The South Can Be a Dangerous Place To Be Black and Pregnant

In much of the developed world, dying while pregnant or delivering a child is practically unknown. In Australia, for example, there were just 3 maternal deaths for every 100,000 live births in 2021.

But that’s not the case in the American South. And especially not for Black women.

In South Carolina, Black women were more than four times as likely to die of a pregnancy-related cause in 2020 than White women. And discrimination was a factor in more than a third of the state’s 18 pregnancy-related deaths of women of all races, according to a recently published legislative report by the state’s Department of Health and Environmental Control.

Discrimination was the most common circumstance associated with South Carolina maternal deaths from 2018 to 2020, the report found, topping obesity, substance use disorders and mental health conditions.

It’s a problem across the South. Arkansas had the highest maternal mortality rate in the United States from 2018 to 2021, according to data compiled by KFF43.5 deaths per 100,000 live births, about four times the rate in California. Mississippi had the second-highest rate: 43 deaths per 100,000 live births. The top eight states are all below the Mason-Dixon Line.

South Carolina’s overall pregnancy-related mortality rate dropped by 16 percent from 2019 to 2020, but improvement was observed only among White patients. The pregnancy-related mortality rate among Black women increased year over year, and the gap in pregnancy-related deaths between Black and White people widened, according to the state’s report.

A spokesperson for South Carolina Gov. Henry McMaster, a Republican, did not respond to questions about the report, and no one from the state health department was made available to be interviewed about its findings. Via email, agency spokesperson Casey White highlighted that the report recommends hospitals and health providers across the state mandate cultural competency training for employees to address discrimination.

“When you say racism, people think of the worst of the worst — a Klansman or something of that level,” said Lesley Rathbun, a certified nurse-midwife who sits on the state’s Maternal Morbidity and Mortality Review Committee, which produced the report. But racism in health care, she said, is often so pervasive that many providers don’t even recognize it.

For example, some nurses and doctors still believe Black patients have a different tolerance for pain than White patients.

“That’s the kind of thing that’s been entrenched in health care for a very long time,” she said. “We have a very long history of racism.”

The review committee first convened in 2016. Rathbun said the group meets quarterly to review pregnancy-related deaths.

Members consider evidence including medical records, autopsy reports and interviews that health department nurses conduct with surviving family members to determine if a death is pregnancy-related.

The group examined 79 deaths in 2020 and determined that 18 were pregnancy-related. Seventeen of those deaths, the panel determined, were preventable.


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