Community-Based Solutions Can Prevent More Black Women From Dying in Childbirth

Systemic racism has biological effects. Addressing these mental and physical health conditions together—through Black-led community-based peer support—can reduce maternal mortality rates.

In 2021, the maternal mortality rate among Black women was nearly 70 deaths for every 100,000 live births—2.6 times the rate for white women, regardless of income or education. (Ariel Skelley / Getty Images)

Last month, the United Nations analyzed maternal mortality for Black birthing people across the Americas for the first time. They found that systemic racism and sexism—rather than choices or genetics—are the primary drivers for maternal morbidity and mortality. While the U.S. looks to maternal mortality review committees for answers, we must change how we classify Black birthing people’s preventable deaths. Classifying a death’s cause only as a physical health condition masks the truth and leads to narrow, hospital-based solutions only. 

Let’s examine the case of Olympic athlete Tori Bowie, who died last month while undergoing labor. Despite news articles citing her autopsy, Bowie did not die from respiratory distress and eclampsia. Of course, the official reason for her death, according to the autopsy report, is eclampsia, a condition that typically develops from pre-eclampsia (high blood pressure). But the underlying cause of her death was the U.S. system that leads to chronic stress, particularly for Black women.

We’re doing a disservice to Black women and birthing people by separating mental and physical illness when we talk about the unacceptable mortality rates in the U.S. This perpetuates the idea that Black women and birthing people, not the system, are to blame. 

Almost all U.S. states have developed maternal mortality review committees, often classifying the underlying cause of pregnancy-related deaths as physical or mental. Based on the data collected:

  • The leading cause of death among white women is said to be mental health conditions, including deaths of suicide and overdose/poisoning related to substance abuse.
  • The leading cause of death among Black women is said to be pre-eclampsia and eclampsia.

As a maternal and child health epidemiologist of 15 years who has worked across the globe, I’ve seen that people often associate these conditions, linked to high blood pressure, with choices that individuals make. This couldn’t be further from the truth. This binary classification of mental and physical health is problematic and doesn’t take into account weathering. 

Weathering, the biological effects of racism, is a well-known phenomenon coined by Arline Geronimus in 1992. When the body is under continuous stress, it leads to physical health conditions. This is often why Black women experience physical conditions, such as preterm birth, at higher rates. These solutions are necessary but only part of the puzzle, where 13% of deaths occur on the day of delivery. Hospital-based deaths have decreased by 76% for Black women, although maternal mortality in Black women continues to increase. 

To ensure Black women get the justice they deserve, we must double down on elevating Black-led community-based peer support. A peer support person shares lived experiences with patients and supports them in healing. Our Roots, the social venture I founded and run, connects BIPOC pregnant and postpartum communities with peer support coaches to prevent perinatal anxiety and depression. Both of these are drivers of maternal morbidity, such as preterm births. 

Peer support people originated during the civil rights movement. They were Black people who banded together to advocate for each other after experiencing trauma and being abused by the mental health system. Data shows peer support can reduce perinatal depression, anxiety and physical health conditions, such as preterm birth. Black-led organizations such as HealthConnect One and the Shades of Blue Project have been critical to working with Black communities to bring about the radical changes our society needs to value and elevate the work of peer support people.

To continue to build off of this work, we need to consider the impacts of systemic racism on both the mind and the body together. This is critical to ensuring we celebrate Black birthing people’s lives and their children, not just talking about their tragic deaths and our inaction.

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Priya Iyer is the founder of Our Roots, a non-profit that virtually connects BIPOC, low-income pregnant and postpartum communities to peer support coaches to prevent perinatal anxiety and depression. She holds an MPH in epidemiology from Columbia University, and she is a public voices fellow with the OpEd Project in partnership with the National Black Child Development Institute.