Black Maternal Mortality:
Dying to Give Birth in America

The United States has the highest maternal mortality rate of any wealthy nation. Within that extraordinary statistic, Black women face a rate that would be scandalous in any other context: 69.9 deaths per 100,000 live births, compared to 26.6 for white women. The disparity is not explained by income: Black college-educated women die at higher rates than white women without high school diplomas. It is not explained by access to care: women with insurance and prenatal care still die at disparate rates. Research consistently identifies one factor that explains the gap across income and education levels: implicit bias in medical treatment — the documented tendency of healthcare providers to take Black patients' pain less seriously, dismiss their symptoms, and delay intervention.

The medical education problem is specific and documented. A 2016 study published in PNAS surveyed 222 medical students and residents and found that 50% endorsed at least one false belief about biological differences between Black and white patients — including "Black people have thicker skin than white people" and "Black people's nerve endings are less sensitive than white people's." Students who held these beliefs were less likely to recommend adequate pain treatment for Black patients. These are students and residents in training right now.

In 2017, Serena Williams — one of the most physically elite athletes alive, winner of 23 Grand Slam titles, accustomed to managing her own body at the highest level — gave birth by emergency C-section and began experiencing shortness of breath the next day. She knew her body. She had a history of blood clots. She told a nurse she needed a CT scan and blood thinners immediately. The nurse dismissed her concern, suggesting the pain medication was making her confused. Williams insisted. A doctor eventually ordered the CT scan, which revealed multiple pulmonary emboli. She required emergency surgery and was hospitalized for six days.

Serena Williams is wealthy, famous, educated, and physically extraordinary. She told a reporter: "I almost died after giving birth to my daughter." If Williams had not advocated as forcefully as she did — had she deferred to the nurse's dismissal — she might have died. The question the disparity data raises is: how many Black women without Williams's wealth, fame, and self-advocacy capacity died in similar situations because they were not taken seriously?

J. Marion Sims is called the "Father of Modern Gynecology." His surgical techniques for repairing vesico-vaginal fistulas — developed in the 1840s — saved countless lives. He developed them by operating on enslaved Black women, without anesthesia, repeatedly. He justified this by arguing that Black women did not feel pain the way white women did. His statue stood in Central Park until 2018, when New York City removed it after protest.

The belief that Black people feel pain differently was not eradicated when Sims's statue came down. It persists in medical education, in treatment patterns, and in outcomes data. The Black maternal mortality crisis is, in part, the 180-year legacy of a medical system that was built on the premise that Black bodies are different — less sensitive, more durable, less in need of the interventions that white patients receive as standard of care.