How to Combat Racial Disparities in Maternal Health: 6 Key Strategies

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When people think about pregnancy and childbirth, they tend to imagine exciting milestones, like hearing a baby’s heartbeat for the first time, preparing the nursery, or meeting a newborn after months of anticipation. But for many families, pregnancy and childbirth also pose serious health risks. In the United States, hundreds of women die during pregnancy or within a year of giving birth each year, and thousands more experience short- and long-term complications related to pregnancy and childbirth. Even more concerning, more than 80% of pregnancy-related deaths are considered preventable.

While advances in medicine have significantly improved maternal care over the last century, pregnancy-related complications remain a major public health concern, with the US maternal mortality rate far exceeding that of other high-income countries. Each year, there are 18.6 deaths per 100,000 live births during pregnancy or within the year following childbirth, and thousands more women experience serious short- and long-term health complications.

Not everyone experiences these risks equally. When we examine the number of deaths per 100,000 live births in 2023, there are significant disparities in the overall maternal mortality rate, with Black women 3-4 times more likely to die from pregnancy-related causes than white women.

10.7 deaths in Asian women
12.4 deaths in Hispanic women
14.5 deaths in White women
50.3 deaths in Black women

These disparities can’t be explained by biology alone. Instead, they reflect the complex ways that healthcare access, racism, discrimination, economic conditions, community resources, and public policy influence maternal health outcomes.

Let’s explore the factors contributing to maternal health inequities and discuss six evidence-based strategies to improve outcomes and advance maternal health equity.

Understanding the Root of Disparities

Maternal health outcomes are shaped by more than medical care alone. Research shows that social, economic, and environmental factors play a significant role in determining who has access to the resources and support needed for a healthy pregnancy and postpartum period.

For many communities of color, barriers such as poverty, food insecurity, housing instability, gaps in insurance coverage, and limited access to healthcare can make it more difficult to receive timely prenatal and postpartum care. These challenges are often linked to broader social and structural inequities that influence health long before pregnancy begins.

Access to care is another important factor. Some communities face shortages of healthcare professionals and facilities that provide maternal care, particularly in rural areas. These shortages disproportionately affect American Indian, Alaska Native, and Black women, creating additional barriers to receiving care throughout pregnancy and childbirth.

Research has also shown that racism and discrimination contribute to disparities in maternal health outcomes. One study found that discrimination played a role in nearly 30% of pregnancy-related deaths. Other studies have found that Black and Hispanic women experience higher rates of mistreatment during pregnancy and childbirth, while Black women are more likely to undergo cesarean deliveries than white women with similar health profiles. While some of these differences persist even after adjusting for clinical risk factors and demographic characteristics, researchers continue to examine how healthcare access, hospital-level practices, quality of care, patient-provider interactions, and structural inequities contribute to these disparities.

These findings highlight an important reality: maternal health disparities aren’t driven by a single factor. They’re influenced by the social determinants of health, access to quality healthcare, experiences of racism and discrimination, and the policies and systems that shape health opportunities. Because these disparities have multiple causes, addressing them requires coordinated action across healthcare systems, communities, and public policy.

The following six strategies represent key opportunities to improve maternal health outcomes and reduce racial disparities in care.

Strategy #1: Improve Access to Quality Maternal Care

Access to healthcare before, during, and after pregnancy is one of the most important factors influencing maternal health outcomes. Prenatal care provides opportunities to identify potential complications before they become an issue, manage existing health conditions, support healthy behaviors, and connect families with the resources they need. Postpartum care is equally important because many pregnancy-related complications occur after delivery.

What happens if someone can’t access care? Research shows that patients who don’t receive prenatal care are 3 to 4 times more likely to die due to pregnancy-related complications, and have an infant mortality rate nearly five times higher than that of infants who received prenatal care.

Geographic barriers also play a role. Many communities face shortages of maternal healthcare providers and facilities, with access varying across insurance types and geographic regions. In California, for example, 82% of Medicaid beneficiaries received timely prenatal care compared with 92% of individuals covered by commercial insurance. At the same time, nearly seven million women in the US live in rural areas and counties without any obstetric providers or hospitals that offer obstetric services, creating additional challenges for accessing care during pregnancy and childbirth.

