Understanding the Black maternal health crisis and how digital health can make a difference 

The U.S. is embroiled in a maternal health crisis, with pregnant people today 50% more likely to die in childbirth than their parents were a generation ago. A driving factor behind the high mortality rate is the disproportionate number of Black birthing parents who experience pregnancy-related complications and death. Devastatingly, the CDC estimates that 84% of maternal deaths in the U.S. are preventable and says “recognizing the urgent maternal warning signs, getting an accurate and timely diagnosis, and quality care can save lives.” 

While the crisis is driven by large, systemic issues, health plans and employers can be crucial players in the fight to improve maternal health outcomes. Because these entities often determine people’s access to quality care, they’re well-positioned to make an impact, reducing disparities and improving maternal health outcomes for their Black members and employees. Here’s what employers and health plans need to know about the challenges facing Black birthing parents in the U.S., and how digital solutions can make a difference. 

The challenges facing Black birthing parents in the U.S.

History of discrimination

For centuries, Black people in the U.S. have experienced discrimination in health care with long lasting, intergenerational consequences, including obstetric violence, a poor quality of care, and medical experimentation. For example, techniques in modern gynecology were perfected through experimental reproductive health surgeries on two enslaved Black women, Anarcha and Lucy, without anesthesia despite its availability at the time. The legacy of these actions still permeate health care delivery today, and is seen in provider biases around pain level thresholds for Black birthing people.

Government-sanctioned control of the reproductive health of Black birthing people extended far beyond slavery. From the 1900s to the 1970s, thirty states supported formal eugenics programs that forced Black women to undergo irreversible sterilizations. 

Today, 11% of Black people report having experienced discrimination in the health care system. In parallel, 55% of Black Americans say they don’t trust the healthcare system. A lack of trust in the health care system due to discriminatory health care practices often leads people to delay care, ultimately contributing to worsening health outcomes. 

Poor quality of care & bias in care delivery

Many Black birthing people do not have access to high-quality care today, resulting in significantly worse maternal health outcomes among this population compared to their white counterparts. Studies show that Black women are dying from childbirth-related causes at rates almost 300% higher than white women. Another study in New York found that 75% of Black birthing parents give birth at Black-serving hospitals. These birthing locations perform worse than white-serving locations on 12 out of 15 maternal health outcome measures, including trauma, C-section births, and maternal mortality. 

Implicit bias among healthcare providers also is a significant contributor to negative Black maternal health outcomes. Research shows that clinicians have biases toward Black patients that impede their ability to provide effective care. Roughly a third of all Black people report personally experiencing racial discrimination when going to a doctor or health clinic. This bias is shown to negatively impact patient-provider interactions, treatment decisions, treatment adherence, and health outcomes. 

Lack of access to high-quality care

Maternity care deserts
‍March of Dimes deems over a third of counties in the U.S. maternity care deserts. In these counties, birthing parents have either limited or no access to maternity care services, meaning they have to travel significant distances to receive essential pre- and postpartum care. Racial disparities also show up in this geographic access to care. 20% of Black women do not have access to adequate prenatal care, compared to 10% of white women. Similarly, one in six Black babies is born in a maternal care desert, contributing to the worsening outcomes experienced by Black families. 

Concordant care matching
‍For Black birthing parents that do have local access to high-quality care, they are still unlikely to have access to a healthcare provider who shares their same background and lived experiences. A Stanford University study pairing Black patients and doctors identified several benefits to care matching, including:

• More engaged patient-doctor conversations
• Improved prescription adherence 
• More detailed note-taking by practitioners 
• Greater willingness to undergo preventative treatment
• Better patient understanding of health risks and complications

However, while close to 13% of the U.S. population is Black, only 5% of the physicians in the U.S. are Black. This makes care matching more difficult, preventing this community from benefiting from the improved outcomes associated with culturally concordant care.

Poor data collection processes

A lack of standardized data collection processes in the U.S. healthcare system further contributes to the negative outcomes experienced by Black birthing parents.

Existing race & ethnicity data collection processes
‍Existing data collection processes can contribute to inequitable care. When completing forms at a doctor’s appointment, patients usually only have one of six options for their race/ethnicity: White or Caucasian; Black or African American; Latino or Hispanic; Asian American; Native Hawaiian and Pacific Islander; and American Indian or Alaska Native. However, these limited options eliminate nuances, hindering the delivery of patient-centered care. Without in-depth race and ethnicity data, health care systems can’t adequately train their staff to care for culturally and linguistically diverse populations. What’s more, health disparities and inequities can go unaddressed, and research is less robust without the desegregation of data by race. 

Social determinants of health screening
Only 24% of hospitals screen for the social determinants of health (SDOH)—like access to safe and affordable housing, reliable transportation, and healthy and nutritious food. SDOH play an outsized role in health outcomes due to inequitable access to high-quality social support for varying groups of people. However, the lack of standardized SDOH data collection means that the vast majority of people don’t get an opportunity to share their needs with their providers. As a result, providers and health systems aren’t able to provide patients with resources that can help fill unmet social needs, further exacerbating health disparities.