Women of color, particularly Black women, encounter distinct challenges during pregnancy and childbirth. This results in disproportionately adverse outcomes such as invasive treatments, infant mortality, severe complications, and even death experienced by these women. The role of racism and discrimination are highlighted even when controlling for certain underlying social and economic factors. For example, education and income are not protective of poor outcomes, and inequity in health care persists for Black women.

Many Black women endure unheard and unseen negative experiences, leading to lives lost because of dismissiveness that discourages reaching out or believing their pain is normal when it’s not. A pregnant Black mom, better known as Serena Williams’s own experience, exemplifies this reality. Her essay about the issue last February gives direct insight into where medical staff initially dismissed her concerns about blood clots, wasting crucial time before proper diagnosis and treatment.

Even as an affluent woman, William’s wishes were still disregarded. Diversity and equity in hospitals and health care provider facilities are the first steps toward a safe and respectful space for all. No one should feel like they cannot talk or speak up. Black women face a higher risk of delivery complications and invasive treatments compared to white women due to significant disparities in health care. These disparities include frequent dismissal of pain, the projection of stigmas, and the unequal treatment of Black women in the health care field. This narrative reviews three themes elucidated from several sources.

Theme 1: Racial biases and stereotypes against Black women contribute to disparities

A Black woman is looking to have a child and is adjusting her life accordingly. In doing so, she does not recognize the risk she is taking for herself. As of 2023, Black women are three times more likely than white women to not only die but also have severe pregnancy complications. Dismissal of pain, poor communication, and the projection of biases by health care providers contribute to this statistic. These are some key differences women of color face compared to white women.

Theme 2: Inequitable health care further exacerbates the challenges Black women face

Equity implies that everyone receives what they need, while equality occurs when everyone gets the same and just treatment. However, nothing is equitable or equal when one individual gets better or more than another. Concerning health care quality, white women are treated better compared to Black women. “Even controlling for clinical characteristics, Black women are less likely than white women to undergo labor induction or receive regular cervical examinations during labor and more likely to undergo cesarean delivery under general anesthesia.” Racist behavior, whether intentional or not, affects the overall treatment of that patient.

Inadequate health care is more prevalent among Black Americans with lower socioeconomic status. This is associated with access, insurance, and monetary income because as you earn more, it “translates into superior access to the fastest, most expensive health care.” The lack of resources given to Black women happens regardless of socioeconomic status. For example, it is more prevalent for a Black mother to be without prenatal health care or little to none if she is both poor and Black. Many Black women tend to live in maternity deserts where they’re further marginalized due to the lack of resources. “To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer’s, and, most recently, COVID-19.” Furthermore, Black Americans have less access to adequate medical care and a shorter life expectancy compared to white Americans. In addition to the lack of health care many African Americans experience, much of the care they receive is inequitable.

Theme 3: Morbidity and mortality in the Black pregnant population

Institutionalized and embedded racism in medical curricula contributes back to increased suffering among Black women, who also face heightened risks due to inadequate, impersonal, and biased health care. Relative to their babies and themselves, Blacks experience significantly higher morbidity and mortality rates compared to their racial counterparts, particularly whites. Stark evidence is highlighted by Donna Hoyert, PhD, “In 2021, the mortality rate for non-Hispanic black women was 69.9 deaths per 100,000 live births.” This notes the nearly three times higher mortality rate African Americans have than their Hispanic and white equivalent. Even controlling for socioeconomic factors doesn’t fully explain this stark discrepancy. Spotlighting, racism, dismissal, and inadequate treatment in the care of Black patients, further exacerbate negative health outcomes.

Solutions

Fortunately, multiple solutions can be implemented to improve the adverse experiences Black women face during labor and delivery.

Pair white and Black women through their pregnancy. The pair’s focus would be to ensure the women receive the same treatment. This could diminish stereotypes projected onto Black women because the health care would be women-centered (not race-centered).

Augment the workforce to include more doctors of color. The simplicity of having things in common allows for comfort because one’s guard is down, allowing for trust, connection, and rapport between a patient and health care provider. “In addition to shared culture and values, a Black physician can offer Black patients a sense of safety, validation, and trust.”

Eliminate ties between race and certain diseases during medical training. This sort of thought process is an “unscientific racial stereotype.” With the disregard of this ideal more trust will ensue.

Create a safe place to talk freely and ask questions. Black women often feel unseen and refrain from asking questions due to feelings of invisibility. Addressing patient concerns and reassuring them can help solve this issue. Overall, achieving equity in health care is essential to eradicating the adverse experiences faced by Black women.

Conclusion

Due to implicit biases, stereotypes, and inequitable health care, Black women face adverse outcomes during labor and delivery, placing them at high risk for negative outcomes. These risks stem from doctor-patient interactions influenced by biases rooted in medical training, leading to inequitable treatments. Acknowledging imperfections and biases is the first step toward improvement while spreading awareness and promoting trauma-informed care are crucial for achieving a more equitable future for all.

Acknowledgment: Research Scholars Program Harvard Student Agencies

Sophia Alexander is a high school student. Deepjot Singh is an obstetrician-gynecologist. Jessica L. Jones is a public health physician.