Why are so many Black women dying during pregnancy, childbirth, and postpartum?

Contributor: Fatmata Williams

I wrote this post for my blog “Fatmata’s Blog: Journeys and Perspectives”  in April 2018, and it is reassuring to see the attention that maternal mortality, including the disparity therein, has gained over the years. I decided to revise my post to share it with nursing colleagues broadly.

According to the World Health Organization, maternal death is when a woman dies from direct or indirect obstetrics causes during pregnancy, childbirth, or up to forty-two days after termination regardless of the pregnancy site. With advancements in medicine, medical and other technologies, we assume giving birth is “routine.” There is nothing routine about giving birth today, especially for Black, Indigenous, People of Color (BIPOC) women, and birthing people.

Approximately fourteen years ago, I lost my sister from postpartum complications, precisely one month after she gave birth to her first and only child. The circumstances surrounding her death mirror the ones described later in this post. It was déjà vu when I heard Shalon Irving’s story on public radio; her story reignited buried mistrust, so I researched the subject at the Centers for Disease Control and Prevention (CDC) website and what I found was sobering.

According to the CDC, the U.S. has a higher maternal death percentage than other developed countries. Black women in the U.S. are three times more likely to die during and after childbirth than their White and Hispanic counterparts.

The Shalon Irving story, which aired on Public Radio (All Things Considered –December 07, 2017) “Lost Mothers: Maternal Mortality in the U.S.”  Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why details one Black mother’s fight for her life. According to this report, all Shalon’s accolades did not prevent her from becoming a part of this dire statistic. Shalon’s work at the CDC aimed to eliminate inequities and ensure better health outcomes for all. Isn’t it ironic that a woman with such an advantage, working for the agency that sets and dictates healthcare standards, died three weeks after giving birth to her baby from complications of high blood pressure? Granted, Shalon went into pregnancy with some chronic health conditions, the actual events surrounding her death are questionable. This young woman sought assistance from healthcare providers shortly after discharge; each time, she was evaluated and sent home with instructions to monitor her condition, follow up with a primary care provider, or seek emergency treatment if the condition worsens. Her final attempt to seek care received a similar response – tests were normal, so she was sent home with a high blood pressure medication script. She died on her way to the hospital from complications of high blood pressure.

Now juxtaposed with Serena Williams’ experience as written in the January 10, 2018 issue of VOGUE Magazine;  also, a very prominent Black woman, elite athlete, and millionaire, went into pregnancy with a known clotting disorder. One day after C-section, Serena started experiencing shortness of breath and suspected pulmonary embolisms due to not taking her blood thinner. Serena recounted getting out of bed and walking to the nurses’ station to request a C.T. scan and intravenous heparin; however, the nurse told Serena that the pain medication confused her. Despite the nurse’s dismissal, Serena insisted on a C.T. scan and IV heparin. Next thing, a doctor was performing a Doppler on her legs, but according to Serena, “I was like, a Doppler? I told you I need a C.T. scan and Heparin drip.” Worthy of mentioning, the Doppler was normal; however, the C.T. scan showed several small blood clots in Serena’s lungs, and she was immediately started on a heparin drip. Serena explained, “I was like, listen to Dr. Williams!” Thankfully, Serena lived to tell her story!

Finally, Patrisse Cullors (co-founder of Black Lives Matter and author) also described her birth experience in the February 01, 2018, issue of Essence magazine. Patrisse’s plan to have her baby with nurse-midwives fell through because of a necessary C-section. According to Patrisse, everything went downhill after arriving at the hospital. The surgeon did not explain the procedure or what to expect, and when she asked, the reply was, “what do you want to know?” After the surgery, Patrisse described gross undertreatment of her pain. Patrisse stated that she did not achieve adequate pain control for the entire duration of her hospital stay. Patrisse went home, only to return to the E.D. with respiratory symptoms and was diagnosed with pneumonia.

Without a doubt, Serena knew her risks, happened to be at the right place and time, recognized her symptoms quickly, and insisted on the kind of care she needed, notwithstanding dismissive attitudes from healthcare providers. Likewise, Shalon knew her risks, recognized her symptoms, and sought care at the right place and at the right time; however, she was dismissed by healthcare providers. Patrisse demanded the care she needed but was also rejected by healthcare providers.

Should Shalon have insisted and refused to leave on that fateful day when all the tests were normal, but she knew something was wrong? Should Patrisse have raised the roof of the hospital when she was being undertreated for pain? We hear only about those cases that pertain to the affluent, well-placed, or where the situation is so egregious that it can’t be ignored; what about the thousands of cases that go unnoticed? We cannot Monday morning quarterback these issues; we can learn, increase awareness, appreciate the nuances of being Black in America and become proactive in changing the culture.

