Expert Outlines Steps to Close Gaps in Black Maternal Health Care

In the U.S., Black women continue to experience disproportionately high maternal mortality rates

Each year, Black Maternal Health Week is recognized from April 11 to 17 to amplify the urgent need to address maternal health care disparities.

Despite this ongoing focus, Black women continue to experience disproportionately high maternal mortality rates, with the U.S. rate nearly three times higher than that of any other racial group, according to a 2023 report from the National Center for Health Statistics.

Throughout the United States, these disparities are driven by factors - including social and economic barriers, food insecurity, chronic stress and limited access to health care facilities - and linked to redlining, a discriminatory practice that restricts investments and access to financial services in communities with predominately racial and ethnic minority populations. These factors are compounded by cultural gaps among health care providers and preexisting health conditions such as diabetes, obesity and hypertension, which can increase the risk of pregnancy-related complications.

Damali Campbell-Oparali, an associate professor in the Department of Obstetrics, Gynecology and Reproductive Health Division at Rutgers New Jersey Medical School, discusses drivers behind these disparities, the experiences Black mothers navigate during pregnancy and postpartum and actionable steps to improve health outcomes and advance equity in maternal care.

There continues to be growing attention on Black maternal health. Where have you seen meaningful progress and where do gaps remain?

Over the past decade, people across the country have become increasingly concerned about maternal health, especially the health and safety of Black mothers. In New Jersey, we continue to see significant racial and ethnic gaps in both maternal and infant health.

While there has been some progress, including increased awareness, greater engagement from community and women's health organizations, more involvement from pregnant women and their families and policy efforts such as the Momnibus Act aimed at reducing preventable maternal deaths, many agree that a person's race or zip code should never determine whether they have a healthy pregnancy or postpartum experience. Families want real, lasting improvement.

We often talk about disparities in Black maternal health. Can you elaborate on what that means and how those disparities show up in patient settings?

Studies show that four out of five maternal deaths that occur after childbirth are preventable, with Black women being three times more likely to die from pregnancy related complications than white women. These differences in outcomes, known as disparities, are not due to biology but are driven by unequal circumstances and barriers that some communities face more than others. The United States has a higher maternal mortality rate than many developed countries, and one key difference is that families here often face significantly higher out-of-pocket health care costs.

How are Rutgers Health and University Hospital working to address Black maternal health disparities and improve outcomes for patients and families?

Rutgers Health and University Hospital are working to close these gaps through several initiatives, including screening for and addressing social determinants of health such as housing, food access and transportation. They are also implementing Centering Pregnancy, a group-based prenatal care model that improves health outcomes for mothers and their babies, building strong connections to home visiting programs and partnering with Nurse-Family Partnership, a program that provides free at-home parent coaching to first-time expectant mothers.

These efforts are strengthened through the collaboration with the nonprofit organization Partnership for Maternal & Child Health of Northern New Jersey, which offers education, support and advocacy services to families.

What are some challenges Black mothers face during pregnancy, childbirth and postpartum - and what should patients and families be aware of to help ensure timely care?

Black mothers often face challenges during pregnancy that make it harder to get early and consistent prenatal care. These include transportation issues, work schedules that don't allow time for appointments, lack of childcare, food insecurity and housing instability.

Even when these issues are less of a factor, for example, among college-educated Black women, maternal health outcomes are still unequal. This points to deeper causes, such as chronic stress, the long-term effects of racism and the impact of not feeling heard in health care settings.

Another ongoing challenge is making sure Black moms feel listened to, respected and confident in the evidence-based care available to them. Patients and families should also be aware of warning signs that require medical attention including severe headaches, sudden swelling of hands and feet, trouble breathing and extreme exhaustion.

As we recognize Black Maternal Health Week, which runs from April 11 to 17, what actions are needed to create lasting change?

It's clear that improving outcomes requires a multipronged approach. Health systems, community organizations, policymakers and individuals have a role to play. Raising awareness, supporting families and taking meaningful action can help create the lasting change New Jersey families deserve.

For those looking to take action, that can start with becoming more informed about structural racism and health inequities in the U.S. For providers, this includes engaging with research such as the Listening to Mothers Study and committing to ongoing implicit bias training regarding race ethnicity. For community members, it means helping pregnant patients advocate for themselves, encouraging them to ask questions, developing a birth and postpartum plan and working with their care team to address risks such as anemia, preeclampsia, gestational diabetes, stress and sleep challenges.