Why Do Black Women Experience More Pregnancy Loss?

Research has shown that Black women experience all types of pregnancy loss, including miscarriage, stillbirth, preterm birth, and infant death, more often than White women. In addition to their babies being at increased risk of adverse outcomes, Black mothers themselves are three to four times more likely than White mothers to die of pregnancy-related complications.

The reasons behind this disparity are multi-faceted and unclear, despite years of research. We do know that Black women have higher rates of the risk factors associated with pregnancy loss, such as diabetes, tobacco use, obesity, and low socioeconomic status.

However, the underlying causes that make Black women more susceptible to these risk factors are also related to various issues of racism and systemic inequality in healthcare.

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Miscarriage

Defined as a pregnancy loss occurring earlier than 20 weeks of gestation, miscarriage is a devastating event in the life of parents.

One 2013 study that examined 4,070 Black and White women in the southeastern United States found that Black women experienced miscarriage more often than White women. Between gestational weeks 10 and 20, their rate was nearly twice that of White women.

The study controlled for factors such as alcohol use and age, and early pregnancy ultrasounds were no different between the races. This particular study suggests the difference in miscarriage risk may somehow be linked solely to race.

Late Pregnancy Loss

In an analysis of medical records from 2015 to 2017 conducted by the Centers for Disease Control and Prevention, scientists found that Black women were more than twice as likely as Hispanic and White women to experience a stillbirth, which is defined as the loss of a baby at 20 weeks of gestation or later.

The records indicated that health problems (both pre-existing and pregnancy-related) were cited as the cause for stillbirth more than three times as often among Black women compared to Hispanic or White women. Unfortunately, the authors noted that the reasons for the disparity in health status among the different races are not clear.

Preterm Labor and Premature Births

One of the major contributors to the higher rate of infant deaths among Black women is an increased rate of preterm labor and premature birth. Black infants are also 3.8 times more likely to die of complications due to low birth weight compared to non-Hispanic White infants, according to a 2019 report published by the U.S. Department of Health and Human Services.

However, these facts don’t explain why Black women are more likely to go into early labor than White women. As with the other pregnancy-related issues that Black mothers face, socioeconomic factors could play a role by influencing the overall health of Black women as well as the quality of prenatal care they receive.

Maternal Complications

Black women also experience pregnancy-related morbidity (illness) and mortality (death) at higher rates than White women, and some doctors believe the issue is another symptom of the broader social problems of racially-based stereotypes and bias.

These racial issues affect the overall quality of health care available to Black women, so in many cases they are less healthy when they get pregnant, increasing the risk of problems during their pregnancy.

Structural Racism in Healthcare

Although socioeconomic factors are important in the discussion of pregnancy loss in Black women, several studies have found that the risk is the same even among educated, affluent Black women.

For example, in 2019, the American Heart Association noted that Beyoncé and Serena Williams, two of the best-known and affluent Black women in the United States, both suffered life-threatening pregnancy complications.

This example and many others reveal a disturbing truth about structural racism within the healthcare system and how prenatal care is administered differently to White vs. Black mothers.Black women are less likely to have access to prenatal education and care, which can affect their health behaviors during pregnancy.

Once again, though, when studies control for socioeconomic status and compare White women receiving little or no prenatal care to Black women with adequate prenatal care, Black women still have higher rates of infant mortality.

One commentary on these studies pointed out that quality of care differs between racial groups, so that even when Black women do receive prenatal care, it may not be comparable to that of White women. In other words, there is a higher likelihood that White women will receive more effective medical care than Black women.

Another reality is that Black mothers do not appear to be monitored as closely as White mothers in clinics and hospitals, revealing the underlying racial inequality that is embedded in our healthcare system.

What Can Be Done?

The Centers for Disease Control and Prevention is working with healthcare agencies in individual states to achieve a more standardized model of care for mothers, and educational programs focused on identifying bias are aimed at helping healthcare workers treat all patients equally.

Community programs that integrate the Life Course Perspective aim to tackle the problem holistically, addressing the ways in which people's health-related decisions affect them physically, socially, and emotionally.

These programs, which are often offered as part of research studies, offer everything from job assistance to transportation to prenatal care visits. They have shown some success and aim mostly at alleviating the socioeconomic factors that contribute to perinatal mortality.

Prenatal care offered to economically-disadvantaged women through the USDA Women, Infants, and Children (WIC) program has also been shown to improve pregnancy outcomes.

The WIC program operates in every state, providing healthcare services, formula, and other wellness resources for mothers and their infants. Check out their website for a listing of WIC programs in your area.

These programs can’t completely close the gap, however, until we understand what causes the health disparities even among women who aren’t economically disadvantaged.

Steps to Take for a Healthy Pregnancy

In the meantime, there are things Black women can do to improve the chances of having a healthy pregnancy. Here are some steps you can take:

A Word From Verywell

Although some of these statistics related to Black women and pregnancy loss may be concerning, it's in your best interest to be informed. Keep in mind that many of these risk factors are still not well-understood, and researchers do not know how they affect individual women during pregnancy.

The best course of action is always to take care of yourself physically and emotionally. Don't be afraid to bring up any potential concerns with your doctor.

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Article Sources
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  1. American Heart Association. Why are Black women at such high risk of dying from pregnancy complications? February 20, 2019.

  2. Mukherjee S, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Risk of miscarriage among black women and white women in a U.S. prospective cohort study. American Journal of Epidemiology. 2013;177(11):1271-1278. doi:10.1093/aje/kws393

  3. Centers for Disease Control and Prevention. Black mothers are more likely to experience stillbirth compared to Hispanic and White mothers. Updated September 17, 2020.

  4. U.S. Department of Health and Human Services Office of Minority Health. Infant mortality and African Americans. Updated November 28, 2019.

  5. Center for American Progress. Exploring African Americans' high maternal and infant death rates. February 1, 2018.

  6. Pies, C, Parthasarathy, P, Posner, S. Integrating the Life Course Perspective into a local maternal and child health program. Maternal and Child Health Journal. 2011;16:649-55. doi:10.1007/s10995-011-0800-2 

  7. Centers for Disease Control and Prevention. Smoking during pregnancy. Updated January 2018.

  8. Centers for Disease Control and Prevention. STDs during pregnancy - CDC fact sheet. Updated March 2016.

  9. National Institutes of Health. What is prenatal care and why is it important?. Updated January 2017.

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