Why are so many Black mothers dying from pregnancy-related complications?
By Jenny Peterson
It’s a question that echoes through OB-GYN offices across the country, surfacing in quiet waiting rooms and lingering long after appointments end.
Why are so many Black mothers dying during childbirth and in the year after from pregnancy-related complications?
The answer, despite decades of research and data, remains incomplete.
In the United States, Black women are three times more likely to die from pregnancy-related causes than White women, according to the Centers for Disease Control and Prevention. Those disparities don’t stop at delivery — they extend through the entire first year postpartum, a period that is often overlooked in maternal care.
For Dr. Kenosha Gleaton, one of the few Black OB-GYNs practicing in South Carolina, that reality is on every Black patient’s mind.
“Patients are keenly aware of how the color of their skin ties into the outcomes they may experience or the care they may receive,” said Dr. Gleaton, who practices at The EpiCentre in Charleston and North Charleston.
Even among women who receive regular prenatal care and follow medical guidance, outcomes can shift suddenly and without warning.
The recent death of Dr. Janell Green Smith, a 31-year-old Black midwife and new mother due to childbirth complications in early 2026 has renewed public attention to maternal mortality. She had been preparing to open a midwifery practice in Greenville.
Despite her medical training and access to care, she could not escape the risks Black women face during pregnancy.
Black Maternal Mortality
Dr. Gleaton describes Black maternal mortality as a “perfect storm” of biological, medical and social factors.
On the medical side, Black women in the Southeast experience higher rates of hypertension, preeclampsia, diabetes, obesity and heart disease — conditions that significantly increase pregnancy risk. These are tied to the leading causes of maternal death, which are hypertensive disorders, cardiac complications and postpartum hemorrhage.
But even when researchers account for those conditions among other populations, disparities remain.
“When we look at studies that match patients by age and complications, outcomes are still worse for African-American women and women of color,” Dr. Gleaton said.
Chronic Stress and Health Care Trust
One major driver is chronic stress. Research shows that prolonged exposure to racism and socioeconomic inequality can cause measurable changes in the body, increasing inflammation, raising blood pressure and straining cardiovascular health over time.
“There is chronic stress that is completely unrelated to pregnancy, but very much related to being a Black woman in America,” Dr. Gleaton said. “That keeps cortisol levels elevated and increases risk for complications and even mortality.”
That stress is often compounded within the health care system itself. Trust, or lack of it, can shape how patients engage with providers.
“Many women of color distrust the providers charged with taking care of them,” Dr. Gleaton said. “If you start with distrust, when something feels wrong, patients may not feel empowered to speak up.”
She stresses that communication has to meet patients where they are.
“If a patient wants to try something like apple cider vinegar for blood pressure because that’s what her grandmother did, we have to find common ground,” Dr. Gleaton said.
Too often, warning signs are recorded but not acted on quickly enough.
“It’s that one time in a thousand where we get comfortable and say, ‘take Tylenol and call us if it doesn’t improve,’ and it turns out to be something more serious,” Dr. Gleaton said.
Preventable Maternal Deaths
Studies suggest that as many as 80 percent of maternal deaths are preventable. Many states now use maternal mortality review committees to examine deaths up to a year postpartum and identify missed opportunities for intervention.
To combat these statistics, hospitals are expanding Rapid Response Teams that bring together ICU nurses, respiratory therapists and critical care specialists to intervene quickly.
Other supports, including midwives, doulas and patient advocates, can help ensure concerns are heard and acted on, particularly in high-stress moments.
At the center of the crisis is the fact that no single cause explains the disparities in pregnancy-related deaths among Black women. Structural racism, chronic stress, implicit bias, underlying health conditions and communication gaps all intersect.
“It’s multifactorial,” Dr. Gleaton said. “It all comes together.”
A Personal Mission for Change
Black Maternal Health Week, organized by a national nonprofit and observed annually from April 11–17, continues to spotlight these inequities and push for systemic change. Physicians are increasingly focused on implicit bias training and efforts to ensure consistent care regardless of race.
For Dr. Gleaton, the issue is deeply personal. She remembers a conversation with Dr. Janell Green Smith months before her death, when Smith spoke excitedly about opening her Greenville midwife practice.
“She was so excited,” Dr. Gleaton said. “I’ve now brought in many of the things she wanted to implement, including comprehensive and holistic care. I feel like I’m passing the torch.”
