Maternal Mortality Among African American Women in the Bay Area by Thais Souza Aoyama

What is Maternal Mortality?

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Maternal Mortality, or a pregnancy-related death, is one that occurs during pregnancy or within a year of its conclusion, resulting from a new complication (including mental health conditions), a chain of events initiated by the pregnancy, or the worsening of an unrelated condition due to the physiological effects of pregnancy.

(Centers for Disease Control and Prevention, 2024)

Who is Most Affected by the Problem?

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According to the National Center for Health Statistics, the non-Hispanic Black population in the U.S is the most affected by maternal death, regardless of income, education, or lifestyle. In 2023, Black women had a mortality rate of 50.3 deaths per 100,000 live births, three times higher than their White counterparts (14.5).

(Health E-Stats, February 2025)

The Extent of the Maternal Mortality Crisis

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Black women are three times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, including variations in healthcare quality and underlying chronic conditions. Social determinants of health prevent many women from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.

(Centers for Disease Control and Prevention, 2024).

Some of the Individual Determinants for Maternal Mortality:

Kimberly_Becerra — 2025-10-13 17:50:37 UTC

Low health literacy can keep black mothers from understanding key health information, causing delays or gaps in prenatal care. Without this knowledge, it's harder to recognize warning signs or navigate the health system, raising maternal mortality rates.
Substance abuse can harm judgment, leading to risky actions and poor prenatal care for Black women. This can strain connections with healthcare providers and support networks, worsening vulnerabilities.

(CDC, 2024)
(NCBI, 2020)

Domestic and Institutional Threats Leading Maternal Mortality:

Kimberly_Becerra — 2025-10-15 00:26:14 UTC

A lack of support from an intimate partner places mothers at risk for delayed or absent prenatal care, as well as depression and anxiety during pregnancy.
Domestic violence increases the risk of obstetric complications, injuries, psychological harm, and harm to the fetus.
Implicit bias among healthcare professionals can lower the quality of care black women receive during pregnancy. These biases affect decisions, leading to unequal treatment and poor health outcomes.

(OSG, 2020)

(Nouri, 2020)

Community Determinants for Maternal Mortality:

Kimberly_Becerra — 2025-10-15 00:34:05 UTC

Maternal Care Deserts, areas lacking prenatal and maternal care, heighten risks for black women. Lack of nearby facilities delays critical care, especially in rural and low-income communities, raising mortality rates.
Under-resourced hospitals in mainly black communities may lack equipment, staff, and skilled professionals for high-risk pregnancies, reducing care quality and increasing risks for black mothers.
Low socioeconomic status limits black women's access to healthcare, nutritious food, and safe housing, raising stress, chronic health conditions, and maternal mortality risk.
Racism, including biased treatment by providers, creates significant hurdles for black women seeking care. These experiences erode trust and discourage timely care.

(ABC News, 2022)

(March of Dimes, 2024)

(World Journal of Gynecology & Women's Health, 2019)

(The Century Foundation, 2022)

Ways Racial Discrimination Impact Black Maternal Mortality:

Kimberly_Becerra — 2025-10-15 00:46:43 UTC

In the U.S., black women are three times more likely to die from pregnancy due to structural inequities such as systemic racism and policy exclusion. Some of the major factors are:

Inadequate Health Insurance
Lack of cultural competence and humility among healthcare professionals can result in misunderstandings or inadequate care for black mothers, as their unique cultural perspectives and needs may be overlooked.
Lack of Paid Family Leave (The U.S. has no federal paid family leave policy)
Structural racism, including practices like redlining, police brutality, inequitable criminal justice, limited educational opportunities, and unemployment, creates persistent barriers to healthcare access and economic stability for black families.
Weathering hypothesis (cumulative stress of lifelong exposure to racism and socioeconomic disadvantage throughout generations)

(Austin Women’s Health, 2023)

(Springer Nature Link, 2025)

(St. Catherine University, 2021)

Impacts of Maternal Mortality

Kimberly_Becerra — 2025-10-15 01:07:16 UTC

High healthcare costs:

Preventable maternal complications and emergency interventions, such as intensive care unit admissions, transfusions, and extended neonatal care, increase healthcare expenditures for payers and restrict access to necessary services.

