In 2020, Black women accounted for one-third of maternal deaths. This is a mortality rate that was nearly three times that of white women. Giving birth while Black should not be a death sentence.
As the nation marks Black Maternal Health Week, founded by the Black Mamas Matter Alliance to deepen the national conversation about Black maternal health, it is important to recognize the urgency to curb this unacceptable but persistent disparity by prioritizing community-driven care solutions.
The circumstances Black people face are not simply a matter of an economic or education system, but of a system that reinforces inequitable and discriminatory practices. There’s no clearer example than that of Serena Williams, who despite being one of the world’s greatest athletes and a successful businesswoman, faced life-threatening failures in her care in the time surrounding childbirth. In her own words, Williams said, “Being heard and appropriately treated was the difference between life or death for me; I know those statistics would be different if the medical establishment listened to every Black woman’s experience.”
Improving maternal health outcomes for Black women, and for all communities of color, will require addressing the numerous contributors to health inequities, like worse cesarean delivery rates, breastfeeding rates, and rates of delivery complications, including the many risk factors perpetuated by structural racism, such as nutritional, housing, and transportation barriers. Although it may seem simple on its face, parents should be listened to and receive personalized, respectful, and easily accessible care that is built on autonomy, justice, and healthy alliances.
One solution is to create pathways and partnerships that provide safe environments for families. To advance this goal, Mass General Brigham and the New Commonwealth Racial Equity and Social Justice Fund have embarked on a five-year partnership to advance maternal health equity, support practitioners and advocates in making critical advances in patient care and outcomes, and improve the health equity of Black and brown communities across Massachusetts. This initiative supports parents throughout pregnancy and delivery, ensuring increased equity, accessibility, and quality of maternal health care.
Today’s inequities are too stark to ignore. In a national sample by Listening to Mothers, 24 percent of respondents reported having some form of discrimination in their maternity care, with 10 percent of Black people saying they were treated poorly due to their race, ethnicity, cultural background, or language. Only 3 percent of white respondents reported the same. In the Giving Voices to Mothers Study, 1 in 6 women reported mistreatment during maternity care, and those risks are even higher among women of color, those who delivered in a hospital or had an unplanned cesarean, and those whose partners were Black.
While there are a range of birthing options available, from hospital deliveries to midwife-assisted home births, Black mothers often find only a hospital birth is accessible to them. In fact, 85 percent of births that take place in hospitals are considered low risk, and 86 percent of these are attended by physicians. Less than 1 percent of births take place in birth centers where midwives are the predominant providers of care, and even fewer births are supported by doulas, a workforce with a proven track record of improved outcomes, including lower rates of maternal mortality, infant mortality, and fewer complications during birth. It is important to meet our families where they are, both geographically and in their preference of a birthing model that best suits their needs, which is why we are supporting the Neighborhood Birth Center, which will be the first birthing center to open in Boston.
A lifetime of health equity begins before birth. A baby born to a Black mother in the Boston neighborhoods of Roxbury, Dorchester, Mattapan, and Hyde Park is over three times more likely to die by their first birthday than a baby born to a white mother. By expanding the maternal health care ecosystem, resources through partnerships, youth development, and economic empowerment can also be addressed.
Society holds a legacy of systemic, structural, and interpersonal racism. The influence of bias and racism results in lower-quality care and suboptimal birth outcomes, running the risk of perpetuating intergenerational trauma. By building a community around Black and brown women, health care leaders can broaden their birthing options, support success in delivery, and encourage the health and well-being of their children. This will create an equal playing field from which parents, children, and families can build healthy and vibrant lives for generations to come.
Dr. Allison Bryant is senior medical director for health equity at Mass General Brigham and chair of the Massachusetts Maternal Mortality Review Committee. Dr. Makeeba McCreary is president of the New Commonwealth Racial Equity and Social Justice Fund. Dr. Elsie Taveras is the chief community health equity officer at Mass General Brigham.