Race and maternal health in the United States

Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent."^[1] Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030.^[2][3] The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death.^[4] Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).

There are multiple explanations for racial disparities in maternal health. Biological factors, such as higher rates of preexisting chronic disease prior to pregnancy, fail to fully account for differences in outcomes.^[5] There is a lack of evidence to support a genetic difference between racial groups as a cause of maternal health disparities such as preterm birth.^[6] Social factors, such as structural racism, have been suggested as a contributory cause of the wide racial disparities in maternal health in the United States.^[7][8] Disparities in adverse pregnancy outcomes for Black women have been hypothesized to be related to higher loads of allostatic stress before and during pregnancy, epigenetic changes, and/or telomere shortening.^[9] Studies of potential biomarkers of allostatic stress have failed to date to demonstrate the racial group differences seen with self-report measures.^[9][10] Inequities in access and the provision of health care may also effect maternal outcomes.^[5] The effects of implicit and explicit provider bias in obstetrical care has been poorly studied and may contribute to disparate outcomes.^[11] The information health care providers share and how that information is presented affects the autonomy and decision-making of birthing women.^[12]

Proposed interventions to reduce racial disparities in maternal health outcomes target changes at individual, health care system, and health care policy levels.^[1] Some states are utilizing federal block grant money for initiatives targeting reductions in maternal morbidity and mortality for Black and Hispanic women.^[13] Measurement, methodological, and ethical issues arise when using race in health outcomes research.^[14][15] Recommendations for appropriate use of race as a research variable may limit use of white normative standards in the future, which can imply non-white people as being atypical.^[16] Proposed alternative variables for race may be genetic ancestry, socioeconomic factors, or differential opportunities.^[16]