Black maternal health disparities: reducing mortality rates

Conventional wisdom holds that women live longer and healthier lives than men—but that’s only partly true. Globally, women may outlive men, but they spend 25 percent more of their lives in poor health.¹ For Black women in the United States, the picture is even more troubling. Maternal-mortality rates are two to four times higher for Black women than for White, Hispanic, or Asian women, reaching 50 deaths per 100,000 live births in 2023.² If current trends continue, that rate could nearly double to 94 deaths per 100,000 live births by 2040, placing the United States on par with many low-income countries.

Mortality is only part of the story. Black American women are disproportionately affected by a range of potentially debilitating maternal-health conditions, including preeclampsia, gestational diabetes, and postpartum depression. An analysis by the McKinsey Institute for Economic Mobility (IEM) and McKinsey Health Institute (MHI) finds that these conditions not only pose immediate health risks but also have long-term consequences. In 2025 alone, these conditions could result in the loss of 350,000 healthy life years for Black women giving birth—meaning that disability and chronic illness connected to maternal health may shape a substantial portion of their lives.

This health gap extends from mothers to infants. Black infants in the United States are more than twice as likely to die as their White, Hispanic, and Asian peers.³ Contributing factors include complications such as preterm birth and low birth weight, as well as inadequate access to high-quality prenatal care. Closing this gap could save the lives of 35,000 Black infants by 2040—and dramatically improve long-term health outcomes for children.

Disparities between pregnant women—related to socioeconomics, age, race, access, or other factors—exist around the world. MHI and IEM focus on the United States in this report for three reasons. First, the United States is an outlier among Organisation for Economic Co-operation and Development countries in both maternal and infant mortality. Although more than 90 percent of maternal deaths occur in low- and middle-income countries, the United States has one of the highest maternal-mortality rates among high-income nations—marked by persistent racial disparities in maternal, neonatal, and infant outcomes, even after adjusting for income and education.⁴ Second, robust data sets in the United States indicate how many of the deaths are preventable. Claims and economic data are also readily available. And third, the potential for saving lives and boosting economic growth is substantial.

This report builds on foundational research from MHI, initiated in 2024 in collaboration with the World Economic Forum (WEF), with the publication of “Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies.”⁵ That report quantified the impact of systemic undercounting, insufficient research, and suboptimal care delivery—together contributing to a women’s health gap of 40 million to 45 million disability-adjusted life years (DALYs) per year. Closing this gap could yield significant returns: up to seven healthy days per woman per year, and as much as $1 trillion in annual global GDP by 2040. In 2025, MHI and WEF released a follow-on report, “Blueprint to close the women’s health gap: How to improve lives and economics for all,” which outlined a five-pillar framework—count, study, care, include, and invest—to guide coordinated, cross-sector action to close the gap.⁶

In this report, we examine urgent and preventable disparities in Black maternal health—disparities that cost lives, diminish quality of life, and leave lasting effects on families and communities. Addressing this gap is, first and foremost, a health imperative: Every mother and baby deserves the chance for a healthy start. It is also a pragmatic one. Reducing these disparities would strengthen families, improve community health, and contribute meaningfully to the nation’s economic vitality.

About the research

In this report, we assessed the societal and economic impact of the Black maternal-health gap by using publicly available data from sources such as the US Centers for Disease Control and Prevention (CDC), as well as clinical and public health literature.

Our analysis to estimate future trends in maternal mortality used CDC data from 2018 to 2023 as a foundation and applied a historical compound annual growth rate (CAGR) from 1999 to 2019 to make projections for 2040.

We examined the societal impact of the Black maternal-health gap by calculating the potential number of Black maternal lives that could be saved by closing the racial gap in maternal mortality. This involved projecting the total number of Black live births up to 2040 using a CAGR based on 2021 to 2023 and multiplying it by the weighted maternal-mortality rate for non-Black populations.

We estimated the economic impact of the Black maternal-health gap by translating potential health improvements into associated economic participation. The economic impact of closing this gap comprises both a potential increase in GDP due to a boost in labor force supply tied to health improvements, as well as savings from reduced healthcare costs.

To estimate the GDP impact, we analyzed 17 of the most prevalent maternal-morbidity conditions and assessed the average potential years of life lost in disability due to these conditions, which, in turn, impacts the potential absenteeism in the workforce. For instance, conditions such as eclampsia, which can result in long-term neurological disabilities, can have a substantial impact on lost working years. Other conditions, such as gestational diabetes, can also contribute to years of life lost in disability, but have a more limited impact on labor potential. We assessed the health outcomes of these conditions and their potential economic impacts for Black and non-Black women across age categories, taking into account that younger women have more years in the workforce ahead of them. By calculating weighted average impacts by age, and the associated labor force participation rates and unemployment rates by age, we estimated the potential economic impact on GDP of closing the Black maternal-health gap across the lifetimes of women giving birth in 2025.

The economic opportunity in closing the Black maternal-health gap also includes the annual savings involved by avoiding unnecessary healthcare costs, including unnecessary cesarean sections, as well as reduced cost of care for conditions such as postpartum hemorrhage, gestational hypertension, preeclampsia and eclampsia, and hysterectomies. Our figures likely understate the true economic impact, as they do not account for the full cost of care associated with sequelae, such as additional hospitalizations.

We acknowledge that historical and current data may have limitations, and that there can always be improvements in quality and collection methods. Our analysis was conducted with the best available information we were able to obtain at the time of our research to inform this report and incorporated best-practice research and evidence. It included sources such as comprehensive Medicaid claims data from the Centers for Medicare & Medicaid Services, as well as commercial claims data sets. We also solicited input from dozens of experts from academic institutes, medical schools, not-for-profit organizations, and healthcare organizations.

Drawing from the MHI framework for closing the women’s health gap, we present a targeted strategy to count, study, care, include, and invest in all women with a specific focus on Black women. While focused on addressing disparities, this approach can also elevate outcomes for all women. This analysis focuses on the US, but maternal health is a critical issue in many countries and we encourage organizations to close gaps globally. In the United States, advancing equity in maternal and child health could save thousands of lives, improve quality of life by reducing disabilities, and generate billions in economic value for the United States over the next 15 years (see sidebar “About the research”).

Some of the key findings from our US research include the following:

Lives saved and health restored. Addressing the gap could save more than 3,100 lives of Black mothers and 35,000 Black infants by 2040 if current trends persist. The impact goes far beyond mortality: Targeted interventions in maternal care could restore an estimated 350,000 healthy life years for Black women giving birth in 2025 alone.
Economic gains. Closing the Black maternal-health gap is lifesaving and community strengthening—and it could add $24.4 billion in GDP to the US economy over the lifetimes of women giving birth in 2025, driven by improved health and workforce participation.
Healthcare cost savings. Closing the gap could also save $385 million in avoidable, preventable healthcare costs annually. For example, reducing unnecessary cesarean sections (C-sections) among Black women in the United States could save $215 million, and improving maternal morbidity and well-being could save $170 million while enhancing maternal and infant outcomes.

By closing the Black maternal-mortality and morbidity gap, the United States can strengthen communities, improve individual and family well-being, enhance workforce productivity, and release significant economic gains. No single effort will reverse this trajectory. A collective of proven, actionable, and scalable interventions—across stakeholders and communities—is required to save lives and enhance economic impact. Acting now can help to ensure healthier futures for mothers, infants, and families, achieving better outcomes for generations to come and offering a road map for others.

Understanding the Black maternal-health gap

To understand the Black maternal-health gap in the United States, it’s important first to consider the broader global context. In 2023, nearly 800 women died every day worldwide—one every two minutes—due to pregnancy- or childbirth-related complications.⁷ Despite spending more per capita on healthcare than any other high-income country, the United States still reported 669 pregnancy-related deaths that same year, with rising rates in certain geographies and among specific racial and ethnic groups.⁸

The US maternal-mortality rate (MMR) was 18.6 deaths per 100,000 live births, notably higher than the 13.0 deaths per 100,000 reported in other high-income nations and nearly double the OECD average of 10.9 (Exhibit 1).⁹ According to the US Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are considered preventable.¹⁰

Black women's maternal mortality in the United States is about five times greater than in OECD countries.

