March 20, 2025 Story by: Editor
Despite advancements in medical care, significant racial disparities in maternal and infant health continue to persist in the United States. The COVID-19 pandemic further highlighted these disparities, drawing increased attention to long standing health inequities.
Additionally, the Supreme Court’s decision to overturn Roe v. Wade and subsequent restrictions on abortion access may widen existing gaps in maternal health outcomes. These factors have intensified discussions on improving maternal and infant health while addressing racial disparities.
This report provides an overview of racial disparities in maternal and infant health, examines contributing factors, and highlights recent efforts to mitigate these inequities.
The analysis is based on publicly available data from sources including the CDC WONDER online database, the National Center for Health Statistics (NCHS) National Vital Statistics Reports, and the CDC Pregnancy Mortality Surveillance System. While this report focuses on racial and ethnic disparities, disparities also exist across socioeconomic and geographical dimensions, including income, education, and urban-rural divides.
Data collection often assumes cisgender identities, potentially excluding transgender and non-binary individuals from systematic representation. In cases where cited data use cisgender labels, it reflects the definitions set by the original data sources.
Persistent Racial Disparities in Maternal and Infant Health Outcomes
Racial disparities in maternal and infant health remain stark. The pregnancy-related mortality rate for American Indian and Alaska Native (AIAN) and Black women is more than three times higher than that of White women, at 63.4 and 55.9 per 100,000 live births, compared to 18.1 per 100,000.
Similarly, Black, AIAN, and Native Hawaiian or Pacific Islander (NHPI) women experience higher rates of preterm births, low birthweight births, and inadequate prenatal care. Infants born to Black, AIAN, and NHPI individuals also have significantly higher mortality rates than those born to White individuals.
Socioeconomic and Structural Inequities Contribute to Disparities
These disparities are deeply rooted in broader social and economic inequities, which are often linked to systemic racism and discrimination. While disparities in health insurance coverage and access to care contribute to poorer maternal and infant health outcomes for people of color, socioeconomic inequalities—such as income disparities—play a more significant role. Moreover, these disparities persist even when factors like education and income are accounted for, emphasizing the role of racism and discrimination in driving health inequities.
Expanding Efforts to Improve Maternal and Infant Health
The increased focus on maternal and infant health has led to initiatives aimed at expanding healthcare access, increasing service availability, diversifying the healthcare workforce, and improving data collection. Addressing socioeconomic factors that contribute to poor health outcomes is essential. Moreover, the persistence of maternal health disparities across income and education levels underscores the need to tackle systemic racism and discrimination as part of broader health equity efforts.
The Impact of Policy and Legislation
Looking ahead, policy decisions and the 2024 presidential election could significantly impact efforts to address racial disparities in maternal and infant health. State variations in abortion access following the overturning of Roe v. Wade may exacerbate racial health disparities. Additionally, the differing policy positions of Vice President Kamala Harris and former President Donald Trump on abortion, reproductive healthcare, and maternal health will likely have distinct implications for future maternal health equity.
Pregnancy-Related Mortality Rates: A Growing Concern
In 2020, approximately 900 women in the U.S. died due to pregnancy-related causes, defined as deaths occurring within one year of pregnancy. A quarter (26%) of these deaths happened during pregnancy, another quarter (27%) occurred during labor or within the first postpartum week, and nearly half (47%) took place between one week and one year postpartum.
This underscores the importance of healthcare access beyond pregnancy. Notably, over 84% of pregnancy-related deaths are considered preventable. While causes of death vary by race and ethnicity, infections (including COVID-19) and cardiovascular conditions are the leading causes across all groups. Additionally, maternal mortality reviews in 38 states identified mental health conditions as the top cause of pregnancy-related deaths.
Black and AIAN individuals face disproportionately high pregnancy-related mortality rates, at 55.9 and 63.4 per 100,000 live births, respectively—over three times the rate of White individuals (18.1 per 100,000). Hispanic individuals also have a higher mortality rate (22.6 per 100,000) compared to White individuals, while Asian individuals have a slightly lower rate (14.2 per 100,000).
Limited data on NHPI women prevent precise mortality rate estimates, but earlier findings indicate NHPI individuals had the highest pregnancy-related mortality rate among racial and ethnic groups (62.8 per 100,000).
Research shows that disparities persist regardless of education and income. Black women with college degrees face higher pregnancy-related mortality rates than White women with the same educational background and even White women without a high school diploma.
Similarly, high-income Black women experience the same risk of dying in the first year postpartum as the lowest-income White women. Furthermore, Black women face a significantly higher risk of severe maternal morbidity, such as preeclampsia, compared to their White counterparts. AIAN, Black, NHPI, Asian, and Hispanic women also experience higher rates of intensive care unit admissions during delivery, a key indicator of severe maternal complications.
While maternal death rates declined across most racial and ethnic groups from 2021 to 2022—following a surge due to COVID-19—Black women continued to have the highest maternal mortality rate. The U.S. maintains the highest maternal mortality rate among high-income nations, with Black women experiencing rates over two and a half times higher than White women.
