Is the Black-white disparity in maternal mortality as big as Raphael Warnock said?

When the issue of abortion came up in the Georgia Senate debate, Democratic Sen. Raphael Warnock turned the question into one of maternal mortality.

In the Oct. 14 debate in Savannah against Republican Herschel Walker, Warnock said that the U.S. leads "all the western nations" in maternal mortality, a statement that we found to be generally accurate in our immediate post-debate analysis. 

Warnock went on to say, "Black women are three to four times more likely to die (from childbirth) even when they have the insurance and the income."

Warnock has a point, though the data is a little less solid than he suggests.

We were unable to find any study that explicitly compared Black and white maternal mortality rates while controlling for income and insurance status.

Instead, most studies looked at racial disparities without controlling for those factors.

For instance, one major study published in September 2021 found that "the maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women," but this controlled for neither income nor insurance.

And in a review of the available data, the Centers for Disease Control and Prevention has written, "Black women are three times more likely to die from a pregnancy-related cause than White women." The agency cited a range of factors that "contribute to these disparities," including access to high-quality health care, underlying chronic conditions, structural racism and implicit bias, several of which are linked to differences in income and insurance status.

The closest data we could find that spoke to Warnock’s assertion was framed slightly differently, but was consistent with his point.

The paper, published by the CDC in 2019, controlled for educational attainment. That’s not precisely the same as income, but more education is often correlated with higher income, and with having health insurance coverage.

The lowest two educational categories — people with less than a high school diploma, and those with a high school diploma — displayed disparities in maternal mortality between Blacks and whites, but the degree of disparity was lower than Warnock suggested. For women with less than a high school diploma, the Black maternal mortality rate was 1.8 times higher than the rate for white women. For those with a high school diploma, the rate was 2.3 times higher.

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But for those with higher educational attainment, Warnock’s differential was basically accurate. For those who had attended college but did not finish a bachelor’s degree, Black women had a maternal mortality rate 3.5 times higher than white women did. For college graduates, the differential was 5.2 times higher.

In other words, "education exacerbates rather than mitigates Black-white differences in maternal deaths," wrote the Commonwealth Fund, a nonprofit that studies health policy, in its analysis of the data.

Warnock said that "Black women are three to four times more likely to die (from childbirth) even when they have the insurance and the income."

Studies have shown this type of disparity, but without controlling for income or insurance status. We were unable to find any studies that controlled for those two factors.

However, a 2019 study found that for women who had attended college or earned a college degree — a statistic that often correlates with income and insurance coverage — the Black-white differential ranged from 3.5 to 5.2 times, which is in line with what Warnock said.

We rate the statement Mostly True.