Black women in the United States suffer pregnancy-related deaths at rates two to four times higher than White, Hispanic, and Asian women.¹¹ These disparities persist even after adjusting for education and income, pointing to systemic drivers beyond individual socioeconomic status.¹² Mortality among Black women has risen to 50.3 deaths per 100,000 live births—a stark contrast to the rates for non-Hispanic White women (14.5), Hispanic women (12.4), and Asian women (10.7).¹³ Addressing these persistent racial and ethnic disparities in maternal health—and their root causes—should be a priority for maternal-health efforts in the United States.¹⁴

The societal impact of maternal-health disparities in the United States

Maternal-health disparities in the United States exact a devastating toll—not only in the lives lost to maternal mortality, which disproportionately affects Black women, but also in the millions of years of healthy life diminished by preventable maternal morbidity.

In 2023, the CDC recorded 669 maternal deaths—247 of them among Black women. Although Black women make up just 14 percent of the US female population, they account for approximately 40 percent of maternal deaths.¹⁵ The MMR for Black women increased from 37.3 deaths per 100,000 live births in 2018 to 50.3 in 2023 (Exhibit 2). If this trajectory continues, the rate could reach 94 deaths per 100,000 live births by 2040.

The maternal mortality gap between Black and non-Black women in the United States continues to increase.

Closing the maternal-mortality gap between Black women and the broader US female population could prevent 180 deaths in 2025, and up to 210 Black maternal deaths by 2040, saving more than 3,100 lives over that period if the trend persists. The impact extends beyond those tragic losses. Preventing maternal deaths also protects the families left behind: Research shows that children who lose a parent are more likely to experience depression, anxiety, and post-traumatic stress, with lasting effects on health and well-being.¹⁶

While maternal mortality is a critical and urgent concern, the broader—and often overlooked—burden lies in maternal morbidity: health conditions caused or worsened by pregnancy. These conditions, ranging from preeclampsia to postpartum depression, may not be fatal, yet they can profoundly affect a woman’s daily functioning and long-term well-being. For many women, the more immediate consequence of childbirth is not the risk of death, but the likelihood of living with disability, often measured as years lived with disability (YLDs). Despite its scale and impact, maternal morbidity remains under-researched and underreported in the United States. Data collection is inconsistent across states, and many health systems lack the infrastructure to track nonfatal maternal outcomes comprehensively. This limits the ability to respond to the full scope of the maternal health crisis.

Our analysis of maternal morbidity includes 17 maternal-health conditions—such as postpartum hemorrhage, gestational diabetes, preeclampsia, and postpartum depression—that can have lasting effects on women’s health.¹⁷To estimate the impact of the number of women living with conditions/diseases impacting maternal morbidity, we identified 17 maternal conditions. Our selection of maternal-morbidity conditions was based on expert input looking at the long-term impact, rather than simply severe maternal morbidity as defined by the CDC. The combination of selected conditions is used as a proxy for estimating all maternal morbidity. However, it is not inclusive of all maternal-morbidity conditions. Selected conditions include acute renal failure, C-sections, cardiovascular conditions, dyspareunia, eclampsia, gestational diabetes, gestational hypertension, hysterectomy, mood and anxiety disorders, obstetric anal sphincter injuries, postpartum hemorrhage, preeclampsia, puerperal cerebrovascular disorders, pulmonary edema and heart failure, urinary incontinence, uterine prolapse, and vaginal fistulas. For women giving birth in the United States in 2025, these conditions are projected to result in up to 5.5 million YLDs over the course of their lifetimes (Exhibit 3). On average, for a woman who gives birth in 2025, this amounts to ten days each year, for the rest of her life, in which her health is affected by a disability connected to pregnancy or childbirth.

Women who give birth in the United States in 2025 could live a cumulative 5.5 million years with disability due to maternal-health challenges.

The burden is not evenly distributed. Black women experience a higher incidence than White women for 14 out of the 17 maternal-morbidity conditions included in this analysis. Addressing this disparity could restore 350,000 additional healthy life years for Black mothers—improving not only individual well-being but also the broader social and economic health of families and communities.

The impact of maternal health on infant health disparities

The Black maternal-health gap is connected to profound consequences for infants, driving higher rates of infant mortality, morbidity, and long-term developmental challenges.¹⁸ Black women are more likely than White, Hispanic, and Asian women to have a baby preterm, with a low birth weight, or receive inadequate prenatal care, all of which contribute to elevated rates of infant mortality and poor child-health outcomes.¹⁹

Black infants face double the infant mortality rate (IMR) compared with the US average (10.93 versus 5.61 deaths per 1,000 live births) according to federal data.²⁰ Analysis shows that if the Black infant mortality gap were closed, an additional 2,885 babies could be saved in 2025 and up to about 35,000 babies could be saved by 2040 (Exhibit 4).

Interventions to improve women’s healthcare in the United States could help close the Black infant-mortality gap and save 35,000 children’s lives.

Maternal morbidity can also cause long-term challenges for infants, leading to impacts that extend far beyond birth. For example, in utero exposure to preeclampsia and other maternal hypertension is linked to long-term cardiovascular risks in children, including hypertension, stroke, diabetes, and cardiovascular disease (CVD).²¹ Having a parent with an illness can also take a toll on children. A 2023 analysis finds that having a parent with CVD may cause mental health difficulties, and that therapeutic interventions may be needed for families.²²

Addressing the Black maternal-health gap can improve infants’ future health outcomes, potentially lowering future healthcare costs and improving economic productivity across generations.

The economic opportunity of closing the Black maternal-health gap

Closing the Black maternal-health gap is both a health imperative and an economic opportunity. It means saving the lives of mothers and infants, preventing avoidable suffering, and strengthening families and communities. It also means creating measurable economic benefits—boosting workforce participation, reducing healthcare costs, and contributing billions to the US economy. For Black women giving birth in 2025, closing this gap could generate $24.4 billion in additional GDP over their lifetimes. In two areas—C-section complications and maternal morbidity—closing this gap could also result in $385 million in annual medical cost savings (Exhibit 5).

Closing the Black maternal-health gap in the United States could boost the US economy by up to $25 billion.

This figure is derived from several key areas, which represent only some of the potential economic opportunities:

Health and economic impact over lifetimes. Closing the Black maternal-morbidity gap for women giving birth in 2025 could yield 350,000 more healthy life years for Black women and contribute $24.4 billion to US GDP over the course of their lifetimes. These gains would stem from reducing the burden of maternal-health conditions, preventing deaths, and enabling greater labor force participation. This estimate is based on an analysis of the 17 most prevalent maternal-morbidity conditions, assessing their impact on workforce participation by age group over time, and modeling how improved maternal health could reduce absenteeism and enhance economic productivity.
Avoiding unnecessary C-sections. Unnecessary C-sections pose meaningful health risks to both mothers and infants—including an increased likelihood of hemorrhage, infection, longer recovery times, and complications in future pregnancies.²³ Reducing avoidable C-sections can help save lives and lower long-term healthcare costs.²⁴ An analysis of 2022 Medicaid claims data found that, for Black patients, 35 percent of C-sections among Medicaid births and 53 percent of C-sections among commercially insured births overall were potentially avoidable based on medical guidance and clinical review. The current C-section rate among Black women is 37 percent, according to McKinsey analysis of claims data. Reducing this rate could yield an estimated $215 million in annual savings, with $55 million for Medicaid payers and $160 million for commercial insurers.
Reducing maternal morbidity from common conditions. Addressing the Black maternal-morbidity gap could lead to improved health outcomes for mothers and a reduction in pregnancy-related complications. An analysis comparing rates of five pregnancy-associated conditions—postpartum hemorrhage, preeclampsia, eclampsia, gestational hypertension, and hysterectomies—among Black women with those of other populations found that closing this gap could generate approximately $170 million in annual healthcare savings. These savings reflect a portion of the broader opportunity to reduce avoidable maternal suffering while alleviating strain on the healthcare system.

