This Black History Month 2025, P4A is focusing on Black maternal health. We published a substantial body of research in the last year that examines the factors that contribute to persistent disparities in maternal health outcomes in the United States. Significantly higher rates of adverse outcomes for Black mothers have been known for years, yet the numbers are not improving. Why?

In 2023, while U.S. maternal mortality rates declined overall, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, compared to 14.5 for white women. This significant disparity is not merely a statistic. The gap between Black and white women has complex and multifaceted causes, but the fact that these statistics hold true across socioeconomic groups points to systemic causes.

In 2018, tennis champion Serena Williams experienced life-threatening complications after giving birth. Though she told doctors about her history of blood clots, they dismissed her concerns, leading to a critical delay in treatment. When she shared her near-death experience,  it caught the attention of the nation, and stands as additional evidence that Black women, regardless of their social or economic status, are likely to receive substandard maternal care.

The number of individual stories like Williams’ point to broad systemic factors at play. The following are a sampling of P4A-funded studies that focus on the roles of wealth disparity and structural racism in maternal health care.

Structural Racism and Birth Outcomes

In August 2024, the Urban Institute published a study that delves into how structural racism and neighborhood deprivation contribute to disparities in birth outcomes. The research conducted by Co-Director of Policies for Action and Senior Fellow Lisa Dubay; Health Policy Division Senior Research Associates Anuj Gangopadhyaya and Emily Johnston; and Research Analyst Vincent Pancini found that infants born to Black mothers experience higher rates of preterm birth and low birth weight compared to those born to white mothers, regardless of neighborhood advantage.

Factors such as maternal education, age, and marital status were significant contributors to these disparities, with white mothers generally benefiting more from these factors than Black mothers. However, the findings suggest that, even when they and their children live in relatively advantaged neighborhoods, the pervasive impact of structural racism acts against Black mothers.

For example, in 2020, Dr. Chaniece Wallace, a 30-year-old Black pediatric chief resident at Indiana University School of Medicine, died from complications of preeclampsia two days after giving birth. Despite her medical knowledge and access to healthcare, her condition led to severe complications, including liver rupture and kidney damage, ultimately resulting in her death. Dr. Wallace's tragic story strongly suggests that even highly educated Black women with greater socioeconomic status are not exempt from adverse maternal health outcomes, and that they and their infants derive fewer health benefits from higher social status than do their white counterparts.

The Wealth Gap and Black Maternal Health

Researchers at The New School Budget Equity Project reported on their study of the Multnomah Mother's Trust in Oregon. The program was launched in 2021 within the Multnomah County Department of Human Services in Portland to address “racialized poverty” in the County. Its suite of services includes providing $500 monthly in guaranteed income to 100 Black mothers who head single-parent households.

The mothers selected to receive support are from families that were severely impacted by the COVID-19 pandemic and were part of the County health department’s Healthy Birth Initiative and the County’s Food Justice ARPA-funded program. The study’s focus was to examine whether this guaranteed income could strengthen the crucial connection between economic stability and health.

Indeed, the modest amount of extra money, along with training and development in other wealth-building practices, enabled the women to pay down debt, put aside savings for a down payment on a home, and access more reliable family healthcare.

Maternal Health Outcomes for Black Immigrants

At the University of North Carolina, Chapel Hill, researchers Iheoma U. Iruka, Professor in the Department of Maternal and Child Health at the Gillings School of Global Public Health, and Menna Mburi, a Doctoral Student in Public Policy, explore the unique challenges faced by Black immigrant women in the U.S. healthcare system. These women encounter compound challenges depending on their race, immigration status, and birthplace, leading to poor maternal health outcomes.

The new study aims to understand how these factors affect both their access to maternal care and birth outcomes, with a special emphasis on states with expanded Medicaid/CHIP eligibility for immigrant populations. By shedding light on the unique experiences and obstacles faced by Black immigrant mothers, the study seeks to inform policies that ensure our healthcare systems better serve the diverse needs of immigrant communities of color.

How Can Research, Policy, and Advocacy Inform Solutions?

Addressing today’s lingering disparities in maternal health requires comprehensive policy approaches that target multiple systems and are tailored to the specific needs of Black mothers and infants. Collectively, these studies highlight some of the social determinants of health and the complex interplay between economic factors, structural racism, and maternal health. Their findings present communities and legislators with evidence to support policymaking that produces a healthcare system that works for all. Recommendations include expanding access to quality healthcare, improving neighborhood conditions, and addressing systemic racism in housing, education, and employment. Improving outcomes for this population improves the system for all of us, supporting a national culture of health.

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These and other studies will be the topics of discussion during the Advancing Maternal Health Equity event on February 27, 2025, hosted by Policies for Action (P4A) at the Urban Institute and sponsored by the Robert Wood Johnson Foundation.

Policymakers, community leaders, providers, researchers and other interested individuals are invited to join in. The program will begin at 1:00 pm at The Urban Institute, 500 L'Enfant Plaza SW, Washington, DC 20024. It will be live-streamed as well, with opportunities for Q&A with audiences online and in person.

Register here: https://www.urban.org/events/advancing-maternal-health-equity-how-can-research-policy-and-advocacy-inform-solutions 

2024 P4A Research on Black Maternal Health

  1. Empowering Black Mothers through the Multnomah Mother's Trust | The New School Budget Equity Project
  2. Addressing Racial Disparities in Maternal and Infant Health Outcomes
  3. Deeper Than Race: Exploring Black Immigrant Maternal Health in the United States
  4. How Structural Racism, Neighborhood Deprivation, and Maternal Characteristics Contribute to Inequities in Birth Outcomes | Policies for Action

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