The United States is in the midst of a maternal health care crisis, where Black birthing people are 3-4 times more likely to die from pregnancy related causes within a year of childbirth. Black individuals, even those with low-risk pregnancies, have been more likely to experience severe maternal morbidity (SMM), both during and after the birth hospitalization than their white counterparts. SMM is defined by the Centers for Disease Control and Prevention (CDC) as “any outcome of labor and delivery that leads to short or long term health consequences among women….it includes serious and potentially life-threatening events and outcomes such as hemorrhage, eclampsia, blood transfusion, and hysterectomy.” (CDC.gov). In 2017, there were over 25,000 hospital deliveries with an SMM (not including those who only received a blood transfusion) in the U.S.

Birthing people of all racial, ethnic, economic, and geographic regions have been impacted, but no group had been affected more than the Black birthing population. In fact, Non-Hispanic Black women have the highest rates for 22 of the 25 severe morbidity indicators that are utilized by the CDC to classify severe maternal morbidity. CDC notes that the increase in SMM among Black birthing people “may be due to several factors including access to care, quality of care, prevalence of chronic diseases, structural racism, and implicit biases.“ (Pregnancy Mortality Surveillance System, 2020).   

Rate of Severe Maternal Morbidity per 10,000 Deliveries by Race and Ethnicity, 2017

The risk for severe morbidity from postpartum hemorrhage was higher for non-Hispanic Black women (26.6%) as compared to non-Hispanic white woman (21.4%), and Black woman were more likely than non-Hispanic white women to undergo hysterectomy related to postpartum hemorrhage (2.4% vs 1.9%) (Gyamfi-Bannerman, et al., 2018). Additional indicators of SMM, such as transfusion rates and hypertension in pregnancy, have been shown to have poor outcomes among Black birthing women. Although cesarean sections in and of themselves are not an indicator of SMM, they have been shown to increase the likelihood a woman will experience SMM. In a cohort study of 2,660,000 women hospitalized for birth in the United States between 2011 and 2014, researchers found that cesarean birth was associated with an approximately threefold higher likelihood of SMM (Fan et al., 2021) than vaginal birth. Data from CDC National Centers on Health Statistics (NCHS) show a widening gap in the rate of cesarean births among Black first-time moms with full-term pregnancies with a single baby in the head down position (NTSV) then their white counterparts that has persisted for decades. The NTSV cesarean birth rate in 2020 for non-Hispanic Black women was 30.6% vs. 24.9% non-Hispanic white women.

To obtain input on specific steps to reduce these documented, yet unacceptable disparities in maternal health outcomes, March of Dimes, National Birth Equity Collaborative (NBEC), and HHS convened individual expert consultants on March 19, 2021. Thirty-six Black maternal health experts shared their perspectives through a pre-meeting survey, and through robust facilitated conversations where they worked to identify the key drivers of disparities and potential solutions to advance equity in maternal health. Based on their guidance and input, the specific interventions and activities for the Maternal HealthCARE project were developed.