The Black Maternal Mortality Crisis

Medical Experts: Bayo Winchell-Curry, MD; Joanne Armstrong, MD, MPH

“As a physician, I almost died,” says Bayo Winchell-Curry, MD (Dr. BCW), Saint Mary’s Urgent Care medical director in Reno, Nevada. “I knew I did not feel the same way I did after my first cesarean two years earlier. I could barely speak and couldn’t concentrate. I shared my concerns with the medical staff no more than 30 minutes after giving birth and was told my vital signs were good, and there was no problem.” Although Dr. BCW persisted in telling staff members something was wrong, she was continually dismissed and ignored. With no one listening to her at the hospital, she asked her husband to call her OB-GYN. Because they were colleagues, they had his phone number—a perk not given to the average patient. On the phone, her husband told the doctor with great concern, “Something is wrong with Bayo.”

“[My OB-GYN] came back to the hospital, and thank goodness he took the time to see me,” says Dr. BCW. “I say that intentionally—see and listen to me. He took me back to the operating room and found that I was bleeding internally,” she recalls, adding, “I was hospitalized for two weeks and had to be transfused. Everyone [in the labor and delivery room] knew I was a physician with two underlying health conditions, yet my outward appearance blocked the medical staff from taking me seriously. I think that highlights what’s happening to Black women every day.”

The Differences Are Black and White

The U.S. has a higher maternal death rate than any other developed nation. According to a recent National Center for Health Statistics (NCHS) report, it has been rising at an alarming rate, increasing by 60% in 2021 compared to 2019. 

The maternal health crisis is a critical issue in America, and it’s affecting Black women at disproportionate levels. According to Joanne Armstrong, MD, MPH, vice president and chief medical officer of women’s health and genomics at CVS Health, “Black expectant mothers have very different maternal and infant health outcomes in this country than white mothers. Black women have a three times higher chance of dying from causes related to pregnancy than white women and are twice as likely to experience severe maternal health outcomes or near misses.”

This disparity is even more significant for Black women over 30, who are four to five times more likely to die from pregnancy-related causes than white women of the same age. 

We know that money is power in America, but remarkably, how well off a new mom is does not positively affect these statistics—unless they’re white. One of the most comprehensive studies that speaks to maternal health disparities related to socioeconomics was published in November 2022 (and revised in September 2023) by the National Bureau of Economic Research (NBER). The study details how the risks of childbirth vary regarding race and income and how Black women, irrespective of their financial status, are disproportionately affected. The study, which looked at births from 2007-2016, used “linked administrative data that combines the University of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service (IRS) tax records and the Longitudinal Employer-Household Dynamics (LEHD),” a quarterly database of linked employer-employee data.  

The findings were quite shocking. The data showed that per 100,000 births, 437 babies born to affluent Black women would die compared to 173 babies born to affluent white women. For low-income families, 653 Black babies will die, compared to 350 white babies. Even the wealthiest Black moms are seeing higher infant mortality rates than low-income white mothers. Says Dr. BCW, “I am a woman of so-called privilege within health care, and I was ignored.” 

After delivering her baby, Serena Williams, one of the most decorated athletes in history, was dismissed when she told her nurse she couldn’t breathe and thought she might be having a pulmonary embolism, something she was familiar with. After consistently being told she did not have blood clots, she kept demanding a CT scan, and when it was finally given, it revealed several blood clots in her lungs.

Considering a high-ranking medical director and a world-renowned Olympian must fight to be heard, the numbers from these various studies make sense. Dr. Armstrong says, “Black women report almost ten times the rate of being treated unfairly due to their race by hospital providers during pregnancy compared to white women.”

However, problems exist beyond moms not being taken seriously when advocating for themselves. “Economic and social circumstances contribute to poorer outcomes,” explains Dr. Armstrong. “Conditions like poverty, under-resourced communities, less flexible work arrangements, and unreliable access to transportation and housing can make it difficult for Black women to access maternal care resources. These factors also present barriers to health even before one becomes pregnant, and entering pregnancy with existing health complications or conditions can increase Black women’s risks during this vulnerable time. “Still,” she continues, “economic and social factors do not fully explain the differences.”

It Is a Race Issue

“The root is structural racism, unconscious bias, and race-based medical practices. It is happening to all social economics of Black women,” says Dr. BCW. Some of these practices were even built into the day-to-day process of labor and delivery. She explains that a lot of people aren’t familiar with what is called the Vaginal Birth After Cesarean (VBAC) score. “ In 2007, there was this thought that once you had a C-section, you always had to have one because there was a fear that if doctors let you have a vaginal birth, there could be complications.” According to the Art of Medicine (AMA) Journal of Ethics, the VBAC score was developed by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network as a decision-making aid to help clinicians discern how one variable (race) might influence a patient’s success in delivering a baby vaginally following a C-section.

Dr. BCW says this scoring system had four questions that focused on age, height, weight, and whether the patient was African American, Black, or Hispanic. “Imagine you have two women of the same age, height, and weight, with equal risks. To one woman, you will say to try and do a natural birth after a cesarean, and the other one—if she’s Black, African American, or Hispanic—will be pushed towards a C-section. We know Black women are dying at a higher rate, and if we are pushing them towards a surgery that has a higher risk of complications, that is also a part of this issue,” she says. Although Dr. BCW says they removed the scoring system in 2021, she notes that multiple studies, including one from the American Journal of Critical Care (AJCC), show that it takes about 17 years for new evidence to translate into standard clinical practice. “Even though you remove this score, it’s still affecting Black women and Hispanic women every day. A true full circle moment.”

