Black Maternal  Healthcare Disparities

Severe maternal morbidity (SMM) refers to unexpected, potentially life-threatening complications from labor and delivery that can cause significant short- or long-term health consequences (sometimes called “near misses”). The CDC tracks SMM using 21 clinical indicators identified through ICD diagnosis and procedure codes in hospital discharge data.   In the U.S., SMM has risen over time and is closely linked to maternal mortality because the same conditions that nearly kill people during pregnancy and childbirth (for example, severe hemorrhage, eclampsia, sepsis, organ failure, or complications requiring transfusion or intensive interventions) also drive preventable deaths.

 

Maternal mortality typically refers to deaths due to maternal causes during pregnancy or within a defined postpartum window, and it is commonly reported as deaths per 100,000 live births. The CDC’s National Center for Health Statistics (NCHS) publishes national maternal mortality rates and stratifies them by race and ethnicity. In the most recent national reporting for 2023, the CDC shows that Black women experienced a much higher maternal mortality rate than White, Hispanic, and Asian women, with Black women around 50 deaths per 100,000 live births compared to about 14–15 for White women (with lower rates for Hispanic and Asian women).   This persistent gap is widely described as a disparity rooted not in individual behavior or biology, but in structural inequities and differences in care quality and treatment.

 

Black women’s disproportionate burden shows up across the continuum of maternal care—before pregnancy (baseline health and access), during prenatal care, labor and delivery, and postpartum. Professional organizations like ACOG emphasize that racism and inequities in health systems and clinical encounters contribute to these outcomes; they note that maternal mortality rates are multiple times higher for Black women than for White women and call for health systems and clinicians to treat inequities as a core patient-safety issue.   Policy and health-analysis groups similarly summarize the magnitude of the gap and highlight that disparities persist even when controlling for factors like education or income, pointing to differential access, differential treatment, and cumulative stress from racism (“weathering”) as key drivers.  

 

Several mechanisms commonly cited in the maternal health literature help explain how disparities in severe maternal morbidity and mortality develop:

    1.    Quality of care differences (systems and hospitals). Research suggests that where people give birth—and the quality and safety culture of those hospitals—matters. Black women are more likely to deliver in hospitals with higher complication rates, and quality improvement in obstetric care is a major lever to reduce disparities.  

    2.    Delays in recognition and response. Severe complications like hemorrhage, hypertensive crisis, and sepsis can escalate quickly. Inequities can appear as delayed triage, slower escalation to higher-level care, undertreatment of pain, or dismissal of symptoms—patterns often linked to implicit bias and structural racism in clinical settings.  

    3.    Access and continuity gaps, especially postpartum. A meaningful share of maternal deaths occur after delivery. When postpartum follow-up is fragmented—due to insurance churn, transportation barriers, inadequate paid leave, or limited culturally responsive care—warning signs can be missed. Analyses and reporting consistently highlight postpartum coverage and continuity as crucial.  

    4.    Higher exposure to chronic stress and comorbidities shaped by inequity. Conditions like hypertension, cardiometabolic disease, and asthma can increase pregnancy risk, and these conditions themselves are patterned by inequitable environments and access to preventive care. Importantly, the existence of higher baseline risk does not explain away disparities; it underscores how upstream inequities translate into downstream clinical crises.  

 

Because SMM events are more common than deaths, tracking SMM is also valuable for prevention: it offers more “signal” to identify weak points in care, evaluate hospital practices, and implement interventions (for example: hemorrhage bundles, hypertension protocols, rapid-response escalation, standardized checklists, and bias-aware communication training). The CDC’s approach to defining and identifying SMM using the 21-indicator method supports surveillance and quality improvement across systems.  

 

Addressing Black maternal disparities requires interventions at multiple levels: clinical (standardized evidence-based obstetric emergency response), health-system (quality improvement and accountability), and structural (coverage, access, respectful care, and anti-racist policy). ACOG and other maternal health leaders frame this as a patient-safety and equity imperative: preventing near-misses and deaths is not just about medical capability; it is also about ensuring that Black women receive timely, respectful, and high-quality care across pregnancy, delivery, and postpartum.