Maternal Mortality and Morbidity Among African American Women in the United States: An Integrative Review

INTRODUCTION:In the United States, African American women experience higher rates of maternal mortality and severe maternal morbidity compared to other racial and ethnic groups. African American women are three to four times more likely to die from pregnancy-related causes and twice as likely to suffer from a “near-death” pregnancy complication compared to White women. These racial disparities in maternal mortality and morbidity have persisted in the United States for decades, yet little known about why these disparities continue to persist. The purpose of this integrative review was to investigate the factors that place African American women at risk of dying from pregnancy-related complications. This integrative review will summarize and analyze previously conducted research studies about African American women and racial disparities in maternal mortality and morbidity. The purpose of this integrative review was to identify factors that contribute to these disparities and place African American women at risk for poor maternal health outcomes. The findings of this integrative review will inform future research and development of interventions to address racial and ethnic health disparities in maternal health.

METHODS:For this integrative review, the Whitmore and Knafl method was used (Whittemore & Knafl, 2005). The search of databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Sociological Abstracts and PsychInfo was conducted using the following search terms: maternal mortality, maternal morbidity, pregnancy complications, pregnancy-related deaths, Black and African American women, racial differences and health disparities. The studies were limited to qualitative and quantitative studies conducted in the United States, with the results of African American women isolated. There were no limitations on the years of publication. Studies excluded if they conducted outside of the U.S., results for African American/Black women were not separated out, studies that focused on infant mortality or infant health outcomes, non-pregnancy related causes for death (i.e. homicides, trauma), abortion-related mortality or ectopic-related mortality. Each of the studies was reviewed by the author, a certified nurse-midwife with over 20 years of experience.

RESULTS:Thirteen research studies were included in this review. The studies examined racial and ethnic health disparities in maternal mortality and severe maternal morbidity. The studies were published between 2004 and 2016. All 13 studies were predominately epidemiological studies conducted and were retrospective analysis of medical records, birth and death certificates or discharge summaries. Sample characteristics consisted of women identified as African American, Black or non-Hispanic Black and born in the United States. The leading causes of death among African American women were cardiomyopathy, cardiovascular disease, hypertensive disorders of pregnancy, sepsis, and postpartum hemorrhage. African American women had higher rates of co-morbidities, such as chronic hypertension and obesity; were more likely to be younger, receive government health insurance, start prenatal care later and live in low-income neighborhoods.

DISCUSSION: Maternal mortality and morbidity impacts families, communities, and society. In the U.S., this is a concern for all women. For African American women, they experience the worse maternal health outcomes and are more likely to die compared to other racial and ethnic groups. Disparities in maternal health outcomes of African American women is an issue that has persisted in our society and is still not well understood. Further research is needed to understand the causes of these disparities and to identify interventions that could address the issues. Medical risks associated with poor maternal health outcomes were identified, but do not provide an understanding of racial and ethnic health disparities. Future research should investigate the social, genetic and environmental factors that place African American women at risk for maternal mortality and morbidity is needed to develop interventions that improve maternal health outcomes.