Non-Hispanic Black women in the United States experience 3 to 4 times the maternal mortality rate of non-Hispanic White women.1 In a paper in the Journal of Women’s Health, the researchers highlighted the contributing physical and mental health disparities.2
Black women have a higher prevalence of heart disease, stroke, cancers, diabetes, maternal morbidities, obesity, and stress compared with U.S. women overall. Life expectancy at birth is 3 years longer for non-Hispanic White females than for non-Hispanic Black females, and infant mortality rates for children born to non-Hispanic Black women are twice as high as those for children born to non-Hispanic White women.1
Geronimus et al. suggest that Black-White disparities in health are due to the “weather hypothesis,” which suggests differential exposures to stressful environments, such as experiences with racism and socioeconomic disadvantages, substantially contribute to widening health disparities. Babies born to Black women in their teens are at lower risk of infant mortality than babies born to older non-Hispanic Black women, which is the opposite of what has been discovered about infant mortality rates of babies born to non-Hispanic White women.3 Geronimus et al. also found that that telomere length among women aged 49-55 years indicates that Black women are 7.5 years “older” than White women.
Non-Hispanic Blacks also have a higher age-adjusted prevalence of obesity — around an estimated 34% to 50% — than other racial and ethnic groups4 as well as higher rates of cardiovascular disease (CVD). Both clinical and behavioral cardiovascular (CV) risk factors and the development of CVD at younger ages for Black women compared with other groups impact maternal and infant health5.
People of African ancestry have been underrepresented in genomic research and genomic studies rarely analyze the interaction between sex hormones and genetic characteristics so there are concerns that precision medicine efforts relying on such studies may exacerbate CVD health disparities.6-8
Black women are also disproportionately impacted by sickle cell anemia and anemia and have “poor outcomes” associated with ancestrally linked disorders such as G6PD.9-10
The above chronic conditions are associated with higher risk of maternal morbidity and mortality, and Black women, and severe maternal morbidity and subsequent mortality is increasing in non-Hispanic Black women11. Factors involved include the higher occurrence of leading causes of maternal morbidities (such as hemorrhage, infection [sepsis], thrombotic pulmonary/other embolism, and pregnancy-associated hypertensive disorders), hospital quality, and access to quality care.
Howell et al. found that if non-Hispanic Black women gave birth at the same hospitals as non-Hispanic White women, the non-Hispanic Black severe maternal morbidity rate would decrease by 47.7%, from 4.2% to 2.9% and that may non-Hispanic Black women giving birth in lower quality hospitals experience poor patient–provider communication and difficulties in obtaining appropriate prenatal and postpartum care.12-13
Homicide is another leading cause of death during pregnancy and postpartum. Wallace et al. argue that failure to identify and address factors underlying pregnancy-associated homicide will perpetuate racial inequity in mortality during pregnancy and the postpartum period.14
Chronic exposure to environmental stressors such as racial discrimination is associated with poor physical health —including lower overall CV health and compromise of reproductive health based on increase of allostatic load — and psychological stress.15,16
Non-Hispanic Black women are twice as likely to have an infant with low-birth weight than non-Hispanic White women, and 67% participate in prenatal care in the first trimester compared with 77% of non-Hispanic White women.15
An estimated 28% of non-Hispanic Black women experience perinatal depression.17
1. Infographic: Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. 2020. Centers for Disease Control and Prevention. https://www .cdc.gov/reproductivehealth/maternal-mortality/disparitiespregnancy-related-deaths/infographic.html. Updated February 4, 2021
2. Chinn JJ, Martin IK, Redmond N. Health equity among Black women in the United States. Journal of Women’s Health. Published online February 2, 2021. doi:10.1089/jwh.2020.8868
3. Geronimus AT. The weathering hypothesis and the health of African American women and infants. Ethn Dis 1992;2: 207–221. doi:10.2105/AJPH.2004.060749
4. Ogden CL, Fakhouri TH, Carroll MD, et al. Prevalence of obesity among adults, by household income and education — United States, 2011–2014. MMWR Morb Mortal Wkly Rep. 2017;66:1369–1373. doi:10.15585/mmwr.mm6650a1
5. Pool LR, Ning H, Lloyd-Jones DM, Allen NB. Trends in racial/ethnic disparities in cardiovascular health among US adults from 1999–2012. J Am Heart Assoc. 2017;6: e006027. doi:10.1161/JAHA.117.006027
6. Sirugo G, Williams SM, Tishkoff SA. The missing diversity in human genetic studies. Cell. 2019;177:26–31. doi:10.1016/j.cell.2019.02.048
7. Winham SJ, de Andrade M, Miller VM. Genetics of cardiovascular disease: Importance of sex and ethnicity. Atherosclerosis. 2015;241:219–228. doi:10.1016/j.atherosclerosis.2015.03.021
8. Martin AR, Kanai M, Kamatani Y, Okada Y, Neale BM, Daly MJ. Clinical use of current polygenic risk scores may exacerbate health disparities. Nat Genet. 2019;51: 584–591. doi:10.1038/s41588-019-0379-x
9. Francis RO, Jhang JS, Pham HP, Hod EA, Zimring JC, Spitalnik SL. Glucose-6-phosphate dehydrogenase deficiency in transfusion medicine: The unknown risks. Vox Sang. 2013;105:271–282. doi:10.1111/vox.12068
10. Howard J, Telfer P. Sickle Cell Disease in Clinical Practice. London: Springer-Verlag. 2015.
11. Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol. 2019;33:30–36. Doi:10.1016/j.annepidem.2019.02.007
12. Howell EA, Zeitlin J. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Semin Perinatol. 2017;41:266–272. doi:10.1053/j.semperi.2017.04.002
13. Howell EA, Egorova NN, Janevic R, et al. Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities. Obstet Gynecol. 2020;135: 285–293. doi:10.1097/AOG.0000000000003667
14. Wallace ME, Crear-Perry J, Mehta PK, Theall KP. Homicide during pregnancy and the postpartum period in Louisiana, 2016-2017. JAMA Pediatr. 2020;174:387–388. doi:10.1001/jamapediatrics.2019.5853
15. National Academies of Sciences, Engineering, and Medicine. Birth settings in America: Improving outcomes, quality, access, and choice. Washington, DC: The National Academies Press, 2020. doi:10.17226/25636
16. Barajas CB, Jones SCT, Milam AJ, et al. Coping, discrimination, and physical health conditions among predominantly poor, urban African Americans: Implications for community-level health services. J Community Health. 2019;44:954–962. doi:10.1007/s10900-019-00650-9
17. Lara-Cinisomo S, Clark CT, Wood J. Increasing diagnosis and treatment of perinatal depression in Latinas and African American women: Addressing stigma is not enough. Womens Health Issues. 2018;28:201–204. doi:10.1016/j.whi.2018.01.003