Black Mothers: A Crisis in Care
By Darius Spearman (africanelements)
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The Stark Reality of Maternal Mortality
The United States, despite its advanced medical technology and considerable wealth, faces a troubling reality: it has the highest maternal mortality rate among developed countries. This crisis disproportionately affects Black women. In 2022, Black women experienced a maternal mortality rate of 49.5 deaths per 100,000 live births. This rate saw a slight increase to 50.3 in 2023 (newamerica.org). To put this into perspective, this rate is nearly three times higher than that for white women, which stood at 14.5 deaths per 100,000 live births (newamerica.org). The Centers for Disease Control and Prevention (CDC) has revealed that over 80% of maternal deaths in the U.S. are preventable (tcf.org). This alarming statistic points to deep systemic failures within the healthcare system.
The term “maternal mortality rate” refers to the number of maternal deaths per 100,000 live births. It is a critical metric for understanding the health and well-being of mothers. The persistent disparity between Black and white women highlights a profound issue that demands immediate attention. Furthermore, while the rates for White non-Hispanic and Hispanic women declined in 2023, the slight increase for Black non-Hispanic women underscores the ongoing challenges faced by this community. This disparity is not just a statistic; it represents countless lives lost and families devastated.
Understanding Systemic Failures in Healthcare
Systemic failures in healthcare: These refer to breakdowns in the healthcare system that prevent patients from receiving appropriate and timely care. This can include issues with access to services, quality of care, implicit bias among providers, and inadequate policies. These failures contribute to preventable maternal deaths.
Medical Bias and Systemic Racism
Medical bias and systemic racism are significant factors contributing to the Black maternal health crisis. Black women's voices and concerns are often dismissed or ignored by medical professionals (tcf.org). This leads to delayed diagnoses, the dismissal of symptoms, and less effective pain management (tcf.org). These issues compound the dangers of pregnancy-related complications for Black mothers. Even when Black women receive proper healthcare, they are almost 25% more likely than white women to undergo unnecessary C-sections. This increases their risks of surgical complications such as severe bleeding and hemorrhaging.
Systemic racism in healthcare manifests through policies and practices that disadvantage certain racial groups. It is not merely individual prejudice but rather embedded within the structures of the healthcare system. Implicit bias, for example, refers to unconscious attitudes or stereotypes that affect our understanding, actions, and decisions. In healthcare, this can lead to differential treatment based on race, even without conscious intent. Addressing these biases requires comprehensive training and policy changes within medical institutions.
Understanding Unnecessary C-sections
Unnecessary C-sections: This refers to Cesarean sections performed without a clear medical indication, meaning a vaginal birth would have been safe and appropriate. While C-sections can be life-saving, unnecessary procedures carry increased risks of surgical complications, longer recovery times, and potential complications for future pregnancies. The higher rate among Black women points to potential biases in medical decision-making.
Geographic Disparities in Care
Geographic location and access to care significantly worsen maternal health disparities for Black women. More than a third of U.S. counties lack obstetric services or maternity clinics. These areas are often referred to as “obstetric care deserts.” These deserts disproportionately affect rural and low-income areas, where Black and Indigenous mothers are more likely to reside. This lack of local care increases the risks of late or no prenatal care. Women in rural areas face a 9% higher probability of maternal morbidity or mortality compared to urban women.
An obstetric care desert is a county with no hospitals or birth centers offering obstetric care, or no obstetric providers. This means pregnant individuals in these areas must travel long distances to receive essential prenatal, delivery, and postpartum care. The absence of nearby facilities can be critical, especially for complications like preeclampsia or severe bleeding post-delivery, which require immediate medical attention. The interaction of geographic factors with race and socioeconomic status creates a complex web of disadvantages for Black mothers.