Birth Risks and Outcomes: Racial Disparities Persist
Black, AIAN, and NHPI women are more likely to experience birth risks that contribute to infant mortality and long-term health consequences for children. Preterm birth (before 37 weeks of gestation) and low birthweight (under 5.5 pounds) are leading causes of infant mortality. Additionally, receiving pregnancy-related care late (beginning in the third trimester) or not receiving care at all increases the risk of complications.
Data from 2022 indicate that NHPI women are four times more likely than White women to receive prenatal care only in the third trimester or not at all (22% vs. 5%). Black women are nearly twice as likely as White women to receive late or no prenatal care (10% vs. 5%). AIAN women also face significantly higher risks of preterm births and low birthweight babies compared to White women.
Infant Mortality Disparities
Reflecting these disparities, infants born to AIAN, Hispanic, Black, and NHPI women face higher mortality risks than those born to White women. Infant mortality—defined as the death of a child within the first year of life—has shown an overall decline over time, yet disparities have persisted and, in some cases, widened. The leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, injuries, and maternal pregnancy complications.
Between 2021 and 2022, the overall infant mortality rate increased slightly from 5.4 to 5.6 per 1,000 live births. However, racial and ethnic disparities remain stark. In 2022, the infant mortality rate per 1,000 live births was:
- 10.9 for Black infants
- 9.1 for AIAN infants
- 8.5 for NHPI infants
- 4.9 for Hispanic infants
- 4.5 for White infants
- 3.5 for Asian infants
These statistics indicate that Black infants are more than twice as likely to die in their first year compared to White infants (Ely & Driscoll, 2024). The data also reveal disparities in stillbirth rates, with NHPI, Black, and AIAN women experiencing higher rates of pregnancy loss after 20 weeks. Additionally, causes of stillbirth differ by race and ethnicity; for example, Black women experience higher stillbirth rates due to diabetes and maternal complications compared to White women.
Rising Rates of Perinatal Depression
Mental health is a crucial factor in maternal and infant health. Research indicates that perinatal depression affects approximately one in five AIAN, Asian or Pacific Islander, and Black women, compared to one in ten White women. Hispanic women report similar rates (12%) to their White counterparts (11%) (CDC, 2018). The prevalence of postpartum depression has nearly doubled over the past decade, rising from 9.4% in 2010 to 19.3% in 2021, with the largest increases observed among Black, Asian, and Pacific Islander women.
Women of color face greater barriers to mental health care, including limited access to culturally appropriate services, systemic racism, and economic hardships. Perinatal depression is linked to serious maternal health risks such as hypertension and diabetes, and infants born to mothers with depression have higher hospitalization rates and an increased risk of death within the first year.
Factors Driving Maternal and Infant Health Disparities
Disparities in maternal and infant health arise from a combination of medical, social, and economic factors. While health insurance coverage and access to care play a role, broader systemic issues such as racism, discrimination, and economic inequality significantly impact outcomes.
Medicaid covers more than two-thirds of births among Black and AIAN women, helping to address gaps in maternal health care. However, Black, AIAN, and Hispanic women are more likely to be uninsured before pregnancy, which delays access to prenatal care. Additionally, limited provider availability, particularly in rural and medically underserved areas, further exacerbates health disparities. AIAN women, in particular, face challenges in accessing obstetric care, and hospital closures in rural areas have had a disproportionate impact on Black infant health.
Racism and discrimination in health care settings also contribute to poor maternal and infant health outcomes. Studies reveal that racial bias affects medical decision-making, leading to higher rates of mistreatment among Black and Hispanic women. A 2023 KFF survey found that 21% of Black women reported being treated unfairly by a health care provider due to their racial or ethnic background. Additionally, 22% of Black women who have been pregnant or given birth in the past decade reported being denied pain medication they believed they needed.
Efforts to Address Maternal and Infant Health Disparities
Growing awareness of these disparities has led to increased efforts to expand access to care, diversify the health care workforce, and improve data collection. Since the White House Blueprint for Addressing the Maternal Health Crisis was introduced in 2022, several federal initiatives have been launched to improve maternal and infant health.
Key initiatives include:
- A pilot project distributing newborn supply kits
- A $27.5 million program training over 2,000 OB/GYNs, nurses, and health care providers in specialized maternity care
- A new Executive Order issued in March 2024 to fund research on maternal morbidity and mortality warning signs among WIC program recipients
- The Maternal Health Collaborative to Advance Racial Equity, a partnership between the Office of Intergovernmental and External Affairs (IEA) and the March of Dimes, focused on improving Black maternal health outcomes
- The Expanding Access to Women’s Health grant program, providing funding to 14 states and the District of Columbia to enhance maternal and reproductive health coverage
Additionally, most U.S. states have expanded Medicaid postpartum coverage to stabilize care for new mothers. Medicaid finances four in ten births nationwide, but historically, many women lost coverage 60 days after childbirth due to lower eligibility levels for parents. The American Rescue Plan Act (ARPA) of 2021 introduced a policy allowing states to extend postpartum Medicaid coverage to one full year starting April 1, 2022.
Source: KFF
