[1] Maternal health, a vital component of public health, encompasses the physical, mental, and social well-being of women during pregnancy, childbirth, and the postpartum period. Effective maternal health services, which include access to prenatal care, nutritional support, mental health resources, and postpartum care, are essential for reducing maternal mortality and fostering healthy outcomes for mothers and their children. However, the United States faces significant challenges in maternal health, with maternal mortality rates that are alarmingly high for a developed nation.
[2] These issues are compounded by stark racial disparities. Addressing the systemic racism that impacts healthcare access and quality is crucial to improving maternal health outcomes in the United States. Furthermore, the mental health effects of racism, including post-traumatic stress conditions, present additional barriers to achieving health equity for mothers and their children.
The Link between Public Health Services and Maternal Health.
[3] Public health services aim to improve community health by promoting healthy lifestyles, preventing disease and injury, and responding to health threats. Maternal health, as part of this mission, requires comprehensive services that include access to quality prenatal care, safe delivery services, nutritional support, and mental health care. When these services are effective and accessible, they not only protect maternal health but also promote healthier outcomes for children and strengthen overall family well-being.
[4] The U.S. Public Health Service (PHS), under the Department of Health and Human Services, oversees several public health initiatives to prevent disease, improve maternal and child health, and address health disparities. Despite these efforts, maternal mortality rates in the U.S. remain among the highest in developed countries, with deep racial and ethnic disparities. High maternal mortality and morbidity rates signal a gap in maternal healthcare, particularly for marginalized communities.
The Role of Racism in Maternal Health Disparities.
[5] Racism, a systemic structure of unequal power and resources, profoundly affects health outcomes, especially in maternal health. Structural racism in the U.S. has led to economic inequalities, unequal access to healthcare, and chronic stress from discrimination, all of which contribute to worse maternal health outcomes for Black women. These disparities persist even when socioeconomic factors are controlled for, suggesting that racism itself is a direct contributor to poorer health outcomes. [i]
[6] Black women experience higher rates of severe maternal morbidity (SMM)—life-threatening conditions that occur during pregnancy or childbirth—compared to white women. For example, Black women in the U.S. are about 50% more likely to experience SMM than their white counterparts.[ii] Black women are three to four times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention (CDC).[iii] These rates persist across income and education levels, indicating that socioeconomic status alone does not account for these disparities.
[7] Chronic stress from experiencing racism and discrimination can contribute to higher levels of anxiety and depression during and after pregnancy. This chronic stress has been linked to physical and mental health conditions, including postpartum depression and PTSD.
[8] Research from the National Academy of Medicine (NAM) found that Black women often experience biased treatment from healthcare providers, who may dismiss their symptoms, fail to treat their pain, or ignore their concerns. Studies have consistently found that Black patients’ reports of pain are consistently underestimated by healthcare providers, with Black women often receiving less pain management than white women in labor.[iv] A 2016 study found that half of medical students and residents held false beliefs about biological differences between Black and white patients, affecting treatment decisions.[v]
[9] A 2017 study by the American College of Obstetricians and Gynecologists found that Black women were more likely to be dismissed by healthcare professionals when they voiced concerns during labor, leading to delayed diagnoses and treatment of complications.[vi] Mothers of color are also more likely to experience disrespectful or even abusive treatment in the healthcare system, including medical gaslighting, where their symptoms or pain are minimized, causing delays in proper care.
[10] As an example, after giving birth to her daughter, tennis star Serena Williams, who had a history of blood clots, experienced symptoms of a pulmonary embolism. Despite her medical history and self-advocacy, her concerns were initially dismissed by hospital staff, nearly leading to a life-threatening situation.[vii]
[11] An even more chilling example is that of Kira Johnson. In 2016, Kira Johnson, a healthy Black mother, died from internal bleeding after giving birth via C-section. Despite her family’s repeated requests for help as her condition deteriorated, her symptoms were not taken seriously until it was too late. Her case has drawn attention to the role of implicit bias in maternal mortality.[viii]
The Role of Cultural and Linguistic Barriers
[12] Healthcare providers often lack training in cultural competency, resulting in communication barriers and reduced trust between patients and providers. Latina, Indigenous, and Black women frequently report feeling misunderstood or dismissed by healthcare providers. Hispanic mothers who primarily speak Spanish face additional barriers in accessing quality care. Language differences can lead to miscommunications about symptoms, treatment plans, and follow-up care, impacting maternal and infant health. American Indian and Alaska Native women also experience a significantly higher risk of maternal mortality, with rates more than double those of White women.
