The United States has the highest maternal mortality rate in the wealthy world. Maternal health in BIPOC groups is even worse, with Black people bearing a disproportionate share of maternal deaths. This is due to a number of factors, including racism in healthcare, barriers to quality healthcare, health disparities, and a lack of inclusion of BIPOC groups in medical research.
In 2017, 55 other countries had lower maternal mortality rates than the U.S., which had a high maternal death rate of 19 deaths per 100,000 live births. This is significantly higher among BIPOC groups due to a number of healthcare inequities and disparities.
Advocacy, policy change, and addressing racism can all improve maternal health in BIPOC groups.
This article will explain the statistics that demonstrate the poor maternal mortality rate in the U.S. and explain why the situation is even worse for BIPOC groups. It will also list some ways that individuals and the community can work to overcome these inequities.
The U.S. faces a maternal mortality crisis across all demographic groups, especially in comparison with other wealthy nations. For example, Poland, Norway, Italy, and Belarus have reduced maternal mortality to 2 deaths per 100,000 births. The U.S. maternal mortality rate is almost 10 times this figure.
According to the Centers for Disease Control and Prevention (CDC),
This crisis disproportionately affects BIPOC individuals. A combination of racism, lack of access to quality care, and co-existing health issues play a role in this disparity.
Black, American Indian, and Alaska Native (AI/AN) people over the age of 30 years have maternal death rates
Individual factors such as education do not reduce this disparity. Pregnancy-related deaths in 2016 were 5.2 times higher among Black, college-educated people than their white counterparts.
The national maternal mortality rate does not reveal the full picture of BIPOC maternal mortality. In some states, maternal mortality is significantly higher. Georgia, a state with one of the worst maternal mortality rates, had a statewide death rate of 66.3 per 100,000 in 2013–2017. For Black people, the figure was 95.6 per 100,000.
Research consistently shows that BIPOC individuals, especially Black people, face a pattern of racist discrimination in healthcare. This affects all areas of healthcare, including maternal care.
Research has also demonstrated a link between exposure to racism outside of the healthcare system and negative birth outcomes. For example, a
Although poverty rates are falling, most BIPOC groups — including Black and Latin groups — are still more likely than white people to live in poverty. This may limit their ability to pay for and access medical care.
Data from 2019 show that 17.4% of Black or African American families were living under the poverty line at that time. Just 5.5% of non-Hispanic white families were in the same situation.
Pregnant people who worry about their ability to pay for care or transport to facilities may have to delay prenatal care or avoid going to the emergency room until an emergency becomes a crisis.
Well into the 1950s, some state medical societies refused admission to Black candidates. Well into the 20th century, it was commonplace to deny admission to Black students.
Formal educational discrimination did not become illegal until 1964, and the U.S. federal government did not fully ban segregation until 1974. This means that some Black people who would otherwise have provided quality care to Black patients never got the opportunity to practice.
BIPOC medical students continue to report experiencing racism and discrimination. This may affect their performance and may even limit the number of practicing BIPOC doctors.
According to the National Institutes of Health (NIH), BIPOC individuals make up under 10% of participants in medical trials.
Around 67% of the U.S. population is white, but white people make up 83% of research participants, according to the Food and Drug Administration (FDA). Black American people constitute 13.4% of the U.S. population, but just 5% of study participants are Black. Hispanic and Latin American people make up 18.1% of the U.S. population, but under 1% of trial participants are Hispanic or Latin.
If studies do not reflect the general population, it means that the results of general medical research may not apply to everyone. For example, a
Researchers and practitioners alike should also take into account the socioeconomic and discriminatory barriers that play key roles in a person’s maternal health for a more accurate diagnosis and treatment plan.
Learn more about the importance of social determinants of health here.
Black American people face a number of health disparities, with higher rates of chronic and progressive conditions, such as high blood pressure and diabetes. These conditions can complicate pregnancies, increasing the risk of negative outcomes.
Many factors contribute to these health disparities, including discrimination in healthcare, the physiological stress of racism, and a lack of access to quality medical care.
Learn why diabetes rates are higher among African American people here.
High profile stories of BIPOC people who die during childbirth often feature stories of treatment delays. For example, Kira Johnson bled to death internally following a cesarean delivery. Her husband, Charles Johnson, says that hospital staff asserted she was “not a priority” as she begged for treatment.
Education and advocacy are also not enough to save BIPOC people’s lives. Shalon Irving, an epidemiologist and expert on maternal mortality, died in spite of her knowledge, education, and advocacy.
A report from various Maternal Mortality Review Committees showed that provider and system of care factors comprise the biggest share of the blame for patient deaths, jointly accounting for 56.5% of deaths.
For example, in postpartum hemorrhage cases, providers’ failure to properly assess their patients was a leading factor in deaths. Issues with personnel and policies and procedures at the institutional level were also major contributing factors.
These data suggest that individual factors cannot account for all deaths, and a person cannot always advocate their way into better care. Change at the institutional and provider level is critical, as people cannot diagnose or treat themselves.
That said, there are some steps that individuals can take to protect themselves against inequities in maternal care. As mentioned above, however, the biggest changes must come from higher level policies.
BIPOC people can try the following strategies to give themselves the best chance at receiving quality maternal treatment:
- Choose a culturally sensitive doctor: A 2018 study involved Black men seeing Black or non-Black medical professionals. It found that they were more likely to get preventive care and aggressive treatment with Black doctors. A similar phenomenon may hold true for Black women.
- Learn as much as possible: A person can educate themselves about the warning signs of conditions such as hemorrhage and preeclampsia.
- Seek a second opinion: If a person feels that their doctor is ignoring their needs, they may wish to consider seeking a second opinion, going to another hospital, or demanding to see a different doctor.
- Seek early and ongoing prenatal and postpartum care: If financial barriers make accessing care difficult, pregnant people may wish to consider looking into Medicaid.
- Keep a note of everything: Ask doctors to document everything, especially if they dismiss symptoms or deny treatment.
- Record appointments: Ask a doctor about recording office visits. This creates a record of each visit and can promote accountability.
Learn more about what to expect during pregnancy here.
At the institutional level, implementing strategies to combat implicit bias and treatment delays may be helpful. Policies that improve access to care may also help. Those include:
- Expanding Medicaid access: A
2020 studyfound that states that expanded Medicaid had lower maternal mortality rates by an average of 7 deaths per 100,000 births. This may be because Medicaid expansion makes it easier for people from low income households to access quality care.
- Implementing AIM Bundles: AIM Bundles from the Alliance for Innovation on Maternal Health provide clear guidance for dealing with certain maternal health emergencies. These bundles have helped lower maternal mortality in states that implement them.
- Providing more diverse care options: Health systems that recruit and retain doctors of diverse backgrounds may be better equipped to provide patients with professionals who understand their experiences and culture and take their concerns seriously.
- Establishing formal care guidelines: When doctors must follow specific guidelines for all patients, subjective decision making and the bias it often involves are less likely to affect medical care.
- Offering implicit bias training: Implicit bias training may help doctors and other healthcare professionals become more aware of, and then correct, their own hidden biases. However, research into implicit bias training is mixed, and it is not a panacea for racism and sexism in healthcare.
Learn more about health inequity and how to overcome it here.
BIPOC maternal mortality is a serious health crisis. An additional
Although individuals can take some steps to advocate for themselves, it is even more important to find a culturally sensitive doctor and a birthing location with a history of good outcomes for historically marginalized groups.
There are many policies that healthcare systems can implement to help reduce maternal mortality rates among BIPOC groups.