Closing the gap: Evidence-based interventions and a blueprint for action

Closing the maternal-health gap in the United States will require coordinated, sustained action across sectors. No single intervention is sufficient, but together, targeted efforts can meaningfully improve outcomes for Black women and children while strengthening maternal health for all. Building on a framework developed by MHI, we propose a set of priority actions to accelerate progress. These recommendations are not exhaustive, nor do they all focus exclusively on Black maternal health, but each represents a critical starting point with the potential to drive both direct and systemic improvements:

Count women by standardizing maternal-health metrics, improving race- and ethnicity-disaggregated data collection, and exchanging patient information across providers and payers to track outcomes more effectively.
Study women by increasing Black representation in clinical research, prioritizing conditions that drive maternal morbidity and mortality, and using real-world data to evaluate what works in diverse care settings.
Care for women by expanding comprehensive postpartum healthcare coverage, improving provider participation in Medicaid and other health plans, and reducing barriers to timely, high-quality prenatal and maternal care, including postpartum care.
Include women by embedding culturally responsive care practices, equipping providers with tools to recognize and mitigate bias, and increasing representation across healthcare roles.
Invest in women by increasing capital for maternal-health innovation, linking funding to measurable outcomes, and scaling community-based models that address social drivers of health.

Counting all women to close the data gap

Terminology

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.¹
Pregnancy-related death is a death during pregnancy or within one year of the end of pregnancy from a pregnancy complication or the aggravation of an unrelated condition by the physiologic effects of pregnancy.²
Preventable pregnancy-related death is a death that could have been avoided with reasonable changes to patient, family, provider, facility, system, or community factors.³
Maternal-mortality rate is defined as the number of maternal deaths per 100,000 live births.⁴
Infant mortality is the death of an infant before his or her first birthday. The infant mortality rate is defined as the number of infant deaths per 1,000 live births.⁵
Efficacy determines if an intervention produces the expected result under ideal circumstances.
Effectiveness determines the degree of beneficial effect under real-world clinical settings.⁶

The lack of consistent, timely, and disaggregated data on maternal-health outcomes by race and ethnicity makes it difficult to fully understand—and close—the Black maternal-health gap. Health systems cannot improve what they do not measure. Gaps exist across the entire data life cycle—from how outcomes are defined and reported to how they are analyzed and used—limiting visibility into the disparities affecting Black women and children and constraining efforts to design effective, equitable interventions. These gaps include the following areas:

Pre-data generation. Inconsistent definitions and measurement standards lead to misclassification and fragmentation in maternal health data. Terms such as “pregnancy-related” and “maternal mortality” vary by reporting agency (see sidebar “Terminology”). Although the CDC added a pregnancy-status indicator to the US death certificate (the legal document that serves as an official record of a person’s death) in 2003, full state-level adoption did not occur until 2019. Even then, an estimated 15 percent of reported maternal deaths were misclassified, based on studies in four states.²⁵ Notably, while improved identification via the pregnancy-status checkbox may account for some of the long-term rise of the maternal-mortality rate in the United States, current levels remain alarmingly high, and racial disparities persist. Even since full checkbox adoption, age-standardized pregnancy-related death rates climbed by about 28 percent between 2018 and 2022, most sharply affecting Black women.²⁶
Data generation. Fragmented records and inconsistent data capture limits the ability to analyze comprehensive, linked outcomes across mother-infant dyads. For instance, many hospitals and public health systems maintain separate records for the mother and the newborn, which are not consistently connected in real time, particularly in underresourced settings that lack interoperable electronic health records (EHR) structure. A recent health IT guide documents the need for linking maternal and infant clinical data, noting that real-time analysis of maternal-infant outcomes is limited without integrated data pipelines.²⁷
Data aggregation. Even when data exist, race- and ethnicity-disaggregated data are often unavailable in reported statistics. This underreporting and misclassification create distortions in race-disaggregated trends and hinder implementable learnings on Black maternal-health disparities.
Data analysis. Analytic decisions—particularly those that rely on aggregate models without considering delivery site or structural context—can mask where disparities arise. For example, in New York City, researchers found that Black women were substantially more likely to deliver in hospitals with high risk-adjusted severe maternal morbidity (SMM) rates. Delivery site may relate to as much as 48 percent of the Black–White disparity in SMM rates, but because many analyses simply adjust for individual patient risk without accounting for hospital-level effects, they obscure this actionable insight.²⁸

There have been several efforts—internationally, nationally, and regionally—to close maternal-health data gaps:

Standardizing definitions and metrics. The International Consortium for Health Outcomes Measurement (ICHOM) has crafted 24 standardized outcome measures, which track maternal and neonatal mortality, stillbirth, birth injury, preterm birth, quality of life, mental health, and breastfeeding success.²⁹
Ensuring sufficient race- and ethnicity-specific data detail. The Robert Wood Johnson Foundation’s data disaggregation research, which analyzed national birth records from 2013 to 2016, found that foreign-born Black women had lower risks of low birth weight, preterm birth, and gestational hypertension than US-born Black women, but higher risks of gestational diabetes, thus demonstrating the value of more nuanced data.³⁰
Aggregating data across health systems. Cooperative initiatives can enhance comprehensive analysis by facilitating seamless data exchange. For example, Ohio’s Perinatal Quality Collaborative (OPQC) partnered with hospitals and vital-statistics offices to improve the accuracy and completeness of birth registry data, standardizing key variables such as elective early deliveries and antenatal steroid use to better guide quality improvement efforts.³¹ The New Jersey Health Information Network is managed by the New Jersey Innovation Institute and funded by the New Jersey Department of Health and Human Services. It connects more than 21,000 healthcare providers and 960 long-term care facilities, improving care coordination for patients affiliated with 14 million health information records.³²
Linking clinical and social data. In Massachusetts, the Division of Maternal and Child Health Research and Analysis integrates Pregnancy Risk Assessment Monitoring System data with the Pregnancy to Early Life Longitudinal Data System. This linkage combines self-reported social determinants of health data with birth records and hospital discharge summaries. Insights from this initiative shaped the state’s 2022 Special Commission on Racial Inequities in Maternal Health report, leading to policies on doula workforce development and equitable paid leave implementation.³³

Studying all women, particularly Black women, to close the efficacy and effectiveness gap

Closing the treatment gap begins with studying women—especially those who are pregnant and postpartum. Much of the gap in treatment efficacy and effectiveness stems from a long-standing lack of research on broad female populations, particularly during pregnancy and the postpartum period (Exhibit 6). Few medications approved by the US Food and Drug Administration (FDA) include adequate safety or dosing data for pregnant women. At the same time, clinical trials often fail to account for racial and ethnic variation in response to treatment, further widening disparities.³⁴

There is far less clinical investment in medications for maternal and infant health than in those for other diagnostic areas.

This research gap is compounded by rising rates of comorbidities among women of reproductive age, a lack of real-world effectiveness data, and the influence of unmeasured social and structural determinants of health. Maternal-health research also remains underfunded and often overlooks female-specific conditions such as preeclampsia, peripartum cardiomyopathy, and postpartum depression, particularly when studied through a racial-equity lens.³⁵“Funding research on women’s health,” Nature Reviews Bioengineering, October 12, 2024; Chloe E. Bird, “Increased funding for research in women’s health issues could unleash staggering returns,” Fortune, February 11, 2022; Bridget Balch, “Prescribing without data: Doctors advocate for the inclusion of pregnant people in clinical research,” Association of American Medical Colleges News, March 22, 2022; Arthur A. Mirin, “Gender disparity in the funding of diseases by the US National Institutes of Health,” Journal of Women’s Health, July 2021, Volume 30, Number 7; Holly Else, “Gender bias might be working at level of whole disciplines,” Nature Index, August 19, 2024; Nicholas M. Fisk and Rifat Atun, “Systematic analysis of research underfunding in maternal and perinatal health,” BGOJ: An International Journal of Obstetrics and Gynaecologists, January 2009, Volume 116, Number 3; Henrietta O. Fasanya, Chu J. Hsiao, Kendra R. Armstrong-Sylvester, and Stacy G. Beal, “A critical review on the use of race in understanding racial disparities in preeclampsia,” The Journal of Applied Laboratory Medicine, January 2021, Volume 6, Number 1.

