What Are the Racial Disparities in Birth Outcomes Across America?

Racial and ethnic disparities in birth outcomes represent some of the most significant and persistent health inequities in the United States. Black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations experience substantially worse outcomes across all major perinatal health indicators compared to White and Asian populations. This article examines documented disparities in maternal mortality, infant mortality, birth injuries, and related complications based on the most recent available data.

How Do Maternal Mortality Rates Differ by Race?

Black women experience maternal mortality at rates significantly higher than all other racial groups. In 2023, non-Hispanic Black women had a maternal mortality rate of 50.3 deaths per 100,000 live births. This represents 4.7 times the rate for non-Hispanic Asian women (10.7 per 100,000) and 3.5 times the rate for non-Hispanic White women (14.5 per 100,000). Hispanic women experienced a rate of 12.4 per 100,000 in 2023.

The 2022 data shows similar patterns, with non-Hispanic Black women experiencing 49.5 deaths per 100,000 live births, compared to 19.0 for non-Hispanic White women, 16.9 for Hispanic women, and 13.2 for non-Hispanic Asian women.

Black women face elevated mortality from all major pregnancy complications. Case-fatality rates for Black women are 2.4 to 3.3 times higher than White women for preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage. Data from North Carolina documented that Black women had relative risks of pregnancy-related death 4.6 times higher for cardiomyopathy, 4.9 times higher for hemorrhage, and 6.1 times higher for respiratory complications compared to White women.

What Are the Infant Mortality Rates Across Different Racial Groups?

Infant mortality rates in 2023 reveal substantial disparities. Non-Hispanic Black infants experienced the highest mortality rate at 10.9 deaths per 1,000 live births. This is more than double the rate for non-Hispanic White infants (4.5 per 1,000) and more than three times the rate for non-Hispanic Asian infants (3.4 per 1,000).

The 2023 infant mortality rates by race/ethnicity were:

• Non-Hispanic Black: 10.9 per 1,000 live births
• Non-Hispanic American Indian/Alaska Native: 9.2 per 1,000 live births
• Non-Hispanic Native Hawaiian/Pacific Islander: 8.2 per 1,000 live births
• Hispanic: 5.0 per 1,000 live births
• Non-Hispanic White: 4.5 per 1,000 live births
• Non-Hispanic Asian: 3.4 per 1,000 live births

The 2022 data shows nearly identical patterns across all racial and ethnic groups.

How Do Neonatal and Postneonatal Mortality Rates Compare?

Neonatal mortality, which measures deaths in the first 28 days of life, was 6.44 per 1,000 live births for Black infants in 2022. This compares to 2.47 per 1,000 for Asian infants, the lowest rate among all groups.

Postneonatal mortality, measuring deaths from 28 days to one year of age, was highest for Black infants at 4.45 per 1,000 live births. Hispanic infants had a rate of 1.54 per 1,000, and White infants experienced 1.63 per 1,000.

Among teenage mothers aged 15-19, Black infants had mortality rates of 12.54 per 1,000 live births in 2017-2018, compared to 8.43 for White teenagers and 6.47 for Hispanic teenagers.

What Are the Preterm Birth Rates by Race?

Black mothers experience preterm birth (delivery before 37 weeks of gestation) at rates approximately 50-65% higher than White and Asian mothers. In 2022, the preterm birth rate for non-Hispanic Black mothers was 14.59%, compared to 9.44% for non-Hispanic White mothers and 7.29% for non-Hispanic Asian mothers.

The 2022 preterm birth rates were:

• Non-Hispanic Black: 14.59%
• Non-Hispanic American Indian/Alaska Native: approximately 10.3%
• Non-Hispanic White: 9.44%
• Hispanic: 8.54%
• Non-Hispanic Asian: 7.29%

Data from 2020 focusing on singleton pregnancies showed similar patterns. U.S.-born Black mothers experienced significantly higher preterm birth rates (12.1%) compared to non-U.S.-born Black mothers. Black birthing people experience nearly 50% higher rates of extremely preterm birth (before 28 weeks) compared to non-U.S.-born Black individuals.

How Do Low Birthweight Rates Vary Across Racial Groups?

Black infants experience low birthweight (less than 2,500 grams or approximately 5.5 pounds) at more than twice the rate of White infants. According to 2021-2023 average data, Black infants had a low birthweight rate of 14.7%, compared to 7.1% for White infants.

The 2016 data showed non-Hispanic Black infants with an 11.36% low birthweight rate, compared to 5.21% for non-Hispanic White infants.

Very low birthweight (less than 1,500 grams) rates for Black infants were more than three times higher than White infants in 2016: 2.39% compared to 0.77%. Moderately low birthweight (1,500-2,499 grams) rates were twice as high, with 8.98% for Black infants versus 4.44% for White infants.

Infants born to Black teenagers experienced preterm birth and low birthweight-related mortality at 284.31 deaths per 100,000 live births. This is more than double the rate for White teenagers (119.18) and triple the rate for Hispanic teenagers (94.44).

What Is Severe Maternal Morbidity and How Does It Affect Different Racial Groups?

Severe maternal morbidity refers to unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman’s health. These complications