By Aja Melo-Powell

Background
In the United States, around 700 women lose their lives annually from complications linked to pregnancy and childbirth, but about 60% of these deaths are preventable. Black women disproportionately experience maternal morbidity and mortality when compared to their White counterparts (1). Maternal morbidity encompasses fatal and nonfatal health complications related to pregnancy, childbirth, and postpartum care, with life-threatening instances of morbidity categorized as severe maternal morbidity [SMM]. Maternal mortality refers to death related to, but not necessarily caused by, pregnancy, childbirth, and postpartum care (2). The Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System (PMSS) reported a pregnancy-related mortality ratio of 40.8 per 100,000 live births in Black women from 2007-2016. Comparatively, White women experienced only 12.7 deaths per 100,000 in the same time frame (3).

Maternal Morbidity and Mortality Statistics in Nevada
According to the Maternal Mortality Review Committee Report and Maternal Mortality and Severe Maternal Morbidity Data Report, Nevada recorded 1,043 cases of SMM between 2022 and 2023. Black women experienced the second-highest SMM rate at 273.6 per 10,000 deliveries, behind American Indian/Alaskan Native women at 327 per 10,000 (Table 1) (2).

Maternal mortality is broken into three categories: pregnancy-associated death, pregnancy-related death, and maternal death. Pregnancy-associated death (PAD) refers to death occurring while or within one year of pregnancy, for any reason. In contrast, pregnancy-related death (PRD) results from complications associated with the pregnancy during or within a year of pregnancy. Maternal death is classified as death within 42 days of pregnancy, excluding accidental causes (2). Between 2022 and 2023, 55 Nevadans experienced a PAD, with Black women representing 31% of cases and a PAD ratio of 196.1 per 100,000 live births (Table 2). In that same year, Black women of reproductive age also accounted for the highest rates of death across all age groups (Table 3)(2).

Between 2018 and 2019, Black women represented 29% of all PRD deaths in Nevada. They recorded a PRD ratio of 49.9 per 100,000 live births compared to 18.6 per 100,000 in White women during the same year (Table 4) (2). Black women, aged 35 and older, accounted for the most deaths with a PRD ratio of 270.3 deaths per 100,000 live births (Table 5). PRD is most commonly attributed to hemorrhage, causing 29.4% of all PRD in Nevada between 2018 and 2019 (2).

Why do such disparities exist?
Research suggests that disparities in maternal morbidity and mortality for Black women in America are often associated with the social determinants of health. Examples of such factors include trauma and discrimination from a history of structural racism, lack of or limited access to healthcare or health insurance, and negative patient-provider interactions (1,4).

The Weathering Framework, developed by Dr. Arline Geronimus, speculates that “premature biological aging” or weathering can occur in Black women as a result of ongoing oppression that puts them at higher risk for poor health outcomes, including complications associated with pregnancy and birth. Weathering may occur individually or intergenerationally, reflected through elevated cortisol levels among Black women and infants (4).

Lack of access to proper maternal healthcare also contributes significantly to this issue. Maternity care deserts are defined as regions lacking obstetric care centers and providers. In Nevada, 47.1% of counties are classified as such (5). Not having access to care may also lead to disparities in prenatal care, an essential component of ensuring a healthy pregnancy. Data from the Maternal Vulnerability Index revealed that 20% of  Black women living in areas of high socioeconomic vulnerability had inadequate access to prenatal care (5). Black, Indigenous, and People of Color (BIPOC) were also found to have a 56% increased risk of improper prenatal care access if they lived in an area of high vulnerability compared to low (5).

Another significant risk factor is the presence of implicit bias among healthcare providers. In a 2012 survey, the Society for Maternal-Fetal Medicine found that merely 29% of healthcare practitioners acknowledged that their internalized beliefs influence their care and communication with patients, despite 84% of respondents recognizing that disparities exist within their practice (1). Harmful beliefs, such that Black people have higher pain tolerance than White people, may result in care providers dismissing instances of pain in Black patients (1). In another survey, 30% of Black and Hispanic patients reported mistreatment while giving birth, compared to only 21% of White women (1). Black women in the U.S. are also more likely to give birth via cesarean section (c-section), with approximately 36% having undergone a c-section at least once in their lifetime (6). This surgical method of birth is associated with worse health outcomes than traditional birth, such as hemorrhage and infection (1). Vaginal births after a c-section also become high risk, often requiring consultation and procedures to ensure the mother can deliver safely.

Possible Solutions
Policy changes, cultural humility training programs, and alternative birthing methods are methods of addressing disparities among Black mothers. Policy changes that improve telehealth would support women living in high socioeconomic risk, low-care access areas. In Nevada, Medicaid currently covers live video and audio telehealth sessions, but not remote patient monitoring (5). A further expansion of Medicaid to cover remote patient monitoring would make prenatal care far more accessible to women living in high-risk areas. Incorporating doula service coverage in Medicaid as a component of prenatal care may also improve health outcomes for Black women.

Cultural humility and implicit bias training programs should be more heavily incorporated into nursing, medical school, and residency programs. Cultural humility relies on doctors’ lifelong commitment to getting to know their patients and empathizing with them rather than assuming “expertise” on racial, ethnic, and cultural identity (1). These programs are just as valuable as physiological medical training because medical services to Black and Brown patients may be of lower quality without them. Mindfulness programs for healthcare providers can also be implemented, teaching them to recognize implicit biases and address patients with the most cultural awareness and respect (1).

Assisted vaginal delivery is an alternative birthing method that can be lower risk than a c-section. Rather than perform surgery to address an irregular birthing event, trained practitioners may use a tool such as forceps or a vacuum to assist with vaginal delivery (7). Women tend to recover quicker and experience fewer complications than those reported from c-sections (1). Training doctors to perform this technique over a c-section when appropriate has the potential to improve long-term reproductive health and ultimately improve the maternal health outcomes of Black women.

Link: Black Maternal Health Tables

Organizations & Programs in Nevada Working to Improve Maternal Health

• Heart and Sol Collective
• The Phenomenal Mama
• EARN-FS
• Southern Nevada Breastfeeding Coalition
• Make It Work Nevada
• SNHD Nurse-Family Partnership Program
• Doula Co-op

Upcoming Events for 2025 Black Maternal Health Week
Nevada Black Maternal Health Week is April 11th – April 17th. Here are some events in Nevada that bring awareness to disparities and provide support, resources, and a safe space for Black mothers.

April 12th: Maternal Wellness Walk & Kinship Cookout
April 12th: Fatherhood Redefined: Nurturers, Partners, and Pillars
April 16th: Black Mama Magic Brunch

You can find more information or register for these events at: https://thephenomenalmama.com/bmhw2025/