Distrust in the healthcare system and medical professionals:

Persistent disparities within the healthcare system contribute to mistrust among Black families, resulting in decreased participation in prenatal and postpartum services as well as community health programs.

Mental health and effects on family stability:

Maternal deaths result in significant grief for family members, increased risk of depression, and both parental and economic instability. Maternal mortality is also associated with postpartum mental health conditions that remain under-treated in Black communities.

Worse newborn outcomes:

Elevated rates of preterm birth, low birthweight, and infant mortality are linked to maternal mortality, leading to long-term developmental and health disadvantages for affected children.

(Maternity care in California: A bundle of data [PDF], 2019)

(UCSF Institute for Global Health Sciences, 2022)

(California Department of Public Health, 2023)

Sources:

Kimberly_Becerra — 2025-10-15 01:10:46 UTC

Austin Women’s Health. (2023, September 19). A study finds that racism impacts the sexual and reproductive health of Black women in the South. https://www.austinwomenshealth.com/a-study-finds-that-racism-impacts-the-sexual-and-reproductive-health-of-black-women-in-the-south/

California Department of Public Health, Maternal, Child, and Adolescent Health Division. (2023). Centering Black Mothers in California: Insights into racism, health, and well‑being for Black women and infants. https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/Centering-Black-Mothers/Centering-Black-Mothers-Report-2023.pdf

California Health Care Foundation. (2019, November). Maternity care in California: A bundle of data [PDF]. https://www.chcf.org/wp-content/uploads/2019/11/MaternityCareCAAlmanac2019.pdf

Casimir, L. (2018, June 26). Why are so many of San Francisco’s black mothers and babies dying? The Guardian. https://www.theguardian.com/world/2018/jun/26/black-maternal-mortality-babies-san-francisco-crisis

Centers for Disease Control and Prevention. (n.d.). Pregnancy-related deaths: Data from Maternal Mortality Review Committees. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/

Centers for Disease Control and Prevention. (2023, March 16). Maternal mortality rates in the United States, 2021. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm

Centers for Disease Control and Prevention. (2024, April 8). Working together to reduce Black Maternal Mortality. https://www.cdc.gov/womens-health/features/maternal-mortality.html

Deliver birth justice - perinatal equity initiative. San Francisco city seal. (n.d.). https://www.sf.gov/perinatal-equity-initiative

Granovsky, R. (2022, March 1). Black maternal mortality: A human rights crisis. UCSF Institute for Global Health Sciences. https://globalhealthsciences.ucsf.edu/black-maternal-mortality-a-human-rights-crisis/

Hoyert, D. L. (2025, February). February 2025 Health E-Stat 100: Maternal mortality rates in the United States, 2023. U.S. Centers For Disease Control And Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/Estat-maternal-mortality.pdf

Ibarra, A. B. (2024, September 17). Most maternal deaths can be prevented. here’s how California aims to cut them in half. CalMatters. https://calmatters.org/health/2024/09/maternal-deaths/

Kekatos, M. (2022, August 4). Millions of women in the US have limited access to maternal care, new study finds. ABC News. https://abcnews.go.com/GMA/Wellness/millions-women-us-limited-access-maternal-care-new/story?id=101875868

Lister, R. L., Drake, W., Scott, B. H., & Graves, C. (2019, November 22). Black maternal mortality-the elephant in the room. World journal of gynecology & womens health. https://pmc.ncbi.nlm.nih.gov/articles/PMC7384760/

March of Dimes. (2024, August 14). Nowhere to go: Maternity Care Deserts across the US. https://www.marchofdimes.org/maternity-care-deserts-report