Dr. Armstrong notes, “Black women report being twice as likely than white women to feel pressured to have medical interventions during labor and delivery. For example, 18% of Black women reported feeling pressured to have a cesarean birth compared to 9.5% of white women.”

Race continues to take center stage in the country’s Black maternal health crisis. During her first TEDx Talk on why Black patients don’t trust the health care system, Dr. BCW brought up studies that show how 40% of doctors in training believed that Black patients felt less pain than white patients. “They also thought that our nerve endings were less sensitive and that we had thicker skin,” says Dr. BCW. 

These misconceptions and implicit biases stem from a long, barbaric history. Deemed the father of modern gynecology, J. Marion Sims, performed surgical procedures on Black enslaved women with no anesthetic in the late 19th century. He is also thought to have believed Black people didn’t feel pain. It is no great wonder why that thread would continue to run through this particular industry. Dr. BCW says, “Whether it’s unconscious bias or racist thinking that’s been passed down, those thoughts can affect how you treat someone when they say they’re in pain or something is amiss. I like to tie that into the topic we’re talking about because we see Black women dying, and sometimes it’s due to a dismissal of pain.”

What Are the Solutions?

Black women of all socioeconomic groups need to take their well-being into their own hands. Here are some tips to help your maternal health:

Have a pre-pregnancy plan.

“It’s extremely important that women monitor their holistic health before, during, and after pregnancy. Even before becoming pregnant, women can set themselves up for healthy pregnancies by getting their overall health profile under control—managing existing health conditions, avoiding smoking and drinking, and maintaining a healthy diet, sleep, and exercise,” says Dr. Armstrong. “Women with medical conditions that impact pregnancy should work with their physicians to make sure they are optimally controlled before becoming pregnant. Pre-pregnancy is also a good time to think about the type of birth you would like and the care providers that best match your cultural and linguistic preferences.”

Take care of yourself while you are pregnant.

Dr. Armstrong explains, “During pregnancy, it’s important that women follow prenatal care recommendations, including getting appropriate vaccinations (flu, Tdap, COVID-19), taking prenatal vitamins to increase folic acid and iron intake, and having frequent check-ups with a provider to ensure their overall health is being monitored. Especially for Black women, it’s important to pay attention to your body during this vulnerable time and voice your concerns. You must know that whatever you are feeling is valid. Connecting with a health care provider who affirms your experiences is critical to ensure a healthy pregnancy for yourself and your future child.”

Help Black women trust health care providers.

Dr. BCW says that when she reflects on why Black women and babies are dying, a key factor is the lack of prenatal care, which leaves her to question why there’s a disconnect. “It could be that these women don’t trust doctors,” she says. “Health care providers need to build trust in our communities of color. How do we do that? We start by asking questions like, ‘Why do you mistrust?’ or ‘What is blocking you from coming in to get prenatal or regular care?’ When you ask these questions, it is a gift to an expectant Mom. It shows you see them, and you get the opportunity to work with them to develop a relationship that builds trust.”

Hire a doula.

“For women from historically marginalized communities, doulas can be a means of empowerment during the labor process. Doulas provide non-clinical assistance and guidance, listen to your voice, and advocate for you in a situation where you may feel uncomfortable or unable to bring up concerns in front of a clinician,” says Dr. Armstrong. She explains that doulas are associated with improved birth experiences and health outcomes, lower rates of C-section births, use of pain medicine, birthing complications, and low childbirth weight. “Many doulas are community-based, serving as an important liaison between medical professionals and expectant mothers, thus helping create a stronger sense of trust between all parties involved.”

Don’t forget about the fourth trimester.

“Even after pregnancy ends,” says Dr. Armstrong, “it’s essential that women take care of their holistic health needs as they deal with the life changes and challenges that come during the ‘fourth trimester.’ It’s important that women have the support they need to navigate this often emotionally and physically draining period.”

Systematically change the health care system.

“We have to re-educate those providers who are still practicing race-based health care and the institutions that continue to foster that. We need to acknowledge unconscious bias. That is going to be a big step in the right direction. Then we can really take the necessary steps to fix it. We can’t fix anything without acknowledging it. If we can start to break down those walls, then my colleagues and health institutions can start to think about what we’re doing and how it’s impacting lives,” says Dr. BCW.

Reach out to anyone who will listen.

“I’ve reached out to approximately five thousand people,” says Dr. BCW. “I ask myself, ‘Who can I tell this to that will help make this stop?’ That’s why I did my initial TEDx Talk and my second one specifically about the maternal health care crisis. That’s also why I started Beyond Clinical Walls, a social media video series and podcast to discuss health-related topics. I asked myself, ‘What can I create that may be scalable, large, accessible, and free?’ I started writing content and just put it out there. The content is engaging and informative, but it’s solution-oriented.”

The Black maternal health crisis should be everyone’s concern. For more ways to help, sign up for news and updates from the Black Mamas Matter Alliance, whose work inspired Black Maternal Health Week (April 11-17). April is also National Minority Health Month, which is a great time to find opportunities to get involved in ways to help solve this health crisis.