Opinion | Why Is It So Dangerous to Be Pregnant in America?

Source: Surgo Ventures.·Notes: Maternal risk is on a scale from 0 to 100, with a higher score meaning higher risk. W.R.A. stands for “women of reproductive age.” Air pollution is determined by the concentration of particulate matter (PM2.5). Quality of outpatient care is based on the U.S. Department of Health and Services’s Prevention Quality Indicators.

One of the most striking findings is that a woman’s risk of poor maternal health varies largely by race, and those racial gaps vary greatly by region.

For example, there are big gaps in risk for Black versus white women in the Midwest and Northeast.

For American Indian and Alaska Native mothers, the gaps in risk compared with white mothers are largest in the West and Midwest, especially in states with American Indian reservations like Montana, South Dakota and New Mexico, suggesting that women of reproductive age living on American Indian reservations may die at higher rates and have riskier pregnancies.

What’s contributing to the large gap between white and Black women?

In almost all states, three types of factors play an outsize role. White women are more likely to live in good physical environments: communities with less pollution, less violent crime and better access to high-quality housing and transportation options. They are also more likely to be in good physical health, with access to treatment and prevention strategies for sexually transmitted infections and non-communicable diseases. And they face fewer socioeconomic barriers: They are more likely to have access to educational opportunities, financial resources and healthy food options, and are less likely to face language barriers.

But there are a few exceptions — in Wisconsin, for example, the state with the single highest risk gap between Black and white women. Mental health and substance abuse play an important role, in addition to the factors described above. This includes general stress levels, mental illness such as depression, access to mental health care and use of substances like nicotine and illicit drugs.

Over the past two decades, maternal mortality has increased almost 60 percent. The United States is the only other Group of 7 country besides Canada to experience such a drastic decline in maternal health. (Canada saw a minor increase in pregnancy-related deaths.)

President Biden has invested funding in a variety of programs to improve maternal health, like expanding Medicaid coverage to 12 months after a person gives birth, implicit bias training for health care providers and state-level maternal mortality review committees.

Passing the Black Maternal Health Momnibus Act, which includes a set of transformative policies for maternal health, is the next important step in tackling this complicated issue. It is the most comprehensive and evidence-based legislative approach to date in addressing barriers to good maternal health for women of color.

These broad federal policies can’t fix the problem on their own, though. We also need much more targeted local action, in the form of a specific bundle of solutions tailored to the issues each community faces, because the reasons for maternal risk can vary from county to county.

Consider two counties where pregnancies are especially risky: Georgetown County, S.C., and Webb County, Texas.

In Georgetown County, local leaders could focus on non-communicable diseases and increasing screenings for sexually transmitted infections, providing low-cost transportation options to help women get to medical appointments, or offering more high-quality, affordable housing where pregnant women don’t have to worry about black mold growing in their bedrooms.

But in Webb County, risks are driven by things like English proficiency, whether a woman has a high school diploma, whether she lives in poverty or food insecurity, access to OB-GYNs and midwives, and access to abortion clinics. Decision-makers there should focus on a different set of solutions, such as expanding access to nutrition programs like WIC and SNAP, and increasing access to midwives, doulas and family planning services.

While the vulnerability index demonstrates the range of problems facing lawmakers, it does not fully explain the racial disparities. This suggests that other causes are at play. Black women face implicit biases that result in worse treatment and must endure other manifestations of racism, such as residential segregation at the neighborhood level.

Solving racial disparities in maternal health outcomes is the responsibility not only of people who work in health care. Housing authorities can help lower-income women find better living arrangements; city planners can increase access to healthy food options in underserved communities; and educators and school administrators can provide flexible G.E.D. or higher-degree options for mothers, potentially including free or low-cost daycare.

The United States is long overdue in addressing the devastating racial maternal health gap. Policymakers, researchers, community health organizations and advocates from all sectors must come together to provide a better future for all people giving birth.