Examining racial disparities in maternal health

This article was last updated on Feb. 6, 2023.

Going through pregnancy and giving birth is usually an exciting time in someone’s life. Decorating the nursery, picking out the cutest baby clothes, and feeling the baby kick for the first time are all treasured experiences throughout those nine months.

However, when it comes to health care during pregnancy and immediately after giving birth, not everyone’s experience is the same. According to The Commonwealth Fund External Site, pregnant women in the United States are more than twice as likely to die from complications related to pregnancy Glossary popover or childbirth than other high-income countries. And, the U.S. is one of only 13 countries External Site where the maternal death rate is worse than it was 15 years ago.

Find support for your pregnancy from Wellmark

Wellmark Blue Cross and Blue Shield members have access to online resources like WebMD® Pregnancy Assistant, Count the Kicks® and text4baby^SM through myWellmark®. All you have to do is log in or get registered for your secure member portal.

The Kaiser Family Foundation reports that stark racial disparities External Site (issues that disproportionately affect people of color more than white people) in maternal and infant health in the United States continue to be swept under the rug despite significant advances in medical care. This has resulted in Black, American Indian, and Alaska Native women being two to three times more likely* to die from pregnancy-related causes than white women. The worst part? Most studies have shown that around half of these deaths are preventable External Site.

“The higher maternal morbidity rates among women of color are unacceptable in this era of advanced medicine,” said Dr. Tim Gutshall, Wellmark’ Blue Cross and Blue Shield's chief medical officer. “We must understand and address these health disparities to ensure women of all races experience healthy pregnancies and babies.”

The latest Health of America Report® External Site from the Blue Cross® and Blue Shield® Association (BCBSA) examines where our health care system needs to improve care for expecting parents, in particular pregnant people of color. Here’s what you need to know about the racial disparities that currently exist in maternal health care — and what’s being done to fix them.

What’s happening to pregnant people of color?

The main issue at stake for pregnant people in the United States is the rising rate of Severe Maternal Morbidity (SMM).

Image Description for what is SMM infographic

SMM measures unexpected outcomes from labor and delivery that bring significant short- or long-term consequences to a pregnant person’s health. The Centers for Disease Control and Prevention (CDC) include 21 different poor health events External Site in their definition of SMM — some of which are associated with maternal death.

Though rates of SMM have been steadily rising among all pregnant people, the BCBSA found that in 2020, people in majority Black communities had a 63 percent higher rate of SMM and people in majority Hispanic communities had a 32 percent higher rate of SMM than those in majority white communities.

The BCBSA report found some of the SMM health events with the highest racial disparities External Site include:

• Acute kidney failure
• Adult respiratory distress syndrome
• Sepsis 
• Pulmonary edema/acute heart failure
• Ventilation
• Hysterectomy

Among Black women living in Iowa, SMM rates have more than doubled between 2019 and 2020 — increasing from 55 per 10,000 hospital deliveries in 2019 to 114 in 2020, according to the Iowa Department of Health (IDPH). The rate among Hispanic women rose from 52 to 69 per 10,000 births those same years, compared to a much smaller increase of SMM rates among white women — which rose from 45 in 2019 to 51 in 2020.   

Risk factors that increase the prevalence of SMM

Some pre-existing health conditions raise a pregnant person’s risk of SMM, in addition to circumstances or conditions that develop during pregnancy or around the time of birth.

Pre-existing health conditions that make it more likely for a pregnant person to develop SMM, compared to someone without these conditions, include:

• Cardiac disease (14.4 times more likely to develop SMM)
• Bleeding disorders (9.7x more likely)
• Asthma (4.1x more likely)
• Gastrointestinal disease (3.3x more likely)
• Chronic hypertension (3.1x more likely)
• Pre-existing diabetes (3x more likely)
• Anemia (2.7x more likely)
• BMI greater than 40 at time of delivery (2x more likely)

In addition to these conditions, the likelihood of SMM goes up if a pregnant person is diagnosed with preeclampsia or gestational hypertension, gives birth before 37 weeks gestation, experiences their placenta detaching from their uterus before delivery, is pregnant with multiples, is older than 35 at the time of delivery, or has had a prior cesarean birth.

Why does SMM predominantly affect people of color?

Now that you know what’s happening, let’s dive into the big question: why is this happening?

Image Description for SMM risk factors infographic

Certain risk factors for SMM are higher in predominately Black and Hispanic communities due to differences in social determinants of health (more on that in a minute). Plus, the type and quality of care someone receives while pregnant, during childbirth and after giving birth can impact their likelihood of experiencing SMM.