Health Disparities Maternal Mortality, Morbidity, and Mental Health
[14] Maternal mortality, a key indicator of national health, is alarmingly high in the U.S. compared to other developed nations. This disparity is not solely due to socioeconomic status; it reflects the compounded effects of structural racism, discrimination in healthcare, and chronic stress. For example, Dr. Shalon Irving, an epidemiologist with the CDC, died from complications of high blood pressure after giving birth in 2017. Despite her knowledge and access to healthcare, her concerns were reportedly dismissed by medical providers. Her story has become emblematic of how even well-educated, insured Black women face significant risks due to biases and systemic inequities in healthcare. [ix]
[15] Beyond physical health, maternal mental health is significantly impacted by experiences of racism. Women of color experience higher rates of prenatal and postpartum depression and anxiety, which are exacerbated by stressors such as racial discrimination, limited access to mental health resources, and economic instability.
[15] The high rates of mental health challenges in marginalized communities are partly due to systemic discrimination, which can create lasting psychological impacts. Racial discrimination can also lead to post-traumatic stress conditions, sometimes referred to as racial trauma. Black women who experience discrimination and bias in healthcare may develop post-traumatic stress disorder (PTSD) as a result of traumatic birth experiences, which can include medical neglect, lack of emotional support, and biased treatment. PTSD can complicate recovery from childbirth, impair parenting, and negatively affect bonding with the newborn. Moreover, untreated PTSD and other mental health conditions increase the risk of substance misuse, physical health decline, and subsequent mental health issues, creating a cycle that can be challenging to break without appropriate care and support.
Systemic Barriers to Quality Maternal Health and Mental Health Care
[16] Several factors in the U.S. healthcare system create barriers to quality maternal care and exacerbate mental health challenges for marginalized groups:
- Financial Barriers: The U.S. healthcare system’s reliance on private insurance limits access to care, particularly for uninsured or underinsured individuals from marginalized communities, including many Black and Indigenous mothers.
- Shortage of Primary and Mental Health Care Providers: Many underserved areas face shortages in primary care and mental health professionals, restricting access to essential prenatal and mental health services, particularly for those experiencing postpartum depression or anxiety.
- Gaps in Care Quality: Marginalized groups often receive lower-quality care, with many reporting dismissals of their health concerns. This lack of adequate, responsive care in both maternal and mental health can lead to undiagnosed or untreated complications, including depression and anxiety.
- Broader Socioeconomic Inequities: Income inequality, reduced educational attainment, and other structural barriers concentrate resources in certain population segments, leaving marginalized communities with inadequate healthcare, nutrition, and housing—all of which contribute to higher stress and poorer maternal mental health outcomes.
Impact on Child Health and Development
[17] Maternal health disparities extend their impact to children, affecting both their physical and mental well-being. The infant mortality rate for Black infants is significantly higher than that white infants, largely due to conditions such as prematurity and low birth weight, which are linked to maternal stress and discrimination. Additionally, the effects of chronic maternal stress and untreated mental health conditions can impair child development. [x]
[18] Children born to mothers experiencing racial trauma or postpartum mental health issues may face greater risks of developmental delays, behavioral challenges, and mental health issues in their own lives. Children in marginalized communities also face increased exposure to environmental stressors such as pollution, limited access to healthcare, and food insecurity, all of which compound the negative impact on their physical and mental health. Addressing maternal health issues holistically—including providing mental health support—can positively impact children’s long-term health outcomes.
Necessary Next Steps
[19] Effective policy reforms and public health initiatives are needed to combat racial disparities in maternal and mental health care. Strategies to address these inequities include expanding access to affordable healthcare, increasing the availability of primary and mental health services in underserved areas, and providing training in cultural competence and implicit bias to healthcare providers. Community-based programs that support maternal mental health can play a significant role.
[20] For example, programs that include culturally relevant doulas and mental health professionals can provide much-needed emotional and psychological support, reducing racial trauma and improving maternal health outcomes.
[21] Healthcare providers trained in cultural competence can help build trust with patients, creating a more supportive environment for addressing mental health concerns. Policy changes that address the root causes of healthcare disparities, such as Medicaid expansion and affordable mental health services, are also crucial for addressing both maternal and mental health disparities.
[22] Expanding support for postpartum mental health services and promoting maternal mental health awareness can further aid in preventing and treating conditions such as postpartum depression and PTSD.
Mental Health and Postpartum Depression Disparities.
Studies have shown that Black and Latina women are more likely to experience postpartum depression than white women, yet they are less likely to receive treatment. This disparity is attributed to barriers such as lack of access to mental health services, stigma, and implicit bias in healthcare.
