By Anna Morrow
In 2023, the maternal mortality rate was 18.6 per 100,000 live births. Although the U.S. rate is back to its pre-pandemic levels, the U.S. maternal mortality rate is still three times higher than in the United Kingdom, according to The Commonwealth Fund. While this rate is off-putting in any context, Black women face significant differences in maternal mortality with a 2023 rate of 50.3 per 100,000 live births. In contrast to the total overall trend of maternal mortality rates, the rate among Black women has risen consistently since 2018 with a small peak during the height of the COVID-19 pandemic. I have become more informed on the maternal health crisis in America each week as a second-year undergraduate student at Davidson College in a doctoral class taught by professor Shanika Jerger Butts titled “U.S. Maternal Health Disparities.”
The large disparity in maternal outcomes for Black women compared to the total maternal mortality rate can be attributed to systemic racism in the U.S. Racism is the root cause for many social determinants of health that deeply influence future health outcomes. A Black woman is more likely to experience low socioeconomic status, poor access to quality healthcare, lack of education, and other negative influences. The stress of continual injustice causes chronic stress for Black individuals and has been linked to cardiovascular disease and other negative health outcomes.
Social determinants and the effects of chronic stress have resulted in higher rates of chronic disease among the Black and African-American populations. Many Black Americans are less likely to have access to improving healthcare for chronic disease due to inadequate insurance coverage and scarcity of care.
Over 35 percent of U.S. counties received designation as a “maternal care desert” by the 2024 March of Dimes report on the subject. They define this term as “a county without a hospital or birth center offering obstetric care and without any obstetric clinicians.” The map of these “deserts” directly overlaps with the concentration of the Black population in the U.S. While there is a risk for all pregnant women living in counties designated as “maternal care deserts,” the risk is compounded for Black women who reside in “deserts” more commonly experience higher rates of chronic disease, and have been historically neglected and mistreated in the medical establishment.
“Maternal care deserts” are not naturally occurring. These so-called deserts have been intentionally created by purposeful neglect from the systems of governance our healthcare system is built on. This sentiment was shared in a session of the American Public Health Association’s Annual meeting I attended in Washington, D.C., in early November. This session, under the maternal and child health section of the APHA, invited experts in the field of maternal health and maternal care deserts to speak on the topic. Aza Nedhari, who is the co-founder and executive director of Mamatoto Village, spoke at this conference. Mamatoto Village provides perinatal care, education and midwifery services to the obstetrically underserved community of D.C.’s Ward 7. In the District, Black people account for half of the births, but 90 percent of maternal mortalities according to the city’s maternal mortality review committee. The concentration of Black residents is greater than 80 percent in Ward 7 and 8, resulting in 64 percent of maternal mortalities occurring within these areas. Despite poor outcomes and obstetric care located in affluent areas, D.C. is considered as a full access to care area. A more detailed designation for under-resourced but still full access areas will be useful for areas similar to Washington, D.C., to recognize and thus direct more care resources toward such areas.
Nedhari and other members of the panel discouraged the understanding of maternal care deserts as inevitable, and they emphasized they are instead intentionally under-resourced spaces created to harm Black communities. March of Dimes’ Chief Medical Officer Michael Warren also agreed with this idea. March of Dimes brings recognition to these disparities and implies intention behind care scarcity. Renaming maternal care deserts as maternal care disinvestment zones will bring more attention to the intentional root of the problem.
The opinions expressed in this commentary are those of the writer and not necessarily those of the AFRO.