Ethical challenges in maternal-health research, such as the need to balance maternal autonomy with fetal well-being, have historically led to the exclusion of pregnant and lactating women from clinical trials, creating critical knowledge gaps. Fewer than one in 200 drug compounds in the global pipeline target maternal and infant health—conditions that account for nearly 4 percent of the world’s disease burden.³⁶ This disconnect underscores a critical missed opportunity to address one of the most preventable and consequential drivers of death and disability worldwide. And despite over 70 percent of pregnant women taking prescription medications, fewer than 10 percent of all medications approved since 1980 have enough information to determine their safety during pregnancy. As a result, most women take at least one drug during pregnancy for which safety data are unavailable.³⁷

The lack of representation in clinical trials also undermines the effectiveness of treatments.³⁸ Fourteen percent of the US population is Black, while only 8 percent of participants in novel drug trials are Black.³⁹The 2020 US Census reports that 75.5 percent of the population is White alone, 18.8 percent is Hispanic or Latino of any race, 13.7 percent is Black or African American, and 6.4 percent is Asian alone. In contrast, 75 percent of participants in novel drug trials are White, 11 percent are Hispanic, 8 percent are Black, and 6 percent are Asian, according to the FDA 2020 Drug Trials Snapshots Summary Report. Data suggest that there have been historically inadequate or untailored outreach strategies that contribute to limited participation from underrepresented groups, while social risk factors, such as poverty, can impact treatment performance in real-world settings.⁴⁰

Efforts to improve efficacy and effectiveness in maternal-health outcomes have been multifaceted, focusing on various aspects of research and community engagement. Here are some examples of innovative initiatives, some for improving general women’s health, and others more directly applicable to Black maternal populations:

Prioritizing research on maternal-health-focused pharmaceutical and medical-device development. The Accelerating Innovation for Mothers (AIM) project, which was launched to address chronic underinvestment in maternal pharmaceuticals, identified an impressive 444 candidate treatments for pregnancy-related conditions—such as postpartum hemorrhage, preterm labor, fetal distress, and preeclampsia—under investigation between 2000 and 2021, with about half showing active research or development activity. This momentum bolstered the pipeline for preeclampsia: 153 candidates in total, some of which are already in advanced clinical testing as of a 2022 study.⁴¹ As a result of such initiatives, there’s renewed optimism about ushering breakthroughs into maternal care, driven not by repurposing old drugs but through dedicated targets and partnerships that accelerate development where it’s most needed.
Enhancing clinical trial design and participation. TriNetX is a global health research network and platform that provides access to real-world clinical data. By integrating and deidentifying EHR and claims data, it evaluates how protocol criteria impact patient eligibility across racial and ethnic groups, improving cohort identification, real-world evidence generation, and patient recruitment—leading to greater racial and ethnic representation in maternal-health studies.⁴²
Addressing participation barriers. Yale’s Cultural Ambassador Program has substantially increased enrollment of underrepresented minorities in clinical trials by partnering with trusted community leaders. These ambassadors work to overcome cultural and historical mistrust, communicate the importance of research, and ensure that studies align with community needs and values. The program also addresses practical barriers by covering transportation and childcare costs and using a direct-to-patient portal for trial matching. As a result, Black and Hispanic participation in Yale’s clinical trials increased to 30 percent, from 3 percent, between 2010 and 2019.⁴³
Studying treatment effectiveness in real-world conditions. The Black Mamas Matter Alliance promotes stronger collaboration between research centers and community organizations by advocating that research reflects the lived experiences of Black mothers, promoting culturally relevant care, policy advocacy, and inclusive study methodologies. It’s necessary to track results over time. For example, through California’s Black Infant Health program and the county’s Perinatal Equity initiative, Santa Clara County has worked with 14,000 families since 2000. Efforts include assigning caseworkers and nurses who visit families at home to monitor blood pressure and other vital signs, offer breastfeeding support, and screen infants for developmental delays. By 2024, maternal hypertension was 30 percent lower among program participants, and the group was also more likely to be screened for chlamydia, gonorrhea, Group B streptococcus, and HIV.⁴⁴ In another example, the Louisiana Perinatal Quality Collaborative Hemorrhage and Hypertension Initiative launched a Reducing Maternal Morbidity Initiative in 2018, focusing on evidence-based best practices and leading coaching calls, learning sessions, in-person visits and more.⁴⁵ The results were a 20 percent reduction in severe maternal mortality from hemorrhage by 2020, which caused 17 percent of the pregnancy-related maternal deaths between 2011 and 2016. Additionally, between 2018 and 2020 there was a 211 percent increase in patients receiving timely treatment of hypertension.

Caring for all women to close access gaps

Expanding health insurance coverage and improving access to high-quality care are foundational to addressing racial disparities in maternal outcomes. For Black women, who face disproportionately high rates of maternal morbidity and mortality, these levers offer some of the most immediate and actionable opportunities for change.

Closing insurance coverage gaps. Medicaid is the single largest payer of maternity care in the United States. In 2023, Medicaid funded 41 percent of all births in the United States, and nearly two-thirds of births to Black women.⁴⁶ Since 1989, Medicaid has covered pregnant women with incomes up to 133 percent of the federal poverty level. Some states have expanded pregnancy-related benefits under Medicaid, which improved continuity of care, reducing postpartum hospitalizations by 17 percent.⁴⁷ Yet despite these gains, overall maternal-mortality rates in the United States—particularly for Black women—have continued to rise. This suggests that expanded coverage alone is not sufficient to address the full set of drivers of maternal-health inequities.

While many women qualify for Medicaid coverage during pregnancy, barriers to high-quality care—such as delays in access, variability in postpartum coverage, and limited provider participation—still exist.⁴⁸ Medicaid’s role as a payer of maternity care is essential, but being effective will require attention not just to coverage, but to delivery system performance. Some challenges include the following:

Provider participation and access barriers. Medicaid acceptance rates vary widely—IEM and MHI analysis found that Medicaid acceptance rates range from 46 percent in Michigan to 92 percent in North Dakota for ob-gyn providers who deliver maternity care. In areas with fewer participating providers, women may face longer wait times, delayed prenatal care, and reduced continuity during the postpartum period—all of which can contribute to poor maternal outcomes, particularly in rural and under-resourced communities. Evidence shows that rural hospitals—many heavily reliant on Medicaid funding—have closed maternity units when reimbursement didn’t cover costs, forcing women to travel farther or deliver in emergency rooms, raising risks of complications and maternal morbidity and mortality.⁴⁹ Medicaid reimbursement rates are markedly lower than those of commercial insurers—on average, $7,461 less than employer-sponsored health insurance vaginal births and $11,084 less for C-section deliveries.⁵⁰ Research indicates that provider participation in Medicaid can increase modestly—by three to four percentage points—when reimbursement rates rise, but results are mixed across studies.⁵¹ A review by MACPAC (Medicaid and CHIP Payment and Access Commission) further found that, while many physicians cite poor reimbursement as a key deterrent, evidence on whether increased rates expand provider participation remains inconclusive.⁵²
Administrative burden. Applying for and maintaining eligibility for Medicaid can be challenging. Other benefits programs may require different paperwork or may renew on various timelines, compounding the difficulties. Those who are pregnant are expected to receive notice of coverage within two to four weeks, but working through the applications and waiting for approvals can disproportionately affect vulnerable populations.⁵³

