The Ongoing Maternal Health Crisis Facing Black Women

Despite advances in maternal care, stark disparities remain in the United States. Black women are still three times more likely to die from pregnancy-related causes — a reality that experts say is largely preventable with earlier recognition, better communication and more consistent care. These outcomes are not driven by a single issue, but by a combination of delayed diagnosis, fragmented care systems and persistent inequities that can leave patients feeling unheard at critical moments.

In an interview with The Educated Patient, Sharrón L. Manuel, M.D., Ph.D., a reproductive endocrinology and infertility specialist at HRC Fertility and assistant professor of reproductive endocrinology and infertility for the Keck School of Medicine of USC, breaks down the most urgent gaps in maternal health care today. She shares what warning signs patients should never ignore, how to advocate for yourself when something feels wrong, and the important role that partners, families and community support systems play in improving outcomes during pregnancy and the postpartum period.

Black women in the U.S. are still three times more likely to die from pregnancy‑related causes, yet most of these deaths are preventable. From your perspective, what are the most important gaps in care that patients and families should be aware of today?

Sharrón L. Manuel, M.D., Ph.D.: One of the most critical gaps is delayed recognition and response to complications, particularly when symptoms are subtle or minimized. Black women are more likely to report feeling dismissed or not taken seriously when they raise concerns, which can lead to dangerous delays in diagnosis and treatment.

Another major gap is fragmentation of care, especially in the postpartum period or inadequate counseling during preconception and/or prenatal visits. Many serious complications occur after delivery, yet follow‑up is often limited to a single postpartum visit weeks later. We need better continuity, earlier check‑ins and clearer pathways for patients to access urgent care when something feels wrong.

Finally, systemic bias (implicit and structural) continues to influence how symptoms are interpreted and addressed. Closing these gaps requires both system‑level changes and empowering patients and families with information and advocacy tools.

What warning signs should Black patients specifically pay attention to during pregnancy and postpartum, and when should they insist on further evaluation?

SM: An individual knows their body best. If something doesn’t feel quite right, speak up and seek help. Don’t dismiss this intuition. Specifically, some warning signs in which patients should seek immediate evaluation include severe or persistent headaches, vision changes, chest pain, shortness of breath, heavy bleeding, swelling of the face or hands, fever or sudden abdominal pain. These can signal serious conditions such as preeclampsia, infection, hemorrhage, cardiopulmonary issues or blood clots. Equally important are changes that feel “off” but may be harder to describe — a sense that something isn’t right, extreme fatigue beyond what’s expected or worsening symptoms instead of improvement postpartum. Patients should insist on further evaluation if symptoms persist, worsen or are dismissed as “normal,” especially if they interfere with daily functioning or recovery.

Patients are often told “everything is normal” when they feel something is wrong. What are some practical questions women can ask their OB‑GYN or care team to make sure their concerns are taken seriously?

SM: Patients can ask:

“Can you explain why this symptom is considered normal in my specific situation?”

“What conditions are you ruling out, and how?”

“If this symptom worsens, when should I come back or seek urgent care?”

“Can this be documented in my chart, along with next steps if it continues?”

Asking for clarity, documentation and a clear follow‑up plan helps shift the conversation from reassurance alone to shared decision‑making. Also, having some of these types of questions written down ahead of time will keep the patient organized and helps to make sure specific concerns are addressed.

What does high‑quality, respectful maternal care look like? What should patients do if they don’t feel heard?

SM: High‑quality maternal care is timely, evidence‑based, and respectful of diversity and individual differences. It centers the patient’s lived experience, listens without assumptions and treats concerns as valid until proven otherwise. Respectful care also means clear communication, consent and inclusion of the patient in decisions, not rushing or dismissing questions. If a patient doesn’t feel heard, it’s appropriate to ask for a second opinion, request another provider or escalate concerns to a supervisor or patient advocate. Bringing a trusted support person to appointments can also help to offer a different perspective, reinforce concerns and ensure clear communication.

How can partners, family members and community advocates play a more active role in helping protect maternal health during pregnancy and postpartum?

SM: Support systems are essential. Partners and family members can help by learning warning signs, attending appointments when possible, and speaking up if they notice changes, especially in the postpartum period when their loved one may be exhausted or overwhelmed. Community advocates and doulas can also play a powerful role by bridging gaps between patients and health care systems, reinforcing education and helping patients navigate care. Maternal safety improves when patients are not advocating alone but are supported by informed, engaged networks.