Addressing these gaps requires action at multiple levels.

Healthcare systems can improve access by standardizing evidence-based care, expanding telehealth services, integrating maternal health screening into primary care settings, and strengthening referral networks. Communities can identify and address local barriers such as transportation challenges, housing instability, food insecurity, financial stress, and exposure to violence.

Healthcare professionals also play an important role by offering their services at community health centers, connecting patients with community resources, supporting insurance navigation, and helping individuals access services such as nutrition counseling, mental health support, and stress-management programs.

Improving access to quality maternal care is one of the most effective ways to reduce preventable pregnancy-related complications and advance maternal health equity.

Strategy #2: Address Bias and Discrimination in Healthcare

Improving access to care is only part of the solution. To reduce racial disparities in maternal health, it’s also important to address the ways that structural racism, bias, and discrimination can influence healthcare experiences and outcomes.

Structural racism refers to the ways that laws, policies, institutions, and systems (often unknowingly) create and perpetuate inequities. These inequities can affect health long before pregnancy begins by influencing access to education, employment opportunities, housing, healthcare, and other resources that support well-being. During pregnancy, structural racism can also shape healthcare experiences and contribute to differences in maternal outcomes.

Within healthcare settings, both conscious/explicit and unconscious/implicit bias can affect the quality of care patients receive and contribute to adverse maternal outcomes. Research demonstrates that Black women are more likely to report having their concerns dismissed during pregnancy and childbirth and experience higher rates of mistreatment (inequitable healthcare access, quality of care, communication, and overall negative patient experiences) than their white counterparts.

Studies have also documented disparities in pain assessment and treatment across racial groups, highlighting how discriminatory beliefs and practices that have historically influenced medical care are still present and actively affecting Black patients. In fact, false beliefs about biological differences between Black and white patients, including the misconception that Black people feel less pain, persist among some healthcare trainees and providers.

The effects of racism in healthcare extend beyond individual interactions. Historical injustices, including unethical medical experimentation on Black communities, have contributed to longstanding distrust of healthcare institutions. Understanding this history is important because trust plays a critical role in healthcare engagement, communication, and maternal health outcomes.

Building trust requires respectful, patient-centered care. In a 2024 poll, 16% of respondents reported feeling ignored, disrespected, coerced, medically harmed, or dismissed by a healthcare provider, with higher rates reported among younger adults and racial and ethnic minority populations. The same poll found that trust declined during the postpartum period, highlighting the importance of continued support after delivery. And when asked what contributes to trustworthy care, 97% of respondents said providers should communicate honestly, clearly, and empathetically while respecting patient autonomy. Respondents from racial and ethnic minority groups also emphasized the importance of active listening and patient-centered care.

Healthcare systems can help address these challenges through a combination of provider education, quality improvement initiatives, and standardized care practices. Implicit bias training can help healthcare professionals recognize assumptions that may influence patient interactions and clinical decision-making. Standardized care protocols can also reduce variation in treatment and improve outcomes. For example, implementing a standardized labor induction protocol has been associated with reductions in racial disparities in cesarean deliveries and infant morbidity.

Addressing bias and discrimination in healthcare is an important step toward ensuring that every patient receives respectful, equitable, and high-quality maternal care.

Strategy #3: Strengthen and Diversify the Healthcare Workforce

Our world is rich and full of different cultures, languages, races, and ideas. Therefore, it makes sense that the healthcare workforce should reflect that diversity.

The healthcare workforce plays an important role in shaping patient experiences, access to care, and health outcomes. Building a workforce that reflects the diversity of the communities it serves can help strengthen trust, improve communication, and advance maternal health equity.

Research reveals that representation matters. Studies have found that Black patients report higher levels of satisfaction when receiving care from Black physicians and may be more likely to agree to recommended preventive services, screenings, and vaccinations. Physicians from underrepresented racial and ethnic backgrounds are also more likely to practice in medically underserved communities, helping expand access to care where it is needed most.

Creating pathways for students from underrepresented backgrounds to enter healthcare professions is one strategy for addressing workforce disparities. Reducing barriers to education, training, and leadership opportunities can help create a healthcare workforce that is better equipped to meet the needs of diverse patient populations. Representation matters, and addressing structural racism, bias, and discrimination in healthcare requires diverse healthcare professionals and leaders at every level of the system.