Key takeaways from a survey included in the BCBSA report suggest that compared to white women, Black and Hispanic women may not be receiving the kind of care necessary to manage their risks for SMM:

1. Only 62 percent of Black mothers completed all recommended prenatal visits, compared to 71 percent of Hispanic mothers and 82 percent of white mothers, mainly due to transportation difficulties or scheduling conflicts.
2. Only 80 percent of Black mothers (compared to 82 percent of Hispanic and 88 percent of white mothers) feel their provider spent enough time with them during appointments, and 85 percent (compared to 91 and 92 percent of Hispanic and white mothers, respectively) were confident that they received the care they needed.
3. And 88 percent of Black mothers felt they could speak openly about pregnancy with their provider, compared to 92 percent and 93 percent of Hispanic and white mothers, respectively.

IDPH reported that overall, 79 percent of Iowa women began prenatal care during their first trimester in 2020. However, just 69 percent of Black and Hispanic women initiated first trimester prenatal care, compared to 82 percent of white women.  

Examining the impact of social determinants of health

According to the World Health Organization, social determinants of health (SDH) are non-medical factors that influence health outcomes External Site between 35 and 55 percent of the time.

Examples of SDH that can negatively impact someone’s health include:

• Unemployment and job insecurity
• Workplace inequality
• Food insecurity (which disproportionately affects External Site Black households in the U.S.)
• Social exclusion and discrimination bias
• Neighborhood violence
• Harsh environmental factors and toxins where people live, work and play
• Lack of access to affordable, quality health services and providers

According to the Center for American Progress External Site, things like income level, education, and socio-economic status are not protective factors for maternal death among Black Americans as they are for white Americans. As an example, a study from the CDC External Site revealed that the prevalence of pregnancy-related mortality for Black women with at least a college degree was 5.2 times that of their white counterparts. And, although women with higher education degrees tend to have lower pre-term birth rates, Black women with a college degree have a higher risk of pre-term birth External Site than white women who didn’t finish high school.

Finally, social biases related to level of education, income, disability, and more can negatively impact someone’s experience in health care settings — and 22 percent of Black women report experiencing discrimination External Site when going to the doctor. This often results in birthing parents of color External Site feeling like their provider doesn’t listen when they speak up about issues with their care, or when they experience pain or discomfort during pregnancy and childbirth.

What’s being done to reduce the racial disparities in SMM and maternal deaths

The Blue Cross and Blue Shield Association unveiled a multi-year strategy External Site to tackle racial disparities in health care, which includes reducing racial disparities in maternal health. The Association has identified their top 10 maternal health equity actions External Site.

Here are just a few:

• Expand benefit coverage to ensure postpartum care, including behavioral health care, to one year postpartum.
• Facilitate access to doulas and community health workers for maternal support services. 
• Include nurse midwives and birthing centers in provider networks and design programs to increase education and awareness for health plan members. 

Take control of your health during pregnancy

Though we can’t tackle the racial disparities in maternal health care overnight, Wellmark has a free Pregnancy Support program to help our members and improve outcomes for babies and mothers with trusted and helpful online resources for every stage of pregnancy and beyond.

Members simply log in to myWellmark® for 24/7 to access these online resources, including:

Image Description for Wellmark Blue Cross and Blue Shield member pregnancy resources infographic

• WebMD® Pregnancy Assistant — Learn about the stages of baby’s growth and get support throughout pregnancy from prenatal to postpartum.
• Count the Kicks® — Keep track of baby’s normal patterns of movement in the third trimester.
• text4baby^SM — Learn about baby milestones, set appointment reminders, and get safety information via text message.

Once logged in, members can also take an online pregnancy assessment to see if they may benefit from one-on-one support from an Advanced Care nurse over the phone. Even with a low-risk pregnancy, an Advanced Care nurse is just a phone call away to answer questions. Just call 800-552-3993 ext. 3727. Wellmark members can also get answers to health-related questions day or night (yes, even at 3 a.m.) from a real person over the phone with BeWell 24/7^SM.

In addition to the Pregnancy Support Program, myWellmark can help you manage all aspects of your health during pregnancy. It gives you a transparent look into your health care usage and easy-to-use tools, resources, and insights. You can check claims details, view health care spending, find an in-network doctor, use tools to understand your benefits and more.

If you aren’t signed up, you only need a few minutes and a valid email address. Get started or log in Opens New Window today!

*Data from the Center for American Progress reports that in the U.S., Black women across the income spectrum are dying from preventable pregnancy-related complications at three to four times the rate of non-Hispanic white women.