Tucker, M. J., Berg, C. J., Callaghan, W. M., & Hsia, J. (2007). American Journal of Public Health, 97, 247-251.

In 2000, the United States ranked 30th in the world in maternal mortality. One of the reasons for this low ranking is the significant discrepancies in U.S. maternal mortality between Black women and White women. Black women consistently experience almost a fourfold greater risk of death from pregnancy complications independent of age, parity, or education This study examined the relative contribution of prevalence and case fatality rates for five pregnancy-related complications to determine the contribution of racial disparities to the U.S. world ranking. Data were obtained from large, population-based data bases. The authors looked at prevalence rates and case fatality rates for five pregnancy-specific conditions: pre-eclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage. The prevalence rates for all conditions among Black women were not significantly greater than those among Women. However, for all five conditions, Black women had case fatality rates that were two to three times greater than White women. The authors posit that reasons for the differences may include late entry into prenatal care, lack of access to adequate care, and the quality and consistency of care. Because the data did not measure severity of the condition or pre-existing comorbidities, they also may be factors. The authors also cited a recent Institute of Medicine report, which documented that minority patients generally receive lower quality of care, even when they have equal access to health insurance and healthcare. Discovering the interaction between social and biological causes of these differences is important in identifying interventions that will decrease healthcare disparities and improve pregnancy outcomes.

Judith A. Lewis