Deeper Than Race: How Reluctance to Examine Black American Diversity Obscures the Maternal Health Crisis

April 5, 2023

If you’ve been following the news in recent years, you might have come across reports concerning the health of Black mothers in the United States. Recently, Serena Williams described her harrowing experience after giving birth in a highly publicized Vogue article. Despite having access to one of the best trained medical staffs that money could provide, she nearly lost her life in childbirth from causes largely due to physician neglect.

Although this may appear to be an isolated incident, it reflects a very present reality for many Black people in the United States. Today, Black pregnant people are three times more likely to die from a pregnancy-related cause than white people in the United States. According to the World Health Organization, their odds of surviving childbirth are comparable to women living in Uzbekistan and Mexico, countries with significantly less medical resources than the highly-industrialized United States. As seen with the experiences of Serena Williams, socioeconomic status and wealth fail to serve as a protective barrier for Black women against these statistics as demonstrated by the recent experiences of Black celebrity mothers. In fact, Black women with a college degree and higher are still more likely to die in childbirth than white women without a high school diploma. Black maternal health is a serious public health crisis that has been and continues to persist in our country.

In light of alarming stories from Black pregnant people in the United States, grassroots movements, policymakers and public health researchers alike have generated much needed conversation around disparities in maternal health between Black and white pregnant people. Many of these movements, policy developments and research are Black-led- such as the Black Mamas Matter Alliance, the Black Maternal Health Momnibus Act and the UCSF California Preterm Birth Initiative. Interventions on behalf of Black birthing people are also largely represented by those from the communities they are serving- such as the Abundant Birth Project in California and the work of Black community doulas across the country. Black doulas in particular have proven to be an incredibly effective intervention in improving Black maternal health. One study found that doula-assisted mothers were 4x less likely to have a baby with low birth weight, 2x less likely for them or their baby to experience a birth complication, and significantly more likely to initiate breastfeeding. As we continue to learn more about this public health crisis Black doulas’ work is increasingly uplifted as a direct way to support the needs of Black birthing people.

While research into Black maternal health is incredibly necessary, it currently is limited and researchers are at risk of overlooking one key aspect that could impact potential interventions- the diversity of Black American identities. In order to truly understand what factors are leading to the urgent Black maternal health crisis, it is imperative to have a deeper understanding of the Black population as a whole in the United States.

Black Americans are routinely viewed as a “monolith” in research studies- ignoring the critical role that their ethnic and even regional diversity can play in their health outcomes. African-Americans (individuals who descend from enslaved Africans in the U.S.), Afro-Carribeans, Afro-Latine and African immigrant populations in the United States, while all grouped into one racial group, have been found to have many differences in health behaviors and health outcomes. Research has explored the impact of these ethnic differences and found stark disparities in the maternal health outcomes of U.S. born Black people and foreign-born Black people. U.S. born Black populations had worse pre-pregnancy nutritional status, worse prenatal health behaviors and gave birth to lower birthweight babies compared to foreign-born Black populations in the U.S. Additionally, when considering the weathering hypothesis- the theory that chronic exposure to racism has cumulative effects that leads to accelerated aging of the body- U.S. born Black populations who have been in the United States for significantly longer periods of time could be susceptible to more of these harmful experiences and health outcomes.

This exploration into ethnicity’s impact on Black maternal birth outcomes is also timely due to the steady expansion of the foreign-born Black population in the United States. A Pew Research Center study found that the number of Black immigrants living in the U.S. more than tripled from 1980 to 2019, growing from 800,000 in 1980 to 2.9 million in 2019, and this population is projected to grow to a sizable 9.5 million by 2060. As the Black immigrant population continues to grow in the U.S., it will be increasingly advantageous to distinguish between Black communities in research.

In order to fully grasp the complexities of the Black maternal health crisis in the United States, it is imperative that public health researchers begin to distinguish between the various Black American identities in their research as this crisis impacts various Black communities differently. Instead of stating that Black pregnant people have three times the risk of dying from childbirth in the United States, we need to begin to explore how this statistic changes depending on the individual’s ethnicity. For my final capstone project at UC Berkeley’s School of Public Health, I am exploring this issue further by using country-wide data of births in the United States to examine differences in both maternal and infant health outcomes between foreign-born and U.S.-born Black pregnant people. While this work is still in progress, our preliminary results are showing surprising differences in key demographics between these populations- aspects that could significantly impact the maternal health landscape for both groups. The time is now for all public health researchers to explore and consider how the differences in ethnicity of Black Americans are captured and integrated in their studies to improve the health outcomes of Black pregnant people.

Do you have a story, research or thoughts to share on Black maternal health? Email us at