Photo by Mustafa Omar
The disparities in medical treatment for women of color, particularly Black women, starkly reflect the deep-rooted racial inequities in the U.S. healthcare system. These disparities are evident in higher rates of C-sections, elevated maternal mortality rates, and a lack of adequate pain management compared to white women, even when receiving care from the same doctors under similar conditions. Black women experience maternal mortality rates two to three times higher than their white counterparts, a statistic that should alarm a country that prides itself on advanced medical care. Despite this being a known issue, efforts to address them remain insufficient.
One of the most glaring examples of this disparity is in labor and delivery care, where Black women are subjected to C-sections at higher rates than white women, often without thorough consideration of alternative options. C-sections are a common surgical procedure used to deliver babies when vaginal delivery poses risks. While they can be life-saving, the frequency with which they are performed on Black women highlights a significant issue in maternal healthcare. Black women are 20% more likely than white women to undergo C-sections, often in non-emergency situations driven by subjective diagnoses like fetal distress. This leads to longer recovery times, higher risks of complications, and greater financial strain.
Disturbingly, studies suggest that unnecessary C-sections for Black women are more likely to occur when operating rooms are empty, pointing to factors beyond medical necessity. One study found that 8% of healthy Black women had C-sections compared to 4.8% of healthy white women when there was no urgent medical reason. This suggests that decisions to perform surgery may be influenced by convenience or implicit racial bias, rather than patient health.
C-sections carry greater risks than vaginal births, including longer recovery times, higher infection rates, and greater difficulty with breastfeeding. These risks exacerbate the vulnerabilities that Black women already face, given their higher maternal mortality rates. The extended recovery required after a C-section can lead to longer hospital stays and increased chances of postpartum complications. The issue of fetal distress, a common justification for C-sections, is often subjective, and Black women are more likely to be diagnosed with it than their white counterparts. This suggests doctors may unconsciously apply different standards when diagnosing Black women, reinforcing disparities in care.
Frequent C-sections among Black women also have long-term implications for their reproductive health. Women who undergo the procedure face higher risks in subsequent pregnancies, including uterine rupture, abnormal placental development, and the need for repeat C-sections. This cycle of unnecessary surgeries creates enduring health risks for women of color, perpetuating maternal care inequities long after the initial procedure.
Financially, C-sections are also more burdensome than vaginal deliveries. On average, private insurance in the U.S. covers $17,000 for a C-section, compared to $11,500 for a vaginal birth. For low-income women of color, this financial strain can be devastating, particularly when paired with the extended recovery and higher risk of postpartum complications.
This disparity is not due to differences in the medical needs of Black and white women, but rather the systemic racism that pervades healthcare. The fact that these disparities emerge in non-emergency situations highlights the influence of implicit and structural biases, rather than purely health-related concerns. For instance, doctors may have a lower threshold for surgical intervention when treating Black women, driven by preconceptions about poorer birth outcomes. While the intention may be to “prevent harm,” these interventions often lead to more complications, longer hospital stays, and reduced breastfeeding success.
The recent overturning of Roe v. Wade compounds these disparities, placing yet another barrier between women of color and reproductive healthcare. With restricted access to abortion, existing health inequities are likely to worsen, disproportionately impacting Black and Indigenous women who already face immense challenges in accessing care.
Addressing these disparities requires not only reforms in how care is administered but also a reckoning with the deep-seated racism embedded in the medical field. Clinicians must be equipped with the tools to recognize implicit biases and understand how structural racism affects their decision-making. Some states, like California, have begun mandating implicit bias training for healthcare providers, but much more remains to be done.
The U.S. is the only industrialized nation where Black maternal health is getting worse. Dismantling the legacy of racism in maternal healthcare requires structural changes that ensure women of color receive the equitable, high-quality care they deserve. This means not only improving medical education but also enacting policy reforms to address the economic, social, and healthcare barriers these women face. Failure to act will only deepen the health crisis for Black mothers, perpetuating a cycle of inequity that must be broken. The U.S. healthcare system has failed Black women for far too long.
