Does Family Structure Help Explain the Racial Divide in Maternal Mortality?

Racism, of the explicit and implicit kind, is the primary cause of different outcomes for black and white Americans. A version of this argument was articulated in a recent article in New York Times magazine that suggested that the disparities in maternal mortality for black and white mothers can be explained, in part, by “pervasive, longstanding racial bias in health care—including the dismissal of legitimate concerns and symptoms—that can help explain poor birth outcomes even in the case of black women with the most advantages.”

The statistics are indeed stark, but the explanation that racism is to blame for the racial divide in maternal mortality deserves further investigation.

Author Linda Villarosa notes,

The United States is one of only 13 countries in the world where the rate of maternal mortality — the death of a woman related to pregnancy or childbirth up to a year after the end of pregnancy — is now worse than it was 25 years ago.…. Black women are three to four times as likely to die from pregnancy-related causes as their white counterparts, according to the CDC.

The first reason to question whether racism is to blame for this disparity is that black maternal mortality has gotten worse in the past 25 years, but is the argument really that racism has gotten measurably worse over the same period?

Villarosa cites the experience of Serena Williams, who says that her doctors did not listen to her regarding her history of blood clots and did not hear her gasping for breath after the birth of her daughter. It is hard to imagine doctors ignoring such a famous patient, but not even she claimed that her race had anything to do with it. Indeed, one might be more inclined to believe that doctors are dismissing the complaints of a “hysterical” pregnant woman or of a “high maintenance” celebrity.

More typical, I presume, is the experience of Simone Landrum, also profiled in the piece. The single mother of two boys in New Orleans who was being beaten by her boyfriend while she was still pregnant with their child, Landrum almost bled to death as a result of undiagnosed pre-eclampsia. The boyfriend was eventually arrested and released on bond. The article explains:

Though she had broken up with him several times, Landrum took him back, out of love and also out of fear that she couldn’t support herself, her sons and the child she was carrying on the paycheck from her waitress gig at a restaurant in the French Quarter.

Villarosa argues that it is not only the way black women are treated by medical professionals but also simply the stress of being a black woman in America today that results in this higher rate of maternal mortality:

For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death.

But for Landrum and many other unmarried mothers like her—who live in fear of their boyfriends or who are worried that they won’t be able to provide for their children without the help of said boyfriends—are presumably experiencing a much greater and more immediate stress than what comes from casual discrimination.

Some research has been done on maternal mortality, but much more has been done on infant mortality. The two, not surprisingly, are inextricably linked. And it turns out that one major correlate of infant mortality is family structure. The infant mortality rate for unmarried mothers, according to one study, is 6.53/1,000 compared to married mothers, for whom it is 4.11/1,000. So it might be useful to think about how the breakdown of the black family has affected maternal mortality as well. According to data from Child Trends, 70% of all births to black women occurred outside of marriage, compared to only 29% of all births to white women (in 2014).

Villarosa’s article provides some understanding of why having a husband, especially a supportive one, might help reduce maternal mortality or even complications from labor. When giving birth to her fourth child, Landrum employs the services of a doula to advocate for her in the delivery room because she does not have anyone else (such as a husband/partner) to do so. The doula instructs doctors to stop asking Landrum about her previous pregnancy every time a new one walks in. She also notices that Landrum has been given twice the dose of anesthesia that she needed for a natural birth and objects.

Villarosa is high on doulas, and maybe we have come to think that the role of an advocate is best performed by a female professional. But frankly, there are plenty of husbands who can advocate for their wives in the delivery room. And having their presence (in most cases) would reduce both the short-term stress of labor and the long-term stress of caring for children.

Dealing with the prevalence of unmarried motherhood in the black community may not be any easier than changing racist attitudes among doctors or the general public, but before we settle on bigotry as the main source of the maternal mortality problem, it might be worth considering other possibilities, including the role of family structure.

​​​​​Naomi Schaefer Riley is a senior fellow at the Independent Women’s Forum and a columnist for the New York Post. Her latest book is Be the Parent, Please: Stop Banning Seesaws and Start Banning Snapchat (Templeton Press).

Editor's Note: The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.