Racial Disparity of Pregnancy-Related Mortality

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May 10, 2021 · By Gaylynn Thomas, RN
By looking closely at some data, we can isolate race as a risk factor separate from maternal age and education level. This data also illuminates cardiovascular risks for mothers of color as it relates to pregnancy-related death.

Maternal age
As maternal age increases, so does the disparity of pregnancy-related death between black and white mothers (pregnancy-related mortality ratio, or PRMR). In the aforementioned study, this black-to-white disparity was lowest for teen mothers (PRMR ratio of 1.5:1), and highest for mothers in their 30s (PRMR ratio of 4.3:1).

Education level
In general, women with higher completed education such as a college degree have a lesser chance of dying as a result of pregnancy than women who completed fewer years of education. But when introducing race as a second variable, the data paints a picture of even greater inequality. Black mothers with a college degree still have a slightly higher chance of a pregnancy-related death than white mothers who didn’t finish high school. Furthermore, when comparing black and white mothers who all completed a college education, black mothers are over 5 times as likely to die due to pregnancy-related issues than their white counterparts.

Cardiovascular issues
The CDC states that cardiomyopathy, thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed to a significantly higher proportion of pregnancy-related deaths among black women than among white women. Black women have a higher risk of mortality due to cardiovascular diseases in general. It is important for healthcare workers to address this intersection of pregnancy and heart disease as sources of mortality for mothers of color. 

What factors cause these disparities?
As with any disparity caused by systemic racism or bias, there are many overlapping contributing factors. These deaths occur when three or four of these variables intersect: 

  • Community
  • Health facility
  • Patient/family
  • Provider
  • Systemic issues

Note that many of these factors, such as community and family, are outside the control of healthcare workers. Still, there is a lot that can be done within healthcare systems in order to prevent these unnecessary deaths.

Reducing the number of preventable deaths 
In the aforementioned study, the CDC states that 60% of the pregnancy-related deaths were preventable. They also state that race and/or ethnicity had no effect on the preventability of those deaths. This indicates that mothers of color are at a heightened risk as a direct result of differences in access to care and quality of care during their pregnancy. In another similar study, black and white women were found to have similar rates of pregnancy complications, but the black women had a higher mortality rate. 

Healthcare workers can help prevent these deaths by identifying and addressing biases and structural racism in their practice and workplace. Making connections to support the community and build social resilience will also improve trust and communication in order to uplift other prevention efforts.

To read another blog post related to Race and Maternal-Fetal care, visit our blog post

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