You may have seen the recent headlines, warning of a crisis in maternal health, citing reports of an explosion in the number of women who die in childbirth. As we note in a recent Boston Indicators report, the reality is actually more complicated. Reported rates of maternal mortality did roughly double during the 2010s, but almost all of this increase is the result of improved data measurement and reporting practices rather than an actual surge in deaths.

The true crisis lies in the stark and widening disparities facing Black women. For both severe complications during childbirth (called “severe maternal morbidity”) and maternal deaths, Black women consistently have the highest rates, and gaps between them and women of other races have increased in recent years. In 2022, for every 10,000 deliveries in the US, 4.95 Black mothers died—more than double the rates of women from other racial groups. Similarly, in Massachusetts in 2020, for every 10,000 deliveries, 191 Black women experienced severe maternal morbidity, a rate 2.3 times that of White women. This disparity increased by 25 percent between 2011 and 2020.

Social determinants of health, such as barriers to economic opportunity and housing instability, are at play here. They significantly impact health outcomes, with Black women experiencing higher rates of pregnancy complications. Systemic and interpersonal racism within the healthcare system exacerbate these disparities, leading Black women in Massachusetts to access prenatal care at troublingly low rates. Historical mistreatment by the medical field has fostered deep-seated mistrust, further affecting access to quality prenatal care. Present-day racism from healthcare providers often results in dismissal of Black women’s concerns, contributing to maternal deaths or near-misses.

Shockingly, 37 percent of Black women in Massachusetts report experiencing racism before delivery, and 31 percent feel upset due to race-based treatment during pregnancy. This pervasive racial bias causes needless stress, to health deterioration and adverse pregnancy outcomes.

These findings do not come as a surprise. A few years ago, the Boston Foundation partnered with Ariadne Labs and the Harvard T.H. Chan School of Public Health’s Women and Health Initiative to map social support gaps in Greater Boston that perpetuate racial inequities in maternal health. That research pointed to core challenges that people of color experience when obtaining services—in particular, accessing social supports, such as housing, childcare, and mental health counseling in a highly-fragmented system, and experiencing structural and interpersonal racism.

These challenges limit access to opportunities, resources, and services from pregnancy through delivery and contribute to health disparities. And that has consequences for our communities, and particularly our communities of color, because healthy children are connected to healthy families.

Repairing conditions that cause or perpetuate inequities in maternal health is one of the focal strategies of the Boston Foundation’s work. In partnership with deeply embedded and respected community organizations such as Vital Village Networks and Neighborhood Birth Center, we strive to address racial disparities in access, quality, and outcomes, and help create a more unified and better coordinated system of health services and social supports.

The teams from the Chan School, Ariadne Labs, and Vital Village Networks partnered with community organizations to co-create solutions with an equity-centered approach. A key focus was to recognize and honor the role of communities as agents of their own solutions. Long-neglected communities have historically been left out of solutions that impact their lives and, subsequently, little progress has been made. This community-led process, therefore, had an intentional goal of building trust, strengthening relationships, and deepening collaboration among leaders. From this effort, the Greater Boston Birth Equity Coalition launched this past spring, with Vital Village Networks as its backbone and a rotating governance team of eleven leaders selected through this process. Through building community power and giving community voice, this coalition of partners, health care providers, and advocates strives to implement concrete strategies to improve maternal and child health outcomes, reduce racial and ethnic disparities, and achieve equity and justice for all birthing families.

One such community partner is Neighborhood Birth Center, set to open in Nubian Square next year. Only the second birth center operating in Massachusetts and the only BIPOC-led facility of its kind in New England, the center will expand birthing options in the community with a personalized, home-like setting for low-risk pregnancies. Birth centers and other community-based approaches have been shown to improve both birthing experiences and health outcomes, particularly for Black women. Even before it opens, the birth center’s policy advocacy has positioned it for success, with major hospitals eager to partner. Slated to be an 11,000-square-foot state-of-the-art building, the birth center will be co-located with other community organizations committed to helping the neighborhood stabilize and thrive.

While Massachusetts has made important strides over the past couple of decades in improving support for birthing people, disparities persist for Black women. Only through intentional partnerships and genuine commitment to solutions that include the voices of birthing people will we be able to reverse these disparities. To nurture strong beginnings in life, we must improve healthcare access, integrate social supports more effectively, and deliver positive and culturally responsive birthing experiences that meet the needs of each person.

Danubia Camargos Silva is a senior program officer at the Boston Foundation; Kelly Harrington is senior research manager at Boston Indicators, the research center at the Boston Foundation.