Maternal mortality and morbidity in the U.S.

This blogpost is part of a mini-series on maternal wellness in the U.S. As part of this project, we are proud to be working in collaboration with Noula, experts on all things maternal health.

Compared to the rest of the developed world, maternal care in the U.S. is lagging far behind. When you take a closer look at maternal mortality and morbidity rates within the country, the picture only gets uglier.

First off, data collection on maternal deaths in the U.S. has been unreliable and underfunded. The federal government stopped publishing official maternal mortality numbers in 2007 due to inconsistencies in how states were reporting maternal deaths. It took another 11 years for the U.S. to publish new data and produce an updated maternal mortality rate. The 2018 report showed there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries

The rate itself isn’t the only problem; there are stark racial disparities across mortality and morbidity. According to the CDC, Black women in the U.S. are three to four times more likely to die from pregnancy-related causes than white women, one of the widest of all racial disparities in women's health. To put this into perspective: a Black woman is 22% more likely to die from heart disease than a white woman, 71% more likely to die from cervical cancer, but 243% more likely to die from pregnancy or childbirth-related causes. This racial disparity in maternal health has existed for decades and has been acknowledged frequently as of late, but effective changes aren’t being made.

America’s staggering Black maternal mortality rate is attributed to a variety of factors. While some of it can be explained by poverty and inadequate access to healthcare, it’s been proven that systematic racism and discrimiation are largely to blame. Studies show that even when controlling for factors such as education, age, health and socioeconomic status, Black women are still more at risk than white women when it comes to maternal mortality. Black mothers receive poorer quality of care due to racial bias in how medical professionals assess pain for Black patients. On top of that, having to deal with the constant stress of racism, also known as a biological process called “weathering”, Black mothers have to deal with extra stressors from which white women are exempt. 

As mentioned, college education also does not protect Black women. While higher education reduces the risk of death among infants born to white mothers by 20%, education as a ‘protective factor’ has zero effect for Black mothers. As it happens, the infant mortality rate for Black mothers is consistently higher than white mothers at every educational level.  A 2016 analysis found that Black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications than white women who never graduated from high school. This escalates for Black women with even higher academic qualifications. Faced with increased discrimination and stress as they attain higher levels of education, Black mothers with an advanced degree are at most risk of losing their infant. 

Clearly, education is not the great equalizer.

Even fame and power can’t pay for adequate maternal care in the U.S. In a 2018 story for Vogue, tennis superstar Serena Williams opened up about the birth story of her daughter where she almost died after giving birth. Beyonce also shared a similar story. Both experienced life-threatening pregnancy complications, just like thousands of other black mothers. The fact that two extremely famous, wealthy and powerful Black women like Beyonce and Serena Williams can’t get the care they need is a sad commentary on the state of the US healthcare system and its prejudices.

Black women deserve to have safe and healthy pregnancies and childbirth. To meaningfully improve Black maternal health outcomes, we need systemic change that starts with the health care system, improves access to care and makes the places Black women live and work healthier, more fair and more responsive to their needs. Only when we do that will Black women be able to achieve their optimal health and well-being throughout their lifespan, including if they choose to become parents.