I’d be remiss if I failed to mention that a lot has happened at federal, state, and local levels since I first wrote this piece in 2018. Federal laws support the expansion of postpartum coverage for women and birthing people from two to twelve months. Different states are implementing expanded postpartum coverage and providing prenatal and postpartum coverage to undocumented women and birthing people; The CDC launched a campaign to improve maternal health outcomes with an emphasis on women of color. There is also the official recognition of the Black Maternal Health Week from April 11 to 17 every year officially recognized by the Biden administration on April 13, 2021.

 Hospitals across the country are implementing patient safety bundles such as hypertension and hemorrhage bundles to improve safety and maternal and birth outcomes for women and birthing people. Some payers include doulas and breastfeeding supports in their value-based payment  reform models to remedy disparities and improve outcomes for women and birthing people. Most organizations have implemented implicit bias training to impact providers’ attitudes, especially toward BIPOC women and birthing people.

 Change begins with awareness; the more informed we are, the better we can advocate for ourselves and our loved ones. Black people, pregnant or not, must endeavor to learn about their risk factors and be their best healthcare advocates despite numerous existing barriers. Knowledge is power; if you know your body and are informed about your risks, you can partner in your health care and demand care that is right for you. Black women can and should be a part of the solution.

As nurses, we can play a pivotal role in empowering BIPOC women and birthing people to demand high-quality, empathetic, and safe care at all levels of the healthcare delivery system. We can achieve this by educating our patients about their risk factors and how to advocate for themselves. We can also advocate for our patients during vulnerable moments when they cannot do it for themselves. When I was going through my unpleasant birthing experience in 2005, my obstetrics nurse’s quick action and swift advocacy saved my baby and me. The swiftness of her movements, words, and subsequent action was aesthetic nursing. My nurse knew exactly what to do; it was admirable and automatic. It was an art! Even though the situation seemed dire, the nurse first and my O.B. second turned things around.

Nurses can also use personal knowing to relate to their patients. Our lived experiences can help us to understand why a BIPOC woman and a birthing person may seem hesitant or uneasy when they enter a hospital to deliver a baby (1 – (see https://doi.org/10.1177%2F08980101211072289). Our professional obligation is to help each patient in a way that meets their need. Finally, we can use emancipatory knowing to turn the tide on overall maternal mortality and morbidity, especially for BIPOC women and birthing people. We can use our collective voices to advocate for federal and state policies to address the issue. Representative Lauren Underwood (former nurse) introduced H.R. 959 – Black Maternal Health Momnibus Act of 2021 to improve maternal health, especially for racial minorities. As nurses, we should use our collective voices and power to foster change at the highest level.


    1. Graham MM. Navigating Professional and Personal Knowing Through Reflective Storytelling Amidst Covid-19. Journal of Holistic Nursing. January 2022. doi:10.1177/08980101211072289

About Fatmata Williams

Fatmata Williams

Fatmata Williams is a registered nurse with twenty five years of nursing experience. She experienced a horrible birthing experience in 2005 and lost her sister in 2008, thirty days postpartum. Fatmata is passionate about reproductive health and is an ardent advocate for equitable maternal health policies.

6 thoughts on “Why are so many Black women dying during pregnancy, childbirth, and postpartum?

  1. Hello Ms. Fatama, As a retired public health nurse in Toronto I would like to express sincere condolences on the death of your sister.
    Thank you for submitting your current blog as a way of memorializing her unnecessary death and the pain, suffering and deaths of so many pregnant and postpartum women.
    My regards,
    Dorothea Fox Jakob

    • Thank you Ms. Fox Jakob. Unfortunately, our stories are not unique in BIPOC communities; hence the the reason we must have these difficult but very necessary conversations and play our part in addressing this problem.

  2. Racism is the reason why so many Black women are dying during pregnancy, childbirth, and the postpartum period. Shortly after what can best be described as the murder of Dr. Shalon Irving by the racist US healthcare system, her friend and then Chief Medical Director of the Planned Parenthood Federation of America, Dr. Raegen McDonald-Mosley, noted that:

    “It tells you that you can’t educate your way out of this problem. You can’t health care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”

    Contrary to what we continuously see in nursing and public health textbooks and hear in lectures by nursing, medicine, and public health faculty, this maternal mortality rate is un-related to socioeconomic status, “genetics”, access to care, or educational level. Black, college-educated mothers are more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school. Dr. Irving, Serena Williams, and Patrisse Cullors are all highly intelligent, highly educated, and successful professional women.

