Kamala Harris is right: Black women in the US have the highest maternal mortality rate

As the Biden administration’s most visible advocate in the fight for reproductive rights, Vice President Kamala Harris has been vocal about the U.S.’ reproductive health care’s shortcomings and how it often fails women of color. Harris has toured the nation railing against state abortion bans and touting the administration’s efforts to expand postpartum coverage.

In a July 6 conversation at the Essence Festival of Culture, which bills itself as the U.S.’ largest African American culture and music event, Harris said Black women fare the worst in maternal mortality rates.

"Black women in the United States of America are three to four times more likely to die in connection with childbirth than other women," Harris said at the New Orleans event. "And we know that there are a variety of reasons for that. But we also know that this is a health care crisis of the highest order that has received very little attention proportionate to the seriousness of the matter." 

Harris has highlighted this issue before, stating that the U.S. has the highest maternal mortality rate compared with other wealthy nations. She made the same maternal mortality claim July 10, in a speech to Alpha Kappa Alpha sorority members in Dallas.

In 2022, we rated a similar statement about the racial disparities in maternal mortality by Sen. Raphael Warnock, D-Ga., Mostly True — Warnock added that the disparity existed even when Black women had insurance and income, but we were unable to find studies that controlled for those factors.

With the topic coming up recently, we wanted to consult new data to see whether the numbers still hold.

They do. The U.S., for years, has had the highest maternal mortality rate among income- comparable countries. Black women in the U.S. also have consistently experienced higher rates — typically between two to four times higher — than other demographics.

Munira Gunja, a senior researcher at the Commonwealth Fund, a health care research organization, called the disparity "unacceptably high."

"No matter what methodology you use, for Black women it’s much higher," Gunja said. "And the majority of these deaths are preventable." 

But gauging and comparing maternal mortality is complicated because of measurement changes in the U.S. and different reporting practices in other countries. Nevertheless, experts said the U.S.’ rate is far too high and remains higher than other wealthy nations, even when adjusting the data. 

Eugene Declercq, a community health sciences professor at Boston University who runs the birth data website Birth By the Numbers, said there have been efforts to improve consistency in data across countries and, while data comes from different vital statistics systems, they’re fairly comparable.

"There may be individual instances of underreporting in other countries, but most have data systems as good or better than the U.S.," he said. "The issue around measurement doesn't get the U.S.’ poor performance off the hook."

There are different systems that collect and report maternal mortality data in the U.S.; the main two being the Centers for Disease Control and Prevention’s National Vital Statistics System and its Pregnancy Related Mortality System.

In 2003, the U.S. believed it was undercounting maternal mortality deaths and updated the way they were measured, adding the "pregnancy checkbox" to death certificates that signaled whether the person was pregnant, or recently pregnant, at the time of death. States gradually integrated the change over the years, with the last state, West Virginia, adding it in 2017.

This helped the U.S. record more deaths that were previously missed, while also logging more misclassifications, thus helping drive up the numbers. Rates reported tripled as more states adopted the updated certificate.

However, the increase in false positives is limited largely to data from the National Vital Statistics System, which uses data only from death certificates, experts said. The Pregnancy Related Mortality System performs additional quality checks, and while its numbers also increased during this period, it did so less dramatically.

Gunja said that although the methodology changes yielded what resembled a spike in U.S. deaths, the picture was a more accurate reflection of maternal mortality. In a June analysis Gunja co-authored that compared the U.S. with other countries, her team used data from the Organization for Economic Co-operation and Development, or OECD, a group of 38 advanced, industrialized nations.

"They collect data from a variety of sources, generally the federal data from these countries but also other sources, and standardize the data so you can make more of an apples-to-apples comparison," Gunja said. "Of course, there are limitations to international comparisons, but the OECD is using a standardized methodology across countries, so there’s no doubt that the U.S. is doing worse."

Saloni Dattani, a researcher at Our World in Data, a research consortium, said that, with or without the measurement change, the data still shows that Black women in the U.S. have around three times the maternal mortality rates as non-Hispanic white women.

Courtesy of the Commonwealth Fund

In 2022, 817 women in the U.S. died of maternal causes — a rate of 22.3 maternal deaths per 100,000 live births, according to data released in May by the CDC’s National Center for Health Statistics. This represents a drop from the 1,205 women that the CDC said died in 2021, a rate of 32.9 maternal deaths per 100,000 live births. The most recent data from the Pregnancy Mortality System is from 2020.

The decline isn’t entirely surprising, public health experts said. Maternal-related deaths spiked in 2021, with the COVID-19 pandemic largely blamed as pregnant patients often fared worse against the disease.

The death rate for Black women, according to the CDC’s report, was 49.5 for every 100,000 live births — around three times higher than the combined 16.3 average of other women (non-Hispanic white, Hispanic and Asian American).

Experts pointed to several reasons behind the U.S.’ high maternal mortality rate and its racial disparity.

Among those: a lack of universal health care coverage, no federal guaranteed parental leave policy, and less robust postpartum health care.

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The U.S has fewer midwives and OB-GYNs than many other wealthy nations, the Commonwealth Fund found, with about 16 providers per 1,000 live births. Nearly 7 million women in the U.S. live in counties where there are no hospitals or birth centers offering obstetric care and no obstetric providers, the organization said, and the shortage is expected to worsen in coming years.

Data has shown that Black patients receive worse-quality care than white patients and that racial disparities exist in hospitals, with inequities in access to care and patients’ experience of care often being rooted in discrimination and clinician bias. 

One CDC analysis of data from 2017 to 2019 found that more than 80% of pregnancy-related deaths were preventable and that three of the leading causes were mental health issues, such as suicide and drug overdose, as well as excessive bleeding, and cardiac and coronary conditions.

There’s also the lack of universal maternal care, which disproportionately impacts Black women, Gunja said. For example, after childbirth, most women in the U.S. have a single checkup at six-weeks postpartum — a critical period when many maternal deaths occur. Some women without child care or paid leave may be unable to make that appointment.

Harris said Black women are "three to four times" more likely to die in connection with childbirth than other women.

Data consistently shows, independent of how it is captured, that Black women in the U.S. are around three times more likely to die from a pregnancy-related cause than other women. Data shows that Black women experienced a 49.5 death rate per 100,000 births in 2022, compared with a 16.3 combined average of other demographics.

We rate Harris’ statement True.