Maternal Health: How Racial and Gender Discrimination Drive Maternal Mortality Rates

The International Day of the Elimination of Racial Discrimination on March 21 offers a significant opportunity to reflect on a key issue in maternal health: despite global progress over the past 20 years, maternal deaths are rising across the Americas. Why?

To find the answer, simply examine who is being hardest hit by this preventable epidemic: women and girls of African descent.

Afrodescendent women and girls are more likely to die during childbirth than almost every other racial and ethnic group in the Americas due to systematic neglect and mistreatment by society and healthcare systems, according to a recent analysis from UNFPA, the United Nations sexual and reproductive health agency, Maternal Health of Women and Girls of African Descent in the Americas. Black women and girls in the United States, for example, are three times more likely to die while giving birth or within six weeks of giving birth compared to non-Afrodescendent and non-Hispanic women. The rate is 2.5 times higher in Suriname, while Brazil and Colombia see figures 1.6 times higher.

“When a woman of African descent dies during childbirth, it is still too often put down to her own poor life decisions or her predisposition to certain medical conditions; then, the world moves on,” said Dr. Natalia Kanem, Executive Director of UNFPA at a press conference launching the analysis. “Justice and equality will only be possible when our health-care systems see these women and provide them with respectful, compassionate care.”

Intersecting Challenges

How did UNFPA isolate the role of racism and sexism in maternal health?

In their  July 2023 analysis UNFPA revealed how disparities in health outcomes for Afrodescedent women and girls persisted even when controlling for educational levels and income.      

The analysis found that higher income or levels of schooling also offer little protection for mothers. Maternal deaths among African American college graduates in the United States, for instance, were 1.6 times higher than among white women who had not achieved a high school diploma. Thus, Afrodescendent women and girls’ worst maternal health outcomes could not be fully explained by the social determinants of health.

Instead, structural problems like racism and sexism play a major role in outcomes. These systemic issues result in Afrodescendent women and girls being denied quality care, or being refused pain relief based on racist beliefs dating back to the era of enslavement that they are less sensitive to pain. They are also subjected to verbal and physical abuse in hospitals.

Their mistreatment and the low-quality services these women receive can have deadly consequences, as they lead to increased complications and delayed interventions.

Revealing the Invisible

Lack of available data is also an issue. Only 11 out of the 35 countries in the Americas collect maternal health data broken down by race. A mere four countries with comparable data count the number of Black women who die during childbirth. This data gap renders the challenges Afrodescendent women and girls face invisible.

The alarming rate of maternal deaths among women and girls of African descent is a human rights crisis that is largely ignored and overlooked by decision-makers. Out of the population of more than 1 billion people in the Americas, 209 million are of African descent. However, only one-third of the 32 national health plans surveyed by UNFPA as part of its research identified Afrodescendents as a population that experiences barriers to health.

Saving Lives

The vast majority of maternal deaths among Afrodescendent women and girls are preventable—but they can only be averted when their voices are heard, and their problems are made visible. They must be at the table as maternal health policies are developed, and their ideas and concerns must be addressed. 

Racist misconceptions rooted in enslavement-era beliefs about people of African descent have no place in medical education, training curricula, hospitals, or doctors’ offices. Obtaining improved data is a critical priority, as is providing services that acknowledge and fulfill Afrodescendent communities’ right to health. This care should reflect preferences defined by women and girls of African descent and integrate culturally appropriate healthcare practices.

Realizing the sexual and reproductive health and rights of Afrodescendant women and girls requires addressing the main barriers they face in finding such care. National governments, international organizations, and healthcare providers in the region can meet the maternal, sexual, and reproductive health needs of Afrodescendent women and girls by addressing the root causes of structural racism, sexism, and discrimination.

UNFPA is committed to zero preventable maternal health by 2030. It plays a leading global role in improving health care and achieving justice and development for people of African descent, especially women and girls. Its chief goal is to accelerate data improvements so countries can take urgent corrective actions to address these challenges.