Maternal and infant mortality - black infant health program (San Francisco). SF Black Infant Health Program. (2023, November 15). https://www.sfbihp.org/health-topics/maternal-and-infant-mortality/

Noursi, S. (2020, August 21). Researchers examine maternal morbidity and mortality through ecological systems theory. National Institutes of Health. https://orwh.od.nih.gov/in-the-spotlight/all-articles/researchers-examine-maternal-morbidity-and-mortality-through-ecological-systems-theory

Office of the Surgeon General (OSG). (2020, December). The surgeon general’s call to action to improve maternal health. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK568220/

Safarzadeh, A. (2025, April 20). Dismantling inequities to end the black maternal mortality crisis in the United States. Springer Nature Link. https://doi.org/10.1186/s12939-025-02488-1

St. Catherine University. (2021, June 13). Understanding maternal mortality rates among black women. https://www.stkate.edu/academics/healthcare-degrees/black-women-maternal-mortality

Taylor, J. (2022, April 26). Racism, inequality, and health care for African Americans. The Century Foundation. https://tcf.org/content/report/racism-inequality-health-care-african-americans/

Pre-existing Health Risk Factors for Maternal Mortality:

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Hypertension, chronic stress, diabetes, or depression can complicate pregnancies and require careful management that might not always be accessible or effective. Limited understanding can prevent black women from understanding vital health details, delaying or reducing the quality of prenatal care. This deficiency increases maternal mortality rates as they struggle to spot key symptoms or use healthcare services.

(CDC, 2024)

Short Term Outcomes

Kimberly_Becerra — 2025-10-22 16:51:45 UTC

Increase in the number of Black women in the Bay Area who know the warning signs of pregnancy-related complications by 6 months.
Increase in the number of Black women in the Bay Area who believe abusing substances is harmful to their social, mental, and physical health, as well as the health of the fetus, by 4 months.

Medium Term Outcomes

Kimberly_Becerra — 2025-10-22 16:52:00 UTC

Increase in the number of Black mothers in the Bay Area who get seen by a clinician when experiencing pregnancy-related complications by 9 months.
Increase in the number of Black mothers in the Bay Area taking actions to access clinical interventions, such as pharmacotherapy or psychotherapy, to manage withdrawal symptoms by 8 months.
Increase the number of Black mothers in the Bay Area who get seen by psychotherapists and receive appropriate drugs to manage withdrawal symptoms by 8 months.

Long Term Outcomes

Kimberly_Becerra — 2025-10-22 16:52:15 UTC

Decrease maternal mortality rates among black women in the Bay Area by 2 years.

Program Name

Kimberly_Becerra — 2025-11-11 23:19:23 UTC

TBMI: The Black Motherhood Initiative

Program Participants

Kimberly_Becerra — 2025-11-11 23:35:37 UTC

Black pregnant women living in Oakland, California
Black pregnant women living in the Bay Area, California

Program Timeline

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Building the Health of Black Pregnant Women

Kimberly_Becerra — 2025-11-12 03:46:20 UTC

This program will utilize workshops, support groups, social media, and case management to build the health of black pregnant women. This program understands the cultural backgrounds of the participants and the importance of incorporating it into the program. Residents in the Bay Area encounter raising costs, therefore accessibility will be accounted for in workshops and trainings. Participants will also be provided with resources such as food pantries, food banks, mental health services, etc. Having in person sessions will also allow for collaboration and the sharing of advice within participants.

