Q&A: Steps to improve ‘maternal mortality crisis’ for Black, Indigenous women

Key takeaways:

• U.S. maternal mortality rates improved since 2021 and 2022, but rates remain high for Black and Indigenous women.
• Advocacy for policies such as Medicaid expansion and paid family leave can improve outcomes.

Maternal mortality rates in the U.S. have declined since 2021 and 2022, but disparities remain for Black and Indigenous women, who are more than three times more likely to die during pregnancy and postpartum, according to CDC data.

“In the last study that was published on the preventability of maternal mortality, the CDC noted that 80% of maternal deaths are preventable, and we can see that in the rates of maternal death in other countries,” Amanda P. Williams, MD, chief medical officer at March of Dimes, clinical innovation adviser at the California Maternal Quality Care Collaborative and adjunct clinical associate professor in the department of obstetrics and gynecology at Stanford University School of Medicine, told Healio. “This can be different. This is not a situation that has to persist. Whether it’s expanding the use of doulas, expanding Medicaid or expanding family leave — there are steps we can take to make the maternal mortality crisis in this country different. We are not stuck in this position.”

Healio spoke with Williams about the CDC report and what can be done to close the maternal mortality gap and improve care for affected Black and Indigenous women.

Healio: Could you summarize the results of the recent CDC maternal mortality report?

Williams: The CDC just released the 2023 U.S. maternal mortality data, and it shows that the rate of death of a mother during pregnancy or in the first 42 days postpartum is 18.6 per 100,000 live births. While that is terrible relative to other economic peer countries — like the U.K., where it is 5.5, or Sweden, where it is 2.6 — that is an improvement for the U.S., which was 22.3 in 2022 and 33 in 2021. However, the disparities between Black and white women are worse now than they were over the last couple years. Now, Black women are 3.5 times more likely to die than their white peers during pregnancy and postpartum. So, while there is something to celebrate that the U.S. is recovering from the impact of the COVID-19 pandemic, and that good policy is starting to have an effect, until we are at the level of other countries and address these disparities, our work is not nearly complete.

Healio: Why might it be that Black and Indigenous women continue having worse maternal mortality compared with other races and ethnicities?

Williams: Non-Hispanic white women, Hispanic women and Asian women all showed improvement during the last 2 years. However, for Black women, the rates are still very high, as they are also for Indigenous women. Those are the populations where we have seen the most biases come to bear in health care. No one could escape the impact of COVID-19. Outcomes worsened for everyone during the pandemic. Now that we know how to take care of patients with COVID-19 and more people are vaccinated, we’re back to operations as usual. Operations as usual in the U.S. means we are back to confronting the impact of social inequities and unequal burdens of health conditions, the cumulative effect of chronic stress and the way that systemic racism is intertwined in the provision of obstetric care.

Healio: What is March of Dimes currently working on to help close the current maternal mortality gap?

Williams: There are multiple March of Dimes programs that can help all patients, and in particular, help close these health outcome disparities. We have our Mom & Baby Mobile Health Centers that go out and bring care to patients in either rural areas or urban areas that have poor transportation or for people who have a hard time getting to doctors’ appointments. We also are supporting doula programs and training for doulas, focusing on making sure that the doulas reflect the communities that they are serving, and that care is being given in a culturally responsive fashion. Then, of course, we also advocate on behalf of policies such as paid family leave postpartum and the expansion of Medicaid to the full 12 months postpartum. We also sponsor the University of Pennsylvania’s Research Center for Advancing Maternal Health Equity that is doing research to understand interventions that might help impact this maternal health equity gap.

Healio: What are some other ways to improve maternal mortality rates for women of all races and ethnicities?

Williams: In terms of outpatient and office prevention efforts, starting patients who are at risk for preeclampsia, in particular preterm preeclampsia, on low-dose aspirin is a simple, over-the-counter intervention. Many patients are candidates for it, and it helps decrease both preeclampsia, which can be a life-threatening condition for pregnancy, and preterm birth. The physician can also educate the patient on warning signs of cardiovascular issues, infection and bleeding, especially during the early postpartum period.

Most important, the physician or midwife can focus on listening to the patient. As I often say when I’m training in obstetrics, the more different someone is from you, the harder you need to listen. Your brain does not have the same shortcuts that say, “This is my sister, this is my cousin, this is my niece.” If someone is more different from you, as much as you think that you are providing the same care to everyone, we know that is not how human brains work, so we have to work extra hard to listen to our patients.

Physicians should also invite patient advocacy. Oftentimes, patients will feel shy because they feel like they’re bothering their doctor or that their doctor won’t hear them. Our society has given many messages about which voices matter and which voices don’t. Particularly when it comes to young women, those voices are often not honored in the same way.

For more information:

Amanda P. Williams, MD, can be reached on Instagram @AmandaPWilliamsMDMPH.

References:

• CDC. Preventing Pregnancy-Related Deaths. www.cdc.gov/maternal-mortality/preventing-pregnancy-related-deaths/index.html#:~:text=More%20than%2080%25%20of%20pregnancy,%2C%20and%2For%20community%20factors. Published Sept. 25, 2025. Accessed Feb. 10, 2025.
• Hoyert DL. NCHS Health E Stats. 2025;doi:10.15620/cdc/174577.