and childbirth-related death comparable to that of women living in countries with far less developed healthcare systems, such as Malaysia and Mexico (Figure 1).

Figure 1. Mortality Gap for U.S. Moms (Harvard T.H. Chan School of Public Health)

Racial disparities in maternal mortality fail to mirror trends seen in other health outcomes, where socioeconomic status and education serve as predictors of health outcomes. For instance, a longitudinal study conducted by the NYC Department of Health and Mental Hygiene showed that college-educated Black mothers were more likely to experience serious complications in pregnancy and childbirth than women of other racial backgrounds who had less than a high school education. Even mega-celebrities such as Beyoncé and Serena Williams have suffered near-fatal pregnancy complications. Williams specifically has been very vocal about her experience, citing in an interview with the Washington Post how “she was not taken seriously” when she alerted the hospital staff to her embolism.

The examples of Williams and Beyoncé highlight the fact that it is not race, or education, or socio-economic status that drives disparities in maternal mortality, it is racism.

In the past few years, there has been growing attention to interpersonal and structural racism as a public health threat. As a student with aspirations to combine policy and clinical practice to address health disparities, I am struck by how Black maternal mortality presents the perfect example of how systematic racial bias and discrimination directly lead to differential patient experiences and outcomes. Acknowledging and owning the role of racism is crucial to ending the pattern of disregard for Black women’s pain and devaluation of their humanity.

One of the most promising interventions to date is right here in San Francisco. SB 65, the California Momnibus Act, was put forth in October of 2021by Senator Nancy Skinner with support from various maternal health and racial justice groups. The bill presents a comprehensive approach that offers Medi-Cal coverage for doulas, reduces barriers to midwife training, and establishes a maternal mortality board to improve research and data collection with specific attention to the role of racial and socioeconomic factors. This is a bold example of systematic reform, critically acknowledging the structural violence in the health care system and stepping up to propose a multi-faceted solution.

The Momnibus Act strengthens data collection efforts, expanding the power of the Maternal Mortality Review Committee to investigate the role of socioeconomic and racial disparities in maternal deaths and offer recommendations. It also expands maternal care and support networks through pregnancy, birth, and postpartum by extending Medi-Cal coverage to 12 months postpartum and including coverage for doulas—specialized birth attendants who provide physical and emotional support to mothers and have been shown to improve maternal and infant health outcomes. Finally, the bill recognizes the inherent association between health and wealth and proposes a minimum income pilot to help low-income families meet the demands of parenthood.

Structural racism and weak peri and postnatal care systems endanger the lives of Black women in America. As we move forward, policymakers, healthcare providers, and scholars alike should learn from the Momnibus Act, and invest in comprehensive solutions to protect and promote every woman’s right to become a mother with joy and dignity, rather than fear.