Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States

Abstract

Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.

Keywords: COVID-19; black maternal mortality; health disparities; intersectionality; morbidity; pregnancy; race/ethnicity; racism; social determinants of health; weathering framework.

Figure 1

Application of Theoretical Framework on Structural and Social Determinants of Maternal and Infant Mortality in the United States.

Figure 2

Socioecological Model for Prevention.