Black women in the U.S. are three times more likely to die from pregnancy-related death than White women.¹ This staggering statistic highlights the urgent need to address the multifactorial causes for disparities in maternal health outcomes.

While Black women are more likely to have underlying risk factors including diabetes, hypertension and chronic kidney disease, these alone do not entirely explain the disparities, but rather reflect broader systemic issues. Social determinants of health (SDOH), such as insurance status compounded by state-to-state variation in Medicaid expansion and laws regulating reproductive health, along with poverty, housing instability, poor access to food as well as implicit bias, discrimination, structural racism and a lack of diversity in the health care workforce, all contribute to these striking, disparate outcomes.² It is crucial to recognize and address these systemic issues to ensure equitable access to quality maternal health care for all women, regardless of race or ethnicity.

Many vulnerable populations are often overlooked when discussing Black maternal health. This includes veterans, active military, persons living in rural communities or low-income neighborhoods, pregnant women with substance use or psychiatric disorders and incarcerated individuals. These vulnerable groups require particularly concerted efforts to improve their access to equitable maternal health care.³

The recent Dobbs v. Jackson Women's Health Organization Supreme Court decision threatens access to reproductive health care, particularly for Black women.⁴ This decision highlights the importance of legislative action to drive change. The Momnibus of 2021 and the Helping MOMs Act are two pieces of legislation that aim to address the maternal mortality crisis in the U.S. by addressing SDOH including insurance coverage. The Consolidated Appropriations Act of 2023 provides funding for essential programs such as rural broadband; rural housing loans and rental assistance; Women, Infants and Children (WIC); Supplemental Nutrition Assistance Program (SNAP); child nutrition programs; Centers for Disease Control and Prevention funding for safe motherhood and infant health; and the Substance Abuse Mental Health Services Administration (SAMHSA).

Despite the legislative actions that have been taken, there is still much work to be done to address the maternal mortality crisis in the U.S. A paradigm shift in the approach to maternal health care is required, ensuring all mothers have maternal health access from preconception through postpartum. New models of postpartum care are needed to ensure that Black women receive the care they need beyond the delivery period, which is often a time of increased risk of morbidity and mortality. This will also serve as a window of opportunity for risk assessment to prevent future cardiovascular disease. These changes will require a transformation in provider payment systems with incentivization of quality and equitable care as well as promotion of value-based care.⁵

It is also essential to recognize the diversity of Black women when proposing solutions and tailoring health care to meet their unique needs. Education and awareness are critical components of addressing the maternal mortality crisis. Health care providers and policymakers must be educated on implicit bias, basic cardio-obstetric care, and inclusive representation within the health care workforce and research.⁶

Addressing the disparities in maternal health outcomes for Black women in the U.S. requires a comprehensive approach that takes into account the complex interplay of SDOH, implicit bias, discrimination and structural racism. By recognizing and addressing these systemic issues, we can work towards ensuring equitable access to quality maternal health care for all women, regardless of their race or ethnicity, including vulnerable populations.

Black Maternal Health Week is an opportunity to raise awareness about the alarming disparities in maternal mortality rates among Black women in the U.S., and amplify efforts for research, policy changes and solutions to advance health equity.

References

1. CDC. Pregnancy Mortality Surveillance System. Maternal and Infant Health. Accessed April 1, 2023. Available here.
2. Lindley KJ, Aggarwal NR, Briller JE, et al. Socioeconomic determinants of health and cardiovascular outcomes in women. J Am Coll Cardiol 2021;78:1919-29.
3. Bond RM, Gaither K, Nasser SA, et al. Working agenda for Black mothers. Circ Cardiovasc Qual Outcomes 2021;14:e007643-e007643.
4. Ramirez VN, Ferraro-Borgida M, Lindsay S. Antiabortion laws and implications for patients with cardiovascular disease in pregnancy. JAMA Cardiol 2022;7:781-2.
5. Mehta LS, Sharma G, Creanga AA, et al. Call to action: Maternal health and saving mothers: A policy statement from the American Heart Association. Circulation 2021;144:e251–69.
6. Ogunniyi MO, Mahmoud Z, Commodore-Mensah Y, et al. Eliminating disparities in cardiovascular disease for Black women JACC review topic of the week. J Am Coll Cardiol 2022;80:1762-71.