In addition to workforce diversity, culturally responsive care is essential to improving maternal health outcomes. Providers who take the time to understand each patient’s experiences, values, and perspectives can build stronger relationships, support shared decision-making, and provide more effective care. Cultural responsiveness also requires curiosity, humility, and a willingness to learn from the communities being served.

Expanding access to midwives, doulas, and community health workers can also help improve maternal health outcomes. Research has shown that patients who receive care from midwives are less likely to experience preterm birth, less likely to undergo cesarean delivery, and more likely to breastfeed. Doulas, who provide support throughout pregnancy, childbirth, and the postpartum period, have been associated with fewer birth complications and lower rates of low birth weight. Community health workers can further support patients by coordinating care, connecting families with resources, and providing culturally relevant education and support.

Together, these approaches can help reduce barriers to care, strengthen trust between patients and providers, and improve maternal health outcomes for communities that have historically experienced healthcare inequities.

Strategy #4: Address Social Determinants of Health

Although medical care plays an important role in maternal health, it’s only one piece of the puzzle. Because not all access to resources is created equal, health outcomes are also shaped by the circumstances in which people are born, grow, live, work, and age. (For example, consider that kids living in neighborhoods with poor air quality often experience higher rates of asthma, whereas children raised in agricultural environments have dramatically lower rates of asthma and allergies).

These circumstances are known as the social determinants of health (SDOH), and they influence access to opportunities and resources that support healthy pregnancies and positive birth outcomes. The SDOH include:

Economic Stability: Being financially stable enables access to quality healthcare, food, and housing, while economic instability decreases life expectancy and increases the risk of unfavorable health outcomes.
Education Access and Quality: Having a higher level of education is linked to better outcomes, including higher earnings, improved health literacy, and better health outcomes. Poor education quality leads to health and educational disparities.
Neighborhood and Built Environment: Safe living environments, healthy food options, and clean water promote better health. Unsafe environments are risk factors for chronic stress, which increases the risk for chronic conditions such as diabetes, hypertension, and mental health conditions.
Social and Community Context: Supporting emotional well-being and access to resources is linked to supportive relationships and social networks. Conversely, discrimination and isolation negatively impact health outcomes.
Health Care Access and Quality: Socioeconomic status, discrimination, provider shortages, and geographic location are limiting factors to receiving high-quality health care and lead to worse health outcomes.

All of these key factors help explain why maternal health disparities persist across racial and ethnic groups. Housing instability, transportation barriers, food insecurity, and economic hardship make it more difficult to access healthcare and maintain health during pregnancy. Research also shows that chronic stress associated with racism and other social inequities negatively affects maternal and infant health outcomes.

Because many of the factors that influence maternal health exist outside of traditional healthcare settings, reducing disparities requires solutions that extend beyond healthcare alone. Cross-sector partnerships that bring together healthcare organizations, public health agencies, housing programs, educational institutions, and community organizations can help address the root causes of health inequities. For example, one recent study found that investments in housing and social services were associated with reductions in severe maternal morbidity during labor and delivery.

Addressing the social determinants of health, including housing stability, food security, and access to healthcare, is a clear and demonstrable method to improve patient outcomes and reduce disparities.

Strategy #5: Improve Data, Accountability, and Policy

Information and data play an important role in understanding and addressing maternal health disparities. While maternal mortality rates highlight the scope of the problem, they don’t always tell the full story.

Information about pregnancy and birth outcomes is often incomplete, particularly when maternal or infant deaths occur. For example, an estimated 25 to 50% of still births don’t have a documented cause because autopsy results can take months to complete, while death certificates must be filed within days. Aside from the cause of death, key information such as patient history, demographics, and behaviors isn’t collected by hospital staff.

Improving data collection helps healthcare systems, researchers, and policymakers identify trends, better understand the causes of maternal morbidity and mortality, and help them develop targeted interventions. Tracking outcomes by race and ethnicity is particularly important because it can help reveal disparities that might otherwise go unnoticed and support efforts to improve health equity.