Conclusions
[24] Racial disparities in maternal mortality and morbidity, compounded by barriers to quality healthcare and the psychological toll of discrimination, demand urgent action. A nationwide call to action is needed to address these important maternal concerns. A laser focused plan against systemic racism and improving access to comprehensive maternal and mental health services can reduce health disparities, foster healthy maternal and child outcomes, and create a more equitable healthcare system. Initiatives that recognize and address the interconnected effects of structural racism and mental health challenges can help break the cycle of health inequities, allowing every mother and child the opportunity to thrive. This can only be achieved by including access to all stakeholders in the community.
[25] The following are links that provide more information and personal stories.
How Does This Happen to All of Us?’: Black Doctors Allege Discrimination at Sutter Health – YouTube
How Does Implicit Bias Affect Health Care? – YouTube
Black people share their experiences of racial bias in health care (youtube.com)\
About Pregnancy-Related Deaths in the United States | HEAR HER Campaign | CDC
With a history of abuse in American medicine, Black patients struggle for equal access (youtube.com)
Some medical students still think Black patients feel less pain (statnews.com)
‘How Does This Happen to All of Us?’: Black Doctors Allege Discrimination at Sutter Health – YouTube
Black Americans more prone to health issues because of racism (youtube.com)
Is Modern Medicine Racist | Dr. Joy Degruy Breakdown (youtube.com)
Racism and Associated Health Impacts – National Academy of Medicine
Why are Black maternal mortality rates so high? – Mayo Clinic Press
Cedars-Sinai faces civil rights suit over Black woman’s death – Los Angeles Times (latimes.com)
Working Together to Reduce Black Maternal Mortality | Women’s Health | CDC
What is CLAS? – Think Cultural Health (hhs.gov)
[i] Claire Cain Miller, Sarah Kliff, and Larry Buchanan. “Childbirth is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds.” The New York Times. February 12, 2023. https://www.nytimes.com/interactive/2023/02/12/upshot/child-maternal-mortality-rich-poor.html
[ii] Lucinda Canty. “The lived experience of severe maternal morbidity among Black women.” PubMed. 2022 Jan; 29(1). The lived experience of severe maternal morbidity among Black women – PubMed.
[iii] Ibid.
[iv] Naomi Greene and Sarah Kilpatrick. “Racial/Ethnic Disparities in Peripartum Pain Assessment and Management.” The Joint Commission Journal on Quality and Patient Safety Volume 50, Issue 8, August 2024, Pages 552-559. Racial/Ethnic Disparities in Peripartum Pain Assessment and Management – ScienceDirect.
[v] Kelly M Hoffman, Sophie Trawalter, Jordan R Axt, and M Norman Oliver. “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites – PMC.” Proc Natl Acad Sci U S A, 2016 Apr 4;113(16):4296–4301.
[vi] American College of Obstetricians and Gynecologists’ Committee on Advancing Equity in Obstetric and Gynecologic Health Care. Racial and Ethnic Inequities in Obstetrics and Gynecology | ACOG (Published September, 2024)
[vii] Maya Salam. “For Serena Williams, Childbirth Was a Harrowing Ordeal. She’s Not Alone,” The New York Times (nytimes.com) (Published January 11, 2018)
[viii] Kristi Pahr. “Charles Johnson’s Loss Launched a Maternal Health Revolution.” Parents. https://www.parents.com/pregnancy/giving-birth/stories/my-wifes-legacy-gives-a-voice-to-the-voiceless-charles-johnsons-loss-launched-a-maternal-health-revolution/ (Accessed March 24, 2023)
[ix] Saralyn Cruickshank. “The death of a young black mother brings attention to the issue of racial health disparities.” | Hub (jhu.edu), (Accessed February 26, 2019)
[x] US Department of Health and Human Services Office of Minority Health. “Infant Mortality and African Americans | Office of Minority Health.” (Accessed September 21, 2023)
Mia McNulty, Ed.D, M.L.S., M.Ed., & MPA, is a passionate advocate for heart health awareness and patient advocacy, serving as the Founder and CEO of the Nia Imani Heart Association (NIHA). Inspired by her daughter Nia Imani's rare heart anomaly, Mia established this non-profit organization with a dedicated mission to promote heart health awareness, particularly among women and girls. Dr. McNulty teaches as an adjunct faculty member at California State University Dominguez Hills. She serves as the elected President of the Carson Torrance NAACP Branch #1030. Outside of her professional and advocacy roles, Mia McNulty is a devout member of the Community Lutheran Church in Los Angeles. Her dedication to faith and community service underscores her holistic approach to making a positive impact in the lives of others.