The US is one of the deadliest high-income countries to give birth in—especially if you’re Black.
A June analysis from the Commonwealth Fund found the country had about 22.3 deaths during or shortly after pregnancy per 100,000 live births overall in 2022, but 49.5 deaths per 100,000 live births for Black patients. Compare this to Norway, which had zero per 100,000 in 2022, or Australia, which had 3.5 in 2021, according to OECD health statistics.
What’s more, the CDC reported in 2023 that 20% of 2,407 surveyed US mothers experienced mistreatment during maternity care—like being ignored or verbally abused—with rates climbing to 30% among those who were Black, Hispanic, or multiracial.
Tanay Lynn Harris, cofounder and director of Baltimore perinatal wellness center the Bloom Collective, told Healthcare Brew she’s heard many stories from Black mothers who say doctors dismissed their pain.
“There’s a lot of harm that is happening,” Harris said. “It has a ripple effect to the baby. It has a ripple effect to the female overall, to the community.”
Birth workers like Harris say the solution is diversifying the medical workforce and providing culturally competent community resources to empower Black patients.
A community effort
A 2021 review from the Association of Black Cardiologists points to the importance of community outreach programs and faith-based partnerships that educate Black patients about the common comorbidities and issues they may face, and how to manage the challenges.
The Bloom Collective is one of these community initiatives that coaches mothers, parents, and families to ask their provider why they’ve scheduled a C-section or are pushing formula over breastfeeding, for instance, or to speak up when they feel their pain is being dismissed, Harris said.
“That gives back the power to someone who feels disempowered,” Harris said.
Doula duty
Another tool in the toolbox: doulas. These are birth workers without any formal medical training who provide support during pregnancy, birth, and postpartum.
Though there aren’t a lot of studies on the impact of doula care, a 2023 review in web-based medical journal Cureus found that doula care was associated with autonomy and confidence as well as decreased premature deliveries and C-sections.
“[Doulas are] particularly helpful for Black women who may not have this support,” Regina Davis Moss, president and CEO of advocacy coalition In Our Own Voice: National Black Women’s Reproductive Justice Agenda, told Healthcare Brew.
For instance, Black patients are more likely than white patients to experience complications like unnecessary C-sections, a 2024 study looking at New Jersey childbirth hospitalizations between 2000 and 2015 found.
But many Black and low-income patients can’t afford doula care, which can cost thousands out of pocket and often isn’t covered by insurance, according to a May 2023 issue brief from the Women’s Bureau of the US Department of Labor.
Moss said the next step is providing Medicaid coverage for the service, an idea that is gaining momentum.As of November 2024, 27 states plus Washington, DC, had implemented or were in the process of implementing Medicaid coverage for doula care. Eight states had signed legislation requiring private health plans to cover the service.
Working together
But doulas aren’t “the end-all be-all” for this issue, Harris said.
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“We have to honor midwives. We have to honor lactation consultants, healthcare therapists, perinatal mental health therapists. It’s this full constellation of care,” she said.
Harris also serves as co-chair of the Maryland maternal health improvement task force, a group convened by the Maryland Department of Health to find solutions to gaps in care for pregnant and postpartum people. She said one of its most helpful tools—the Maryland Maternal Health resource map—connects different professionals to each other.
Veronica Pimentel, a practicing maternal-fetal medicine specialist at Trinity Health of New England, agrees that collaboration is key.
She worked alongside doulas and midwives in her residency program and said she learned valuable insights from both. She said doulas were helpful “cultural interpreters” for doctors who were not part of the same community as the patient.
More barriers remain
Pimentel said it is also important to address the other contributing factors to Black patients’ increased mortality and morbidity rates, including chronic conditions like high blood pressure that can put them at higher risk of birth complications or needing C-sections, per the CDC.
Black patients are also more likely to be on Medicaid, which provides lower reimbursement for pregnancy care and postpartum care than private insurance, and can make it harder to find providers, Pimentel said.
About two-thirds of Black births in 2022 were funded by Medicaid, compared to four in ten births overall, according to the CDC’s April 2024 National Vital Statistics Report.
Pimentel also pushed for diversifying the maternal health workforce in order to overcome harmful stereotypes and assumptions.
For instance, from 2006 to 2021, race and ethnicity were factors in a widely used algorithm used to predict the safety of vaginal birth after a C-section, known as the vaginal birth after cesarean (VBAC) calculator, Pimentel said.
Those criteria were removed after a 2019 commentary from Harvard and Brigham and Women’s Hospital researchers argued that the calculator’s inclusion of race-based correction factors is “historically rooted in deeply racist enterprises” that suggested Black and Hispanic patients’ pelvises were less equipped to birth children than white patients.
A 2023 study from Stanford researchers published in Women’s Health Issues found that large language models can still perpetuate racist ideas by giving “older, biased, or inaccurate information since they do not assess research quality.”
Racism has long been a problem in maternal healthcare, Pimentel said, adding that Marion Sims, who was sometimes credited as “the father of modern gynecology,” conducted research on Black slaves without anesthesia.
“We did not get here today by accident,” Pimentel said.