For example, the Black maternal mortality rate in the US is staggering when compared to other races in the US. However, collecting data is only the first step. Meaningful change also requires accountability. Healthcare systems, public health agencies, and policymakers can use data to evaluate maternal health outcomes and identify gaps in care to improve quality, safety, and overall maternal outcomes.

Policy also plays an important role in shaping maternal health. Investments in maternal health programs, expanded access to care, stronger data systems, and the implementation of evidence-based policies and system-level changes that address health inequities can reduce preventable pregnancy-related complications and deaths.

By improving data collection, strengthening accountability, and supporting evidence-based policy change, we can better understand maternal health disparities and take action to address them.

Strategy #6: Invest in Community-Based and Culturally Competent Care

Improving maternal health outcomes requires more than clinical care alone. Community-led, maternal health equity-focused programs are another fundamental way to support pregnant and postpartum individuals within communities of color by providing culturally specific education, advocacy, care coordination, and culturally responsive services.

Culturally responsive care is especially important for communities that have historically experienced inequities in healthcare. Community-led programs are often uniquely positioned to provide this type of care because they understand the needs, values, and experiences of the populations they serve. By building on existing relationships and local knowledge, these programs strengthen communication, foster trust, improve access to education and resources, and connect individuals with support throughout pregnancy and the postpartum period.

Community health workers, doulas, and peer support programs can help bridge gaps between healthcare systems and the communities they serve by providing education, emotional support, care coordination, and assistance navigating healthcare and social services. Research supports community-based maternal health programs to improve outcomes while helping address barriers to care. For example, Black-led maternal health organizations are working to address persistent disparities through advocacy, education, community support, and culturally responsive care.

While community-based care isn’t a replacement for high-quality healthcare, it’s a critical partner in creating a more equitable maternal health system. By investing in trusted community organizations and culturally responsive programs, healthcare systems and policymakers can help ensure that all families have the support they need before, during, and after pregnancy.

Addressing Maternal Health Disparities: Bringing It All Together

Racial disparities in maternal health mirror the combined effects of healthcare, social, economic, and structural factors. Because these disparities are driven by multiple influences, improving outcomes requires coordinated action across healthcare systems, communities, and public policy.

More than 80% of pregnancy-related deaths are preventable. The disproportionately high rates of maternal mortality and severe maternal morbidity experienced by Black women underscore the urgent need to address racism, inequitable access to care, and other social and structural barriers to health.

Improving maternal health outcomes requires coordinated action across healthcare systems, public health organizations, community leaders, and policymakers. Expanding access to quality maternal care, addressing bias and discrimination, strengthening the healthcare workforce, investing in community-based programs, improving data collection, and addressing the social determinants of health are all important steps toward advancing maternal health equity.

By learning about the systemic factors that contribute to maternal health disparities, we can each play a role in advancing change, whether by listening to and believing patients, advocating for equitable care, supporting community-led maternal health programs, or pushing for policies that improve access and accountability. Together, these actions help create a healthcare system where every person has the opportunity to experience a safe pregnancy, childbirth, and postpartum experience.

Black Maternal Health Resources List

Key Takeaways

Maternal health disparities are driven by interconnected social, economic, healthcare, and structural factors.
Black women experience disproportionately high rates of pregnancy-related mortality and severe maternal complications.
Expanding access to quality prenatal and postpartum care is critical for reducing preventable maternal deaths.
Addressing bias, discrimination, and social determinants of health is essential for advancing maternal health equity.
Community-based programs, workforce diversity, improved data systems, and evidence-based policy changes can help create more equitable maternal health outcomes.

Resources

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Author: Jennice Lavergne, MD, is doctor and a writer who’s passionate about reducing mental health stigma and improving access to mental health resources through culturally competent patient care, writing, digital health, and research. In her free time she loves dancing, reading, and making beautiful memories with her loved ones.

Allopathic Medicine (MD), Equity, Diversity, Inclusion & Belonging, Healthcare Facts, International Medical Graduates (IMG), LPN (Licensed Practical Nursing), Nurse Practitioner (NP), Osteopathic Medicine (DO), Physician Assistants/Associates (PA), Registered Nursing (RN), Research