Every person deserves a safe, respectful, and supported birth experience. In the United States, that is not the reality for everyone. Deep, persistent disparities in maternal health outcomes make it clear that equity in healthcare is not optional…it’s essential.
For many Black women in the U.S., pregnancy and childbirth can come with the added challenge of not receiving the respectful, responsive care they deserve. These experiences are not isolated incidents. A 2024 study published in the Journal of Midwifery & Women’s Health found that Black women were significantly more likely to report mistreatment by healthcare providers during their perinatal care.
This reflects a broader public health crisis, one that continues to affect outcomes year after year, despite growing efforts to raise awareness and improve equity.
The data: Black maternal health in the U.S.
In the U.S., Black mothers are more than three times more likely to die from pregnancy-related causes as white women. In 2023, according to data from the Centers for Disease Control and Prevention (CDC), the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, compared with 14.5 for white women. Most pregnancy-related deaths are considered preventable, with recent data suggesting that more than 80% could be avoided with timely, high-quality, and coordinated care.
Why these inequities persist
When someone dies during or shortly after childbirth, it’s often assumed to be a rare or unexpected medical complication. For too many Black mothers, the risk is shaped by:
Structural racism and social determinants of health
Housing, transportation, employment, environmental exposures, and access to quality healthcare all influence maternal outcomes. Historic and ongoing inequities place Black families at higher risk before pregnancy ever begins.
Bias and dismissal in care
Studies have shown that Black patients are more likely to have their pain underestimated or dismissed. When symptoms are minimized, diagnoses are delayed, interventions are missed, and patients may be sent home when they need urgent evaluation.
Postpartum care gaps
Maternal health doesn’t end when the baby is born, yet, postpartum care is often rushed, fragmented, or difficult to access. Nearly half of pregnancy-related deaths occur in the days and weeks after childbirth, many between one week and one year postpartum. Black mothers are more likely to experience complications in this window and less likely to receive adequate follow-up.
Under-resourced hospitals and overburdened systems
Hospitals and clinics that serve larger Black populations are more likely to be underfunded or understaffed. Longer wait times, high nurse-to-patient ratios, and limited access to specialized care increase the risk that critical signs will be missed, and emergencies will escalate.
What needs to change
Addressing this crisis requires a multi-layered approach. No single intervention will be enough, but key priorities include:
- Equity-focused training and accountability: Healthcare professionals should be trained to recognize their own biases and understand how discrimination can affect outcomes. Hospitals should also track disparities in treatment.
- Stronger, more equitable postpartum support: Policies that ensure extended care after birth, like follow-up visits, mental health screening, and blood pressure monitoring, can help catch complications before they become fatal.
- Person-centered, respectful care: When patients say they don’t feel right, believe them. One of the most powerful things any healthcare professional can do is to listen. This may sound simple, but for many women, being heard can lead to life-saving interventions.
How nurses can support Black maternal healthcare
Nurses are uniquely positioned to advocate for change and improve the Black maternal healthcare experience. As frontline caregivers, educators, and care coordinators, we can help close gaps and build trust at the bedside and beyond.
Here are ways we can lead with intention:
- Prioritize education on warning signs. Make time to clearly explain postpartum warning signs like severe headaches, chest pain, difficulty breathing, heavy bleeding, or high blood pressure. These conversations should be culturally sensitive, free of medical jargon, and ideally begin before discharge.
- Create space for questions. Regularly invite questions, especially when delivering new or complex information. Avoiding assumptions about health literacy is key. Phrasing like, “What questions do you have?” instead of “Do you have any questions?” can open the door to clearer communication.
- Ensure timely and proactive follow-up. Advocate for postpartum follow-up by emphasizing its importance, helping patients schedule appointments, and encouraging them to reach out with concerns. This also means watching for missed visits and helping reconnect patients with care teams when needed.
- Listen actively and validate concerns. Too many patients report feeling dismissed or ignored. Counter this by practicing active listening, affirming concerns, and documenting symptoms and pain levels thoroughly.
- Speak up within the team. If something doesn’t feel right during care, whether it’s a delay in treatment or a colleague’s dismissive behavior, it’s part of our role to say something. Escalating concerns can save lives.
- Address bias and reflect on practice. Regularly reflect on how implicit bias can affect patient interactions. Participating in training, listening to patient experiences, and staying up to date on equity-focused clinical education helps ensure every patient is treated with the dignity and attention they deserve.
Moving from understanding to action
Learning about the causes of Black maternal mortality helps us see the system more clearly, but awareness is only a starting point. With understanding comes responsibility: to listen more carefully, to challenge dismissive or unsafe practices, and to advocate for systems that protect Black mothers and families.
Nurses have a powerful role to play. By combining clinical expertise with advocacy, cultural humility, and a commitment to equity, we can help reshape maternal healthcare so that every patient is heard, respected, and safe.