    Nurses spend more time providing maternity care than most other healthcare providers. About 80% of nurses in the US identify as white. Decades of nursing research has consistently demonstrated that good nursing care leads to better patient outcomes. Recent research has demonstrated that Black mothers have much better outcomes when cared for by Black healthcare providers. This all seems to point to a problem with the quality of maternal care being provided by a significant number of white nurses.

    How do we improve the quality of maternal care of Black patients by white nurses? First, we would have to publicly own up to the fact that this discipline has a significant racism problem, similar to medicine and public health. It is hard to own up to racism when the discipline is thoroughly grounded in the social construction of “nurse” being a person who treats everyone equally, not “seeing” skin color, above the racism (and other forms of discrimination) that plague lay people’s interactions with others who are different from them.

    We need to understand where our implicit bias comes from. It is the result of over 400 years of scientific racism that is embedded in nearly every aspect of our current healthcare practices from racial correction of eGFR and PFTs (neither practice based in scientific evidence), our clinical guidelines, and the continued teaching of hegemonic, non-evidence-based ideas such as the “salty slave” hypothesis of HTN in African- American populations.

    We need to be teaching our students how the social experience of race produces disease, how the lived experience of racism makes black bodies more susceptible to stress-related illnesses like HTN and depression. We need to demand that nursing textbooks and nursing professors address the current, non-contested science in regards to stress physiology, allostasis, allostatic loading and weathering.

    As a NP and Medical Anthropologist who has spent 38 years examining the structural violence of racism imbedded in the bodies of impoverished patients of the global majority (BIPOC) both in the US and Haiti, it is evident that my patients do not have years or decades for us to finally get our act together. Racism kills. Now is the time to end it.

    • Thank you!

      Your reaction is precisely why I published my story in Nursology- to appeal to my nursing colleagues because we are front and center of the healthcare delivery system. You highlighted quite a few critical areas that I would like to acknowledge.

      Racism plays a significant role in Black maternal death. Black maternal mortality transcends education, socioeconomic status, and access to good health insurance coverage. And, yes, as a Black or birthing person of color, your education, health insurance access, or financial security may not save you from maternal mortality.

      While there is growing diversity in the nursing profession, it continues to be a predominantly White female profession.Diversifying the entire healthcare workforce is one way to address this problem. Most major healthcare institutions and organizations have implemented interventions such as hiring DEI (diversity equity & inclusion) managers, mandating implicit bias trainings, implementing patient safety obstetrics bundles, and releasing anti-racism statements because of the publicity Black maternal mortality has gained in recent years. Even with all of these efforts, the disparity gap is still wide. The overall US MMR increased to 23.8 deaths per 100,000 live births, White non-Hispanic women to 19.1 deaths per 100,000 live births, and Black women to 55.3 deaths per 100,000 live births in 2020 (https://www.cdc.gov).

      While I am passionate about maternal health because of personal experience and loss, the health outcomes for BIPOC are also worse in most areas. Systemic racism and structural barriers impact health services delivery for this population. You alluded to the medical algorithms used to determine care amount and type for various populations. Most of these algorithms have race indicators that shift resources away from Black people to other groups (https://www.nejm.org/doi/full/10.1056/NEJMms2004740).

      Similarly, numerous studies have shown the negative impact of systemic racism on the health and longevity of subordinated populations.

      Now, where do we go from here?

      I agree with naming and confronting racism in healthcare and other sectors. All U.S. healthcare programs (nursing, medicine, pharmacy, PA, etc.) should build education about systemic racism and its effects, health care advocacy, and racial and social justice into their curriculum. We can also educate current and future providers about racism and its impact on subordinated populations. New graduates entering the workforce should be conversant with these concepts. They should be prepared to provide person-centered, trauma-informed, equity-driven, and holistic care to all patients regardless of skin color.

      I’d be remiss if I failed to mention the recent apology from the American Nurses Association to nurses of color for its history of racist practices that disenfranchised this group. Taking accountability is the first step.

      I am hopeful that by telling our stories, prompting these discussions, and taking action, we as nurses can dismantle racism and its effects and improve health outcomes for our patients.

      Thanks again for such a robust response.

  3. Extremely relevant topic and clearly articulated and supported. I am not in this field, but you presented your views in such a convincing and jargon-free manner that a reader like me with no knowledge and background in the subject understood it without any difficulty.

    Indeed, your core point about racial disparities in the healthcare delivery system is one that does not warrant any specialized knowledge to comprehend. And towards that goal, you have done a fabulous job.

    Thanks for this insightful piece!

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