Black people in Canada face higher risk of severe maternal morbidity

Black people in Canada have an increased risk of severe maternal morbidity (SMM) - serious complications that can occur during pregnancy, labor or delivery, and postpartum - compared with White people, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.252020.

Severe maternal morbidity includes life-threatening conditions such as preeclampsia, hemorrhage, sepsis, heart conditions, uterine rupture, kidney failure, and more.

Researchers conducted a study looking at the differences in SMM between Black and White people in Canada. The national study included data on almost 1.5 million births, including 108 805 to Black people and 1 388 090 to White people, from 2012 to 2023. Data were from Canada's 2021 long-form Census, linked to national birth, hospitalization, immigration, and tax information databases in all provinces and territories, excluding Quebec.

The rate of SMM was 47.8 per 1000 among Black people compared with 27.7 per 1000 among White people. After accounting for differences in sociodemographic and clinical characteristics, Black people had a 66% increased risk of experiencing SMM compared with White people. Rates were consistently higher among Black people across all types of SMM studied.

Importantly, differences in income and immigration did not explain the disparity. Black people had higher rates of SMM than White people across income levels and among both immigrant and nonimmigrant populations. The findings were also consistent when researchers excluded people with preeclampsia-related conditions, sickle cell disease and HIV - conditions that occur at different rates in Black and White populations and could potentially have contributed to the overall disparity.

"Being Black is not a cause of severe pregnancy complications. Race is a social rather than biological construct, and the higher rates of severe maternal morbidity observed among Black people should not be interpreted as reflecting inherent biological differences," says Dr. Giulia Muraca, perinatal epidemiologist and associate professor in the Departments of Obstetrics and Gynecology and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario. "The findings point instead to the need for further investigation of social, structural, and health care factors that may contribute to inequities in maternal health."

The study, which links population-level health records with self-reported race, was conducted through CanHEAL (the Canadian network for Health Equity using Advanced Data Linkage), in partnership with the Black Reproductive Health Working Group.

"Our results are consistent with a broader body of evidence that structural and systemic factors, including anti-Black racism, contribute to inequities in maternal health. Prior research has documented experiences of dismissal, objectification, and inequitable care among Black people in diverse health care settings." write Dr. Muraca and co-authors.

Black race is not a biological risk factor for severe pregnancy complications. When these inequities persist across income levels, immigration groups, and different medical conditions, we need to ask what it is about our health and social systems that is producing different outcomes. Black communities need to be part of answering that question and shaping the solutions."

Dr. Cynthia Maxwell, co-lead of The Black Reproductive Health Working Group in Ontario, maternal fetal medicine specialist at Women's College Hospital and Mount Sinai Hospital, and professor of Obstetrics and Gynaecology, University of Toronto

To address these inequities, the authors suggest responsible collection and use of race information in health data, public reporting of race-disaggregated data, accountability to track progress and sustain improvements, antiracism training, and partnerships with Black communities to co-design programs to ensure access to high-quality care in pregnancy through the postpartum period.