Racial and Ethnic Disparities in U.S. Maternal Mortality Ratios

1. Racial and Ethnic Disparities in U.S.
Maternal Mortality Ratios
Theresa Consoli
School for Global Inclusion and Social
Development, University of
Massachusetts Boston

2. Maternal Mortality in the U.S.A.
• U.S. #1 in per
capita
spending on
healthcare,
#46 in
maternal
mortality rate
• Not perceived
as a problem
in the United
States,
associated
with
“developing”
countries

3. Racial Disparities
• Problem
– There are approximately 600 Maternal Mortality
cases in the U.S. each year
– Black women are dying at a rate of almost 4 to 1
compared to white women
• 12.5/100,000 vs. 42.8/100,000
– There is a wide range of outcomes among tracked
areas
• The rate in DC is 38.2, while in Maine the ratio is 1.2,
and in Massachusetts: 4.8

4. Considering the Problem
• Problem has been considered predominantly by medical and public
health fields.
• New perspectives needed:
– Historian, Feminist Science Philosopher
– Social Sciences
• The underlying assumption is that the problem is solely Biomedical
or healthcare specific
– social, cultural, economic, political reasons: Underlying pervasive
racial discrimination and/or racial bias in the provision and
accessibility of services
– Financial reasons: Per capita spending reflects per patient spending or
patient access to care
• Distribution across states/regions
• Actual medical spending practices such as high cost procedures and care in the
U.S.
• Accessibility to all pregnant women

5. Some of the Obstacles
• CDC, Maternal and Child Health Bureau
– Access to data
• 2 year wait
• Under 10 cases data is restricted
• 52 locations tracked (50 states, NYC, DC)
– Reporting is not uniform
• CDC notes this lack of standardized reporting
• Not all states have maternal health task forces

6. Consider California
• Rise in maternal mortality, peaking in 2006
• Pregnancy Associated Mortality Reviews
– risk-specific task
– Applied findings to implement targeted
collaboratives
• Maternal mortality rates have been dropping,
but racial disparity in deaths remains firmly in
place

7. Example: California

8. Examining Quality of Care
• Protocols
– Often consider litigious culture in c-section protocols
– Black women more likely to receive a c-section
• Pain Relief
– As indicator of quality of care
– Black women far less likely to receive epidural
• Note that epidurals may carry separate set of risks, here it is
only considered as an indicator of higher quality of care due
to prior research indicating black patients, including children,
less likely to receive adequate pain relief

9. Conclusion
• Multifaceted problem with both biomedical and
sociocultural causes
• Rather than focusing solely on biomedical and
healthcare solutions, the problem may be better
addressed by a joint transdisciplinary effort that
includes
– Medical, OB/GYN
– Public Health
– Social Sciences
• Race, culture, socioeconomics, gender