Maternal Mortality Rates by Race (2023)
Fragmented Insurance and Postpartum Gaps
Fragmented insurance coverage and gaps in postpartum care also contribute to poor maternal outcomes. Nearly half of all U.S. births are covered by Medicaid (tcf.org). However, many women lose Medicaid coverage just 60 days postpartum (tcf.org). This is a critical gap, as over half of maternal deaths occur within the first year after childbirth (tcf.org). There is currently no minimum standard for maternal healthcare coverage across public and private payers (tcf.org). This means critical services may not be covered, further degrading the continuity and quality of care during pregnancy and postpartum.
Medicaid plays a crucial role in maternal health outcomes in the United States, financing 43% of all births in 2018 (healthaffairs.org). The traditional 60-day postpartum coverage limit under Medicaid has been identified as a significant gap. A substantial portion of maternal deaths and health complications occur after this period, extending up to one year postpartum (nationalpartnership.org). This has led to a widespread movement to extend Medicaid postpartum coverage to 12 months, a policy adopted by most states (nationalpartnership.org). Stable postpartum insurance coverage is an important tool to improve maternal health outcomes. It ensures consistent access to needed services to prevent postpartum morbidity and mortality (healthaffairs.org).
Impact of Medicaid on Maternal Health
Underfunded Research and Political Decisions
The underfunding of maternal health research and certain political decisions have hindered efforts to address this crisis. Pregnancy research is chronically underfunded. Most medical funding focuses on the fetus rather than the mother’s health. This limits evidence-based improvements in maternal care. Furthermore, federal funding for research into adverse birth outcomes among Black families has been abruptly canceled. This raises concerns about the future of reproductive rights for Black women. For example, epidemiologist Jaime Slaughter-Acey’s federally funded research into adverse birth outcomes among Black families was terminated because it no longer aligned with the agency’s strategic priorities or demonstrated potential to increase life expectancy. This decision was met with deep frustration and disbelief.
The impact of such decisions is profound. When research is stifled, our ability to understand and combat complex health disparities is severely limited. The Trump administration’s actions, including the revocation of numerous grants and significant scaling back of maternal and child health programs, have further destabilized critical research projects. These cuts threaten programs vital to advancing Black maternal and reproductive health. These policy changes underscore the need for sustained political will and investment to address the Black maternal health crisis.
Solutions and Paths Forward
Solutions to the Black maternal health crisis include extending Medicaid coverage, promoting culturally competent care, and supporting community-driven initiatives. Extending Medicaid coverage to 12 months postpartum and ensuring early follow-up visits within the first three weeks after birth are proven strategies to reduce preventable maternal deaths. While the American Rescue Plan Act of 2021 allows states to extend postpartum Medicaid coverage, full implementation and enforcement are still urgently needed.
Equally critical is the need for culturally competent care. This involves healthcare providers understanding and respecting the cultural beliefs, values, and practices of their patients. It also means recognizing and addressing implicit biases that can affect patient care. Midwifery-led models, particularly those grounded in preventive prenatal and postpartum support, have shown improved outcomes, especially in Black communities (earlylearningnation.substack.com). The Federal Way Birth Center in Washington state, the first Black woman-owned and operated freestanding birth and midwifery center, provides community-focused, culturally informed care that centers the needs of women and babies of color (federalwaybirthcenter.com, earlylearningnation.substack.com). Facilities like this offer trust, dignity, and a direct response to the disproportionate rates of maternal mortality Black women face in the U.S.
Hospitals must also take responsibility for protecting the health and safety of Black mothers. Some hospitals are rising to this challenge. According to the 2024 U.S. News & World Report, 26 hospitals in 13 states were recognized for their commitment to Black maternal health. These hospitals delivered excellent care, particularly in managing cesarean sections and newborn complications among Black patients. Their performance demonstrates the positive impact that intentional, equitable care can have on improving outcomes for Black families. The U.S. maternal health crisis is a public health emergency. Solutions exist, but only if we invest in equitable care, robust research, support postpartum transitions, and prioritize marginalized communities.
ABOUT THE AUTHOR
Darius Spearman has been a professor of Black Studies at San Diego City College since 2007. He is the author of several books, including Between The Color Lines: A History of African Americans on the California Frontier Through 1890. You can visit Darius online at africanelements.org.
