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Maternal mortality in the United States is more than three times the rate in most other high-income countries–and it is worsening. The rate more than doubled between 1999 and 2019. US maternal deaths are disproportionately higher among Black women, who are at least 3.5 times more likely to die from pregnancy-related causes as their White counterparts and twice as likely to suffer serious pregnancy complications such as hemorrhage, preeclampsia, and heart problems.
Identifying ways to increase the participation of Black clinicians in the maternal and perinatal health field is an essential step toward improving Black birth outcomes. Multiple studies support this approach, showing that racial concordance between patients and practitioners improves patient health outcomes, from infant mortality to cardiovascular mortality. Patients who are the same race, ethnicity, and spoken language as their providers report better outcomes and are more likely to report receiving quality care and better communication.
Despite this growing body of evidence, there is a shortage of maternal health providers of color, including midwives, labor and delivery (L&D) nurses, and obstetrician/gynecologists (OB/GYNs). The proportion of Black OB/GYN residents actually declined between 2014 and 2019, and a 2021 national report found that only 7% of certified nurse midwives/certified midwives (CNMs/CMs) identified as Black or African American. In 2020, just 6.7% of registered nurses in the US were Black, although Black Americans made up 12.4% of the population.
In 2022, the Urban Institute partnered with the California Health Care Foundation to chart a path toward increasing the number of Black maternal health care clinicians both within the state and across the country. Focusing on California, Urban researchers conducted qualitative interviews and a review of the relevant literature to examine opportunities for, and barriers to, increasing the number of Black licensed clinicians—specifically OB/GYNs, L&D nurses, and midwives—understanding that California data would shed light on a larger national problem.
Our analysis found systematic evidence that:
Specific solutions will (and should) vary across states, but here are three overarching policy principles for increasing the numbers of Black birthing clinicians and supporting their success.
There are several actions steps that Medicaid and other state agencies can take to improve workforce diversity in maternal health.
Together, these strategies could give Black maternal care providers the support they need to thrive throughout their professional journeys and to do the critical work of improving maternal outcomes and advancing health equity. They will work best if mentors, schools, residencies, hospitals, and clinics engage and partner with Black professionals in all stages of training and practice to understand and enact changes in policy and practice based on what is working and where there can be improvement.