Several initiatives aim to improve maternal-health coverage by expanding timely, comprehensive insurance coverage for women of reproductive age, helping to ensure consistent access to essential care throughout pregnancy and beyond. These efforts include the following:

Providing immediate coverage. More than half of states give immediate Medicaid coverage for pregnant women while their applications are processed, significantly increasing enrollment and timely prenatal care.⁵⁴
Improving provider enrollment. Colorado’s Hospital Quality Incentive Payment Program raises Medicaid payments for hospitals improving maternal and perinatal care, with strong participation across labor and delivery facilities.⁵⁵
Expanding telehealth services. New Mexico Medicaid offers reimbursement for live video telehealth services at the same rate as in-person services, effectively expanding access to various medical services, including mental healthcare. This policy allows for virtual counseling, therapy, and psychiatric consultations statewide.⁵⁶ With approximately 13 percent of new mothers in New Mexico reporting postpartum depressive symptoms—which is even higher in Medicaid-covered and low-income groups—this coverage helps address critical gaps in maternal mental health, particularly in rural and underserved communities.⁵⁷

Increasing accessibility to healthcare services. According to a 2021 McKinsey IEM report, Black Americans are nearly 2.4 times more likely than White Americans to live in neighborhoods with limited access to healthcare services. This gap is especially pronounced in maternal care. More than 35 percent of US counties are classified as maternity care deserts, affecting more than 2.3 million women and accounting for approximately 150,000 births in 2022. Black women are significantly more likely to reside in these areas, and one in six Black infants is born in maternity-care deserts.⁵⁸ Women in these regions are less likely to receive prenatal care and more likely to face complications. From 2020 to 2022, maternity-care deserts were associated with over 10,000 excess preterm births, underscoring the urgent need for more equitable and accessible prenatal care.⁵⁹

While telehealth has the potential to bridge some of these gaps, counties with limited telehealth access are also 30 percent more likely to lack maternity-care services.⁶⁰ Ob-gyn shortages further exacerbate the problem. A report from the American College of Obstetricians and Gynecologists (ACOG) finds that 40 to 75 percent of ob-gyns experience some form of professional burnout. Poor work–life balance and low pay make recruiting and retaining providers increasingly difficult.⁶¹ By 2030, demand for obstetric services will exceed supply, with a 7 percent decrease in ob-gyns and a 4 percent rise in demand. Rural areas are expected to have only 51 percent of the necessary maternal-care workforce.⁶²

How doulas address unmet needs in New York City

Doulas can help pregnant women with nonmedical needs before, after, and during childbirth, with those women often having better birth outcomes. But with cost a barrier for women in underserved communities, New York’s Department of Health and Mental Hygiene sought to increase access to doulas, starting with a pilot program in 2022.¹

In a two-year analysis published in May 2025, prenatal visits, doula-attended births, and postpartum visits had all increased significantly for participants in the Citywide Doula Initiative (CDI), providing professional, no-cost doula services to residents of neighborhoods that were especially affected by COVID-19.² More than 2,000 clients received services through CDI, with nearly 1,300 of them Black women. Black and Hispanic CDI clients had better maternal-health outcomes, including lower rates of cesarean sections (C-sections), preterm births, and low birth weights, compared with citywide averages. For example, while the rate of C-sections was almost 39 percent citywide among Black women, it was 33 percent for Black CDI participants, according to the audit. No pregnancy-associated deaths were reported for CDI clients.

Patients also said their experience with a doula helped them have a better birth experience. More than three-fourths of participants described their pregnancy and birthing experience with a doula as good or excellent. One respondent said, “I honestly think my labor would’ve been a bad experience if it wasn’t for my doula advocating for me.”³

The next steps for the program include efforts to improve data collection, such as more efficient data reporting to determine the effectiveness of doula services on the reduction of negative birth outcomes and maternal mortality. It also hopes to increase non-English-speaking doula capacity, improve access for doulas treating clients in shelters, and promote access and doula-friendly policies—such as a centralized referral system—into the hospitals in the Maternity Hospital Quality Improvement Network.

Limited access to comprehensive postpartum care substantially affects maternal health. More than three-quarters of new mothers experience challenges such as breastfeeding difficulties, fatigue, pain, and mental health issues in the weeks following delivery—yet postpartum care is often limited to a single clinical visit. One in ten women miss this visit entirely, and among those who do attend, more than half report that their care felt insufficient, with 30 percent describing it as rushed or dismissive.⁶³ These gaps are even more acute for Black women, who experience postpartum hospital readmissions at twice the rate of White women—many of which could be prevented with timely, thorough postpartum follow-up.⁶⁴ Expanding access to high-quality postpartum care is essential to improving maternal outcomes and closing persistent racial disparities.

Efforts to close maternal-healthcare-access gaps include several approaches:

Increasing the number of practicing physicians in underserved areas. To address shortages in specialties such as primary care, obstetrics, and gynecology, as well as in underserved areas, the Consolidated Appropriations Act of 2021 added 1,000 new Medicare-funded Graduate Medical Education slots to expand residency programs, particularly in underserved areas. Since 2023, 140 family medicine and psychiatry residency positions have been created. Additionally, 47.2 percent of doctors remain in the area where they completed their residency.⁶⁵
Attracting ob-gyns to underserved areas. The National Health Service Corps (NHSC) program provides loan repayment and scholarships to maternal-health providers who work in underserved areas. A 2024 study of birth certificate data from 2005 to 2019 found NHSC expansion increased prenatal-care utilization, with 211 additional prenatal visits per 1,000 births and a 1.43 percent rise in adequate care.⁶⁶
Strengthening the perinatal workforce with alternative-care providers. The Burke Foundation’s “First 1,000 Days” program in New Jersey aims to train 1,000 community doulas over five years to support 50 percent of Medicaid births. The program also recruits community nurses from different backgrounds for the state’s universal newborn home visiting program, which targets 94,000 families annually.⁶⁷ In New York, the Department of Health and Mental Hygiene’s administration of the Citywide Doula Initiative has increased access to doula services in underserved neighborhoods (see sidebar “How doulas address unmet needs in New York City”).
Expanding ob-gyn services in maternity-care deserts. Children’s Hospital Colorado’s telemedicine program helps ensure broader healthcare access by providing alternatives to travel for high-risk pregnancies in rural communities. The program has reduced travel by 200,000 miles and saved about $30,000 in fuel costs annually, as well as prevented financial losses from missed work.⁶⁸ The March of Dimes’ Mom & Baby Mobile Health Centers, which served 1,353 people in 2024, provides, among other services, adult primary care, prenatal visits, and preventive care in underserved urban areas for vulnerable people. Eighty-five percent of visits are from uninsured individuals.⁶⁹
Explore public–private partnerships. In Chicago, the mortality rate for Black women during pregnancy or within a year postpartum is nearly three to six times higher than for White, Asian, or Hispanic women. The city’s Community Development Grant program awarded $3.3 million to the Chicago South Side Birth Center as part of a $7.7 million renovation of a three-suite birth center and reproductive health clinic located in a “birthing desert.”⁷⁰ Approximately 225 babies per year are expected to be delivered at the center once it’s operational, expanding access to care in a historically underserved area of the South Side. Community birthing centers have been shown to reduce preterm births by 26 percent and childbirth costs by 21 percent when compared with women receiving typical Medicaid care in the same counties.⁷¹
Expanding access to postpartum care. Continuing medical education (CME) courses have improved screening practices for postpartum depression and psychosis, equipping ob-gyns with better tools to support new mothers.⁷² These programs can also strengthen providers’ ability to monitor and manage postpartum physical health needs—such as hypertension, diabetes, infection, and other pregnancy-related complications—helping prevent readmissions and supporting long-term maternal well-being.

Including all women to close the cultural-competency and health-status gaps

Black women are often underrepresented in the design and delivery of maternal healthcare systems, contributing to an inclusivity gap. Addressing this gap requires deliberate investment in clinical education, training, and care models. That includes strengthening cultural competence among providers, recognizing the influence of patients’ baseline health and chronic conditions, and addressing social and structural drivers of health that shape maternal outcomes.

Closing cultural-competency gaps. A lack of culturally sensitive obstetric care can negatively affect patient experience, trust, and outcomes.⁷³ Positive, respectful interactions between patients and providers are associated with greater treatment adherence and continuity of care, while discrimination and poor communication can erode both. Black patients across clinical specialties report substantially lower levels of provider engagement, information-sharing, and shared decision-making than White patients.⁷⁴

In maternal health, these dynamics are particularly concerning. Many Black women report experiencing language, racial, or cultural discrimination in care settings. Nearly two-thirds anticipate bias before a medical visit—a state of “heightened vigilance.”⁷⁵ One analysis of Black women in Maryland and Washington, DC found a link between respectful maternity care and postpartum depression—with mothers who were treated with a low level of respect having higher odds of reporting symptoms of postpartum depression or thoughts of self-harm compared to those treated with high levels of respect.⁷⁶

Black women who see providers of the same racial or ethnic background report more positive and respectful interactions, leading to better diagnoses, timely interventions, and improved health outcomes.⁷⁷ In contrast, racial discordance is linked to lower perceived care quality, weaker communication, and less shared decision-making.⁷⁸ However, the number of Black ob-gyn residents has declined from 10.2 percent in 2014 to 7.9 percent in 2019, despite Black women comprising 14 percent of the pregnant population.⁷⁹

Efforts to ensure Black women receive high-quality, culturally sensitive care can include the following:

Leveraging EHRs. In the Los Angeles area, Cedars-Sinai Medical Center’s Epic alert system has effectively minimized implicit bias. In response to findings that Black patients were less likely than White patients to receive aspirin recommendations when clinically appropriate, the alert identifies patients with high or moderate risk factors. The result was an increase in aspirin recommendations as clinically indicated for preeclampsia prevention among Black patients from 23.6 percent to 58.1 percent, effectively eliminating racial disparities in aspirin administration.⁸⁰
Implementing training for providers, including implicit bias training. Maryland’s Cultural and Linguistic Health Care Professional Competency Program now requires healthcare professionals to complete an approved implicit bias course upon their first license renewal after April 1, 2022—an approach intended to improve equitable care delivery statewide.⁸¹ Emerging evidence suggests improvements in provider awareness and attitudes with similar trainings, but limited data so far connects the trainings to patient outcomes.⁸²
Increasing the proportion of Black physicians in the workforce. Expanding medical school programs within and among historically Black colleges and universities (HBCUs)—such as Xavier University of Louisiana, Morgan State University, Howard University College of Medicine, Meharry Medical College, Morehouse School of Medicine, and Charles R. Drew University of Medicine and Science—is vital. Together, these institutions educate more than half of the nation’s Black doctors, bolstering representation, professional belonging, and residency competitiveness.⁸³ Research indicates that racial concordance between Black patients and Black providers enhances communication, trust, and engagement—factors linked to better health outcomes, including reduced infant mortality and potentially improved maternal outcomes.⁸⁴
Delivering culturally tailored prenatal care. Roots Community Birth Center in North Minneapolis addresses racial disparities in birth outcomes with a culturally centered care model. In an area with high infant mortality rates, Roots offers 13 to 15 prenatal visits, prenatal classes, and 60-minute appointments for comprehensive support. Since 2015, this approach has resulted in zero preterm or low-birth-weight births among 284 families.⁸⁵

Closing health status gaps. Chronic conditions are a key—but often underaddressed—driver of the maternal-health inclusivity gap. Conditions such as hypertension and diabetes dramatically increase the risk of severe maternal morbidity and mortality, with affected women experiencing nearly four times the risk of life-threatening complications⁸⁶ These conditions are not distributed equally: Black women are almost twice as likely as White women to enter pregnancy with chronic disease and tend to develop these conditions at younger ages. For example, nearly half of Black women have hypertension, compared with 39 percent of non-Hispanic White women.⁸⁷ Addressing these disparities in chronic disease prevention, diagnosis, and management is critical to improving maternal outcomes and closing the gap in who survives and thrives in pregnancy and beyond.

This underlying health status gap is compounded by fragmented care, limited awareness of chronic disease impacts on pregnancy, and the rising prevalence of pregnancy-specific conditions (such as preeclampsia, gestational diabetes, and preterm birth). Black women in the United States are 60 percent more likely than White women to develop preeclampsia, and have five times greater risk of dying from eclampsia or preeclampsia than White women.⁸⁸

Beyond physical health, Black communities face disproportionate environmental hazards, such as pollution, which elevate pregnancy risks.⁸⁹ Premature aging and deterioration of health due to prolonged stress can lead to an increased allostatic load, a marker of chronic stress’s toll on the body, and telomere shortening, which increases the risk of cancer, cardiovascular disease, and diabetes.⁹⁰ These disparities persist across income levels and underscore the need for systemic reform, including integrated, multidisciplinary teams for better care coordination before, during, and after pregnancy.

Efforts to improve health outcomes for Black women include the following:

Enhancing care coordination through multidisciplinary pregnancy care. Penn Medicine’s Pregnancy and Heart Disease Program integrates high-risk pregnancy management and cardiovascular care to provide comprehensive maternal heart health support. Additionally, beginning in 2020, Penn Medicine’s birthing hospitals implemented enhanced clinical protocols aimed at improving maternal-health outcomes and addressing systemic disparities affecting Black birthing individuals.
Reducing rates of chronic diseases through culturally tailored interventions. The “Change Your Lifestyle. Change Your Life” (CYL²) program by the Black Women’s Health Imperative, a CDC-approved, mobile-based curriculum, targets type 2 diabetes, heart disease, and hypertension through evidence-based lifestyle changes. This program has achieved an 88 percent retention rate across 3,400 participants in 13 states.⁹¹
Reducing race-related stress. The Resilience, Stress, and Ethnicity (RiSE) program is an eight-week cognitive-behavioral and mindfulness-based intervention for Black women. RiSE focuses on the emotional impact of race-based stress, psychoeducation on racism’s biopsychosocial effects, and skill building for empowerment. Participants in a Chicago-area RiSE group exhibited better coping skills and lower inflammatory markers compared with a control group.⁹² This could be helpful for pregnant women, considering the well‑established links between chronic stress, inflammation, and adverse birth outcomes such as preterm birth, low birthweight, and preeclampsia—conditions disproportionately affecting Black mothers.⁹³

Closing health-related social-needs gaps. Health-related social needs (HRSNs) such as childcare, transportation, and healthcare access affect 80 percent of health outcomes.⁹⁴ Three-fourths of Black women live in high-social-vulnerability areas, even after adjusting for income, which increases the risk for chronic conditions and poor maternal outcomes. Women in these areas are three times more likely to develop hypertension, a major pregnancy risk factor.⁹⁵ Black women also experience significant economic disparities, earning 66.5 cents per dollar compared with White men, which limits healthcare affordability and access.⁹⁶

Food insecurity—the lack of access and ability to afford nutritious food—is another critical HRSN that affects maternal health. Analysis has found that around 11 percent of US peripartum women are food insecure, yet screenings for this issue during prenatal appointments are rare.⁹⁷ Prenatal diets that are lacking in protein, calcium, vegetables, or other components of healthy food have been correlated to preeclampsia, gestational diabetes, and lower birth rates, respectively. A 2024 analysis of almost 20,000 US women found that 14 percent reported food insecurity in pregnancy, and that those women had a higher risk of gestational diabetes, preeclampsia, preterm birth, and neonatal intensive care unit admission.⁹⁸

Transportation issues further exacerbate health disparities. For example, 2.5 million Medicaid members delayed care in 2018 due to transportation issues.⁹⁹ Women also pay a so-called “pink tax” on transportation, spending $26 to $50 more each month due to safety concerns and caregiving duties.¹⁰⁰ For example, pregnant women may need elevators, a restroom, or guaranteed seating, or may feel that walking or using public transportation is unsafe in areas lacking lighting.

