Addressing Racial Disparity in Maternal Health
Marcy A. Metzgar
One of the key challenges in addressing maternal mortality is the racial disparity that exists. Black women are three times more likely to die from a pregnancy-related cause than White women.1 While maternal mortality rates dropped remarkably for White and Hispanic women in 2023, Black women saw markedly higher rates at 50.3 deaths per 100,000 live births compared to 14.5 for White women, 12.4 for Hispanic women, and 10.7 for Asian women.2 In fact, women in the United States are 50 percent more likely to die in childbirth than their own mothers.3
Some of the most common causes of pregnancy-related deaths in Black women are cardiomyopathy, cardiovascular conditions, preeclampsia and eclampsia, hemorrhage, and thromboembolism.4 Healthcare providers should help their Black patients manage chronic conditions that may occur during their pregnancy, including hypertension, diabetes, or depression, and they should advise their patients about how to recognize and get immediate treatment when experiencing critical maternal warning signs.5
Factors that contribute to the racial disparity in maternal health include unconscious biases — both institutional and structural racism — unequal access to care, and lack of insurance.6 Variation in quality healthcare and underlying chronic conditions for black women also can add to the racial disparity.7
Efforts to address the racial disparity may include the following:
- Promote understanding among patient, family, and community resources in order to improve communication.
- Reduce risk factors for Black women.
- Advance the understanding of the experience of Black women.
- Increase protective factors, such as the support women receive before, during, and after pregnancy.
- Adopt evidence-based methods to decrease complications.
- Improve assessment for and treatment of preexisting health conditions and high-risk pregnancies.
Determining and comprehending the root of these disparities is key to improving efforts to reduce them.8 Factors that can be modified at the clinician and healthcare institutional level are contained in The Council on Patient Safety in Women’s Health Care’s consensus statement and safety bundle, Reduction of Peripartum Racial and Ethnic Disparities. Other perspectives include the American Society of Anesthesiologists’ Statement on Reducing Maternal Peripartum Racial and Ethnic Disparities in Anesthesia Care.
Group advocacy efforts to reduce racial disparity include actions undertaken by key national and local community stakeholders, such as the Black Mamas Matter Alliance and the Black Women Birthing Justice. These organizations have developed comprehensive analyses and policy recommendations that address the long-term efforts to combat racial bias and discrimination in maternal health.
To support states in preventing pregnancy-related deaths, the Centers for Disease Control and Prevention (CDC) promotes the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program, perinatal quality collaboratives, the CDC Levels of Care Assessment Tool, and the HEAR HER campaign.
Endnotes
1 Centers for Disease Control and Prevention. (2024, April 8). Women’s health: Working together to reduce black maternal mortality. Retrieved from www.cdc.gov/womens-health/features/maternal-mortality.html
2 Hoyert, D. L. (2025, February 5). Maternal mortality rates in the United States, 2023. National Center for Health Statistics Health e-stats. Retrieved from https://stacks.cdc.gov/view/cdc/174577
3 Institute for Healthcare Improvement. (2019, March 14). Behind the headlines about maternal mortality. Retrieved from www.ihi.org/insights/behind-headlines-about-maternal-mortality
4 American Society of Anesthesiologists. (2021, October 13). Statement on reducing maternal peripartum racial and ethnic disparities in anesthesia care. Retrieved from www.asahq.org/standards-and-practice-parameters/statement-on-reducing-maternal-peripartum-racial-and-ethnic-disparities-in-anesthesia-care
5 Centers for Disease Control and Prevention, Women’s health: Working together to reduce black maternal mortality
6 Saluja, B., & Bryant, Z. (2021). How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. Journal of Women’s Health, 30(2), 270–273. doi: https://doi.org/10.1089/jwh.2020.8874; Radley, D. C., Shah, A., Collins, S. R., Powe, N. R., & Zephyrin, L. C. (2024, April 18). Advanced racial equity in U.S. health care: The Commonwealth Fund 2024 State Health Disparities Report. The Commonwealth Fund. Retrieved from www.commonwealthfund.org/publications/fund-reports/2024/apr/advancing-racial-equity-us-health-care
7 Centers for Disease Control and Prevention, Women’s health: Working together to reduce black maternal mortality.
8 American Society of Anesthesiologists, Statement on reducing maternal peripartum racial and ethnic disparities in anesthesia care.
