The Risks of Being Pregnant While Black

Many people may be shocked to learn that the United States has the highest maternal mortality rate in the developed world - a rate that is actually on the rise, driven primarily by mortality in minority women.  According to the Centers for Disease Control and Prevention (CDC), black women are 3-4 times more likely than white women to die from complications during pregnancy and childbirth: 43.5 deaths per 100,000 live births for black women compared to 12.7 deaths per 100,000 live births for white women.   And for every death, more than 100 women experience potentially life-threatening conditions like hemorrhage, pre-eclampsia, venous thromboembolic events and cardiomyopathy.  The question is why. The answer is at once complicated yet distressingly simple – racism. 

Previous research on racial and ethnic disparities in obstetrics focused on social and biologic/genetic factors and did not examine quality of care.  However, according to a more recent study examining severe maternal morbidity during childbirth in the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for 2010-2011*, it appears that racial differences in the site of care and delivery contribute to these disparities.  Strikingly, approximately 75% of black women receive care in 25% of all hospitals that provide lower quality of care.  These high and medium black serving hospitals are predominantly urban teaching hospitals in the South with high delivery volumes and higher proportions of Medicaid patients.  Women (of all races) who delivered in these hospitals had higher rates of severe morbidity compared to low black-serving hospitals, but black women had the highest rates. 

The Black Mammas Matter Alliance (BMMA) has called attention to racism in healthcare, including the experience of celebrities like Serena Williams whose complaints of shortness of breath post-delivery were initially dismissed.  She was subsequently diagnosed with pulmonary emboli.  Many African American women have experienced similar disrespect, bias and discrimination.  The time for action is now.  The only way health outcomes in our country will improve is for racism in health care to be recognized and rectified. 

* Howell et al.  Black-white differences in severe maternal morbidity and site of care.  Am J Obstet  Gynecol 2016; 214: 122.e1-7.

Judith Wolf, MD                              Associate Director, WHEP