Program Activities Phase 1: Program Development (mos. 1-3)

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Participating in local events and having a stall to spread awareness about the program and gather participants
Find the location in the East Oakland neighborhood of Foothill Square
Hire TBMI Project Director
Hire TBMI Project Coordinator
Hire 2 TBMI Ambassadors
Purchase materials
Develop a SUPPORT GROUP curriculum to train staff to perform health triage
Workshop curriculum

Program Activities Phase 2: Program Implementation (mos. 4-21)

Kimberly_Becerra — 2025-11-12 04:07:08 UTC

Healthy Mother, Healthy Baby Training/Workshop:

Once a week (on Mondays) at 3 pm for 1h and 30 min, a group of 15 participants will meet for 3 months. This will continue for 4-21 months, serving a total of 90 participants
- Cohort 1: Month 4-6
- Cohort 2: Month 7-9
- Cohort 3: Month 10-12
- Cohort 4: Month 13-15
- Cohort 5: Month 16-18
- Cohort 6: Month 19 - 2
Topics that the TBMI Ambassadors will cover:
Nutrition, stress management, community resources, and accessible exercise. Learn how to optimize grocery shopping, create meal plans
Provide information about resources such as food banks and pantries.
They would learn about accessible, intuitive, healthy cooking and dietary practices focused on nutrition that are essential for both mother and baby.
Easy and accessible exercise that can be free or very low-cost.
Consider introducing them to an existing app or developing one that can help them manage their diet and exercise routine.

Mom Chat Group: Safe Pregnancy Support Group:

Once a week, (on Wednesday) at 3 PM for 1h and 30 min, a total of 15 participants per group will meet up for a peer-to-peer support group. Each cohort runs for 3 months, and there will be a total of 90 participants over 4-21 months:
- Cohort 1: Month 4-6
- Cohort 2: Month 7-9
- Cohort 3: Month 10-12
- Cohort 4: Month 13-15
- Cohort 5: Month 16-18
- Cohort 6: Month 19 - 21
Participants will meet the TBMI Ambassadors once a week to discuss scheduled topics regarding mental wellness, substance abuse, domestic violence, and other relevant issues. After the meetings conclude, resources will be provided on the topics discussed.

Social Media:

To promote programs 4-17 months and 4-24 for general publicity
The TBMI Project Coordinator will post informative videos about local resources for prenatal care, doulas, lactation support, mental health services, substance use support, and the other two training workshops our program conducts.
Social Media: Instagram, TikTok, X, Facebook, YouTube.
Content: Videos of participants engaging in activities, program infographics, and promoting local community resources
Twice a week on all platforms. To promote programs 4-17 months and 4-24 for general publicity

Case Management:

The TBMI Ambassadors will provide one-on-one case management, which is also culturally based, and screen for stress, social needs, and substance abuse.
Community-based health clinics that are accessible and led by POC in East Oakland/telehealth
A day before the second workshop, so we can also get their confirmation for the next workshop.
Over-the-phone check-ins once a week

During 4-21 months
90 participants in total (check with each participant 2 times per week)

Program Activities Phase 3: Closing (mos. 22-24)

Kimberly_Becerra — 2025-11-12 04:08:25 UTC

“Mothers and Sisters Block Party”

Hold a block party for the participants that is also kid-friendly.
Will communicate with participants on a day that accommodates their schedules
Located in the East Oakland neighborhood of Foothill Square
3 different local food trucks and 2 black women-owned local vendors, and bouncy houses for the kids.
Art exhibitions by local Black artists on motherhood, and local DJs and musicians from the Bay Area.
Have a tent with a healthcare professional from a local clinic or hospital to advocate for comprehensive maternal health practices (prenatal, postpartum, and newborn care).

Program Outputs

Kimberly_Becerra — 2025-11-12 04:08:53 UTC

4 staffs
90 total participants of the Healthy Mother, Healthy Baby Training/Workshop
90 total participants of support groups
90 total case management appointments/check-ins
3 posts per week on social Media (Instagram, Facebook, TikTok, X, YouTube)
1 curriculum for the “Healthy Mother, Healthy Baby” workshop
1 curriculum for “Mom Chat Group” Workshop

Kimberly_Becerra — 2025-11-21 05:05:27 UTC

TMBI Project Director (part-time)
TBMI Project Coordinator (part-time)
TBMI Ambassador (part-time)
TBMI Ambassador (part-time)

TMBI Budget

Kimberly_Becerra — 2025-11-21 05:08:37 UTC