Housing instability is yet another HRSN that affects an estimated 8 percent of Black women, which can increase stress and pregnancy risks.¹⁰¹ Women experiencing severe housing instability have a 73 percent higher risk of preterm birth and a 64 percent higher risk of neonatal intensive care unit (NICU) admission for their infants.¹⁰² Compared with all women aged 18 to 44, Black women are estimated to be 43 percent more likely to experience housing instability and 21 percent more likely to experience transportation insecurity.

Efforts to reduce HRSN social disparities for pregnant women include the following:

Introducing personalized prenatal care. In April 2025, ACOG released groundbreaking clinical consensus guidance, recommending a shift away from the traditional 12 to 14 fixed prenatal visits and toward a tailored, patient-centered prenatal care model. Care plans are now encouraged to be based on individual risk factors, medical and social needs, and patient preferences, and may include flexible visit schedules, telemedicine, and group care when appropriate, especially for low- or average-risk individuals. This approach is designed to improve access, outcomes, and equity, by meeting patients where they are and screening for social determinants of health before 10 weeks of gestation.¹⁰³
Tackling food insecurity. At the University of Iowa Health Care, patients at the High-Risk Obstetrics Clinic who need help with food are connected to the Upstream Initiative, created by a then-medical student. From January 2018 to December 2021, the Upstream Initiative completed 6,143 screenings covering 2,402 pregnancies, of which 684 identified food insecurity. Volunteers connect those patients in need with state and federal help, as well as local support.¹⁰⁴
Improving access to affordable housing. In 2013, New Moms, with the support of the city of Chicago and the state of Illinois, created a $12 million, 40-unit housing complex for teenage mothers and their children. The complex includes a day care center for community residents and training on parenting and child development.¹⁰⁵ New Moms offers housing for up to two years.¹⁰⁶
Reducing economic disparities. The Bridge Project, New York City’s first guaranteed-income program, provides low-income perinatal women up to $1,000 per month for three years, aiming to improve maternal and child well-being during the first 1,000 days of life. Since its 2021 launch, 63 percent of transient mothers secured stable housing, food security increased by 53 percent, and 73 percent of participants reported a stronger sense of purpose.¹⁰⁷ State governments and philanthropies have supported direct-cash programs with no conditions for economically disadvantaged pregnant women, which can lead to better prenatal care and improved health outcomes for mothers and children. For example, an analysis of mothers in California receiving $333 monthly in direct cash payments found that their babies had higher cognitive, language, and social-emotional skills at age one compared with babies in a control group.¹⁰⁸ In Minnesota, a study found that families across race and income cohorts that received an additional $100 in cash during pregnancy as a result of pandemic-era stimulus and child tax credit payments reduced the prevalence of low birth weight by 2 to 3 percent.¹⁰⁹
Boosting health literacy. Digital education tools can equip all expectant mothers with evidence-based prenatal, postpartum, and newborn care information, offering mobile tracking tools and access to pregnancy classes at participating birth centers. For example, Arkansas and Michigan worked with health tech company Philips through private funding to create state-specific app content on social services, infant health, early childhood programs and other services. Black women are 1.8 times more likely to have a pregnancy-related death than White women in the Delta region, and Arkansas is the third-worst state for infant mortality.¹¹⁰ Since the initial rollout in February 2025, more than 2,500 Arkansas families have used the Philips Avent Pregnancy+ app, with the most-clicked resources being applications for Medicaid benefits, scheduling an appointment at a local health unit, and learning about and signing up for its Women, Infants, and Children education program.¹¹¹ Other examples of expecting-parent education apps that can be offered through a hospital or provider include YoMingo and Babyscripts.

Investing in women to close financial gaps

Public, private, and philanthropic funding for women’s (and maternal) health has been lacking for decades, even though the societal and economic benefits of improving maternal outcomes are profound. Women’s health research historically receives a disproportionately small share of biomedical funding, and when research is conducted, it often overlooks sex-specific differences in disease onset, progression, and treatment response. This underfunding extends to maternal-health innovations, where structural inequities, risk-averse investment patterns, and limited commercial incentives have slowed the development of new diagnostics, therapeutics, and care models. Closing this gap will require coordinated, multisector investment strategies that value maternal health not only as a clinical priority but also as a driver of workforce participation, community stability, and intergenerational well-being.¹¹²

Almost all states have long adopted Section 1115 waivers—special permissions from the federal government allowing them to invest in and test innovative strategies in Medicaid programs. As federal guidance evolves, states may need to adapt how they use these waivers or other programs, creating opportunities to pilot and refine approaches to supporting pregnant women, such as providing coverage for community-based doula services or in-home pantry stocking.¹¹³

Limited venture capital (VC) investment in maternal-health innovation continues to hinder progress. Maternal-health solutions—particularly in healthcare services—are often grouped under the broader FemTech (female technology) category, a sector that remains relatively underfunded.¹¹⁴ Notably, 76 percent of women’s health companies are led by women founders, who often bring lived experience and community insight essential to solving maternal-health challenges. Yet these women-led start-ups face substantial barriers: In the United States, all-women founding teams receive just 2 percent of total VC funding,¹¹⁵ and female-led FemTech teams raise about 23 percent less than male-led teams.¹¹⁶ The disparities are even more stark for women of color—0.1 percent of VC funding goes to Black and Latina women founders (see sidebar “The Black women founders who are tackling maternal-health disparities”).¹¹⁷ This matters because many of the most promising maternal-health innovations—especially those that address the needs of Black and underserved populations—are being propelled by these underfunded founders.

The Black women founders who are tackling maternal-health disparities

In recent years, a number of organizations founded by Black women have emerged as pivotal actors in addressing disparities in Black maternal-health outcomes. These organizations are uniquely positioned to identify and address systemic barriers within healthcare systems, employing innovative, community-driven strategies to enhance access for historically underserved populations.

Despite their critical role and proximity to the challenges faced by Black mothers, these organizations encounter significant structural barriers to securing adequate funding, as they represent just 0.1 percent of recipients of venture capital funding. The prevailing funding landscape often prioritizes other founders, leaving many of these high-potential, women-of-color-led organizations underfunded and constrained in their ability to scale their impact. Nevertheless, since 2018, four such organizations have successfully navigated these challenges to raise capital and expand their reach. These examples show the potential in exemplifying the transformative potential of investing in Black women founders:

Navigate Maternity was founded by Ariana McGee, a healthcare professional and mother of four, whose personal experiences with an emergency cesarean section during her first pregnancy and the near loss of her fourth child due to medical negligence fueled her to establish the company. The organization uses a technology-enabled remote maternal-care platform designed to improve maternal-health outcomes through real-time data monitoring, personalized insights, and direct communication between patients and healthcare providers. Navigate Maternity places particular emphasis on addressing disparities in underserved and rural communities by equipping patients with tools such as a specially designed and validated Bluetooth-enabled maternal blood pressure device, cleared by the US Food and Drug Administration, which facilitates the early detection of potentially preventable complications, including prenatal hypertension and postpartum preeclampsia. Since its founding in 2023, the company has launched operations in Indiana and Kentucky, with plans for national expansion.¹
Health In Her HUE, founded by Ashlee Wisdom, uses a digital platform designed to connect women of color to culturally competent healthcare professionals and provide health information tailored to their lived experiences. The platform emphasizes the importance of Heard and Understood Experiences (HUE) by creating a space where users can access trusted health resources, engage with clinicians, and make informed healthcare decisions. Since its founding in 2018, the company has raised $4 million in funding.²
Cayaba Care, cofounded by Olan Soremekun and Mary Fleming, with Adaeze Enekwechi as CEO, connects patients with local healthcare navigators who coordinate care teams composed of obstetricians, nurses, doulas, and midwives, ensuring comprehensive support throughout pregnancy and the first year postpartum. Cayaba Care has secured more than $15 million in funding, which will be used to grow its team, expand into new markets, and enhance its technology solutions to broaden access to its holistic maternity-care services.³
Irth, created by Kimberly Seals Allers, allows Black and Brown women to search and leave reviews of their ob-gyns, birthing hospitals, postpartum care, and pediatricians during their baby’s first year. The goal is to help hospitals and providers improve the patient experience. It has received grants and awards from the California Health Care Foundation, Grove Foundation, the Tara Health Foundation, and the NY Health Challenge at Hofstra University, as well as a multiyear investment from GreenLight Fund Twin Cities.⁴

Beyond founder demographics, VC is often an imperfect fit for maternal health. Investors frequently prioritize biologic innovation or digital-health tools with proven exit pathways—criteria that favor diagnostics and therapeutics over care delivery models. Yet maternal-health innovation often requires service redesign, community-based engagement, and policy alignment, domains that don’t easily map to traditional VC metrics. Without dedicated capital tailored to the unique nature of maternal health, especially for historically marginalized groups, critical solutions risk being overlooked.

Philanthropy has played an important role in advancing maternal health, particularly by funding community-based programs, research, and advocacy where public and private capital have fallen short. Major foundations and corporate donors have supported initiatives ranging from doula training programs to policy change efforts aimed at reducing racial disparities in maternal outcomes. However, philanthropic investment remains relatively small compared with the scale of the need, and often focuses on short-term grants rather than sustained, systems-level change, limiting its ability to drive long-term impact.

Collectively, the lack of funding is likely to leave women without the comprehensive support needed for equitable maternal-health outcomes, ranging from a lack of access to less help with health-related social needs.

The good news? Some investment efforts have tried to align funding with health outcomes, including the following:

Investing in new care delivery models. Venture-backed investments in maternal health hit $306.5 million in 2023, a 700 percent increase from 2018, according to Pitchbook and Reuters. Investors cite improved outcomes as a key motivator: Oula, which operates maternity centers in New York, reported a 61 percent lower preterm birth rate across 1,500 births since 2021. Millie Clinic, which raised $4 million in its first round of funding in 2022 and $12 million in its Series A round this year, said that among its 150 births, babies had a 71.3 percent lower preterm birth rate than the national rate. Philadelphia-based start-up Cayaba Care focuses on Black maternal and pediatric health. In 2022, it raised a $12 million Series A round of funding from several notable VC firms and established a Series A board that was composed of 50 percent women and 50 percent Black individuals.¹¹⁸ In 2020, the A. James & Alice B. Clark Foundation awarded a $27 million grant to MedStar Health to launch the D.C. Safe Babies Safe Moms program.¹¹⁹ The initiative united women’s health clinicians, pediatricians, health economists, and community-based organizations across MedStar Georgetown University Hospital and MedStar Washington Hospital Center to better integrate health and social services for families. By 2025, the program had demonstrated measurable impact: It prevented more than 58 preterm births in 2022 alone, generating over $5 million in cost savings. Every patient who screened positive for depression or anxiety received mental health care, and nearly all participants were referred to critical support services, including tobacco cessation programs, breastfeeding education, and early childhood developmental guidance.¹²⁰
Increasing investments in women’s health products, technologies, and therapeutics. There is growing recognition among some private sector investors that women’s health is an area ripe for opportunities. Many top pharmaceutical companies derive the majority of their revenue from therapies for clinical conditions that affect women uniquely, differently, or disproportionately, and some are channeling research and corporate venture dollars to disease areas including maternal health.¹²¹ For example, Organon, a global life sciences spin-off from Merck that is focused on women’s health, acquired the Jada System, a vacuum-induced uterine device for postpartum hemorrhage. Jada offers an alternative to medication-based treatments, which often carry contraindications (such as hypertension or asthma) that disproportionately affect Black women. By avoiding reliance on uterotonics, Jada may help close equity gaps in postpartum hemorrhage management and maternal outcomes.¹²²
Channeling philanthropy and mission-driven capital toward innovation. The Gates Foundation recently announced a $2.5 billion investment through 2030 to accelerate research and development across women’s health—including maternal and infant health, maternal nutrition, obstetric care, and preeclampsia treatments—seeking to fill gaps where public and private sector investment has historically fallen short.¹²³ Merck for Mothers, a $650 million global initiative launched in 2011, partners with governments, nongovernmental organizations, and the private sector to improve the quality of maternity care, strengthen health systems, and address social determinants of maternal health. The program reports reaching over 30 million women in more than 60 countries and has supported scalable solutions such as integrated midwifery networks, emergency obstetric training, and digital-health tools for pregnancy monitoring.¹²⁴ Foreground Capital, for example, is a woman-led VC firm that launched in 2024 and focuses on investing in early-stage women’s health companies.

The path to progress

Now is the time to act—for the health of Black women, their babies, and the generations that follow. Closing the maternal-health gap, which ultimately benefits all women in the United States, won’t come from a single solution. The following list of actions is not exhaustive, but they are foundational:

Count: Standardize and integrate maternal-health data. States, payers, and providers could consider investing in interoperable perinatal data systems, including improved electronic-health-record (EHR) integration across delivery sites, community settings, and postpartum care. Better data is essential to identifying disparities, reducing errors, and ensuring continuity of care.
Study: Recognize the full impact of maternal health. Funders and policymakers could broaden the lens on maternal-health investments by quantifying their downstream effects on children, families, labor force participation, and community well-being. Framing maternal health as an economic and societal imperative could open new sources of capital and scale interventions with the highest return.
Care:

Enhance access to maternity care. States and managed-care organizations (MCOs) could work to increase maternity provider participation, especially in areas where ob-gyns, midwives, and doulas are in short supply. This could reduce care deserts and improve early prenatal engagement.
Support healthcare providers in rural areas. Philanthropies, governments, and health systems could support programs for health workers—including ob-gyn and family medicine providers, midwives, nurses, doulas, psychiatrists, and social workers—who commit to working in rural communities and underserved regions.¹²⁵ Sustaining care access in these areas is essential to closing the geographic equity gap.
Prioritize postpartum care as core. Many maternal complications emerge after delivery, yet postpartum care remains fragmented or deprioritized. Payers, providers, and health systems across both Medicaid and commercial markets could redesign postpartum care as a longitudinal service, not a one-time visit. This could include bundled payment models, digital follow-ups, mental health screening, and culturally responsive outreach.

Include all women:

Train providers to deliver respectful, equitable care. Health systems, medical schools, and credentialing bodies could implement robust, recurring training on culturally competent care, codesigned with Black women and informed by patient experience data. These programs should be evaluated not just for completion, but also to support care experience and outcomes.
Address chronic diseases in Black communities. The health system could launch targeted efforts to reduce rates of hypertension, diabetes, obesity, and other drivers of maternal morbidity in Black women. Setting measurable goals—such as reducing local hypertension rates by 20 percent over five years—could improve maternal outcomes and overall population health.

Invest: Advance funding for maternal-health research and assets. Pharmaceutical and biotech companies and philanthropies could increase funding for maternal-health research, including trials that include pregnant and postpartum people and underrepresented populations. A national goal—such as doubling the maternal-health R&D pipeline within ten years—could stimulate innovation in diagnostics, therapeutics, and devices for conditions such as preeclampsia or postpartum cardiomyopathy.

Improving maternal and child health—particularly for Black women—will require bold, unified action. True progress depends on our ability to count what matters, study what works, care in ways that heal, include those too often overlooked, and invest in enduring solutions. By aligning efforts across healthcare, policy, philanthropy, and community, we can create a future where maternal care is safe, respectful, and equitable for every woman and every generation to come.

Closing the Black maternal-health gap: Healthier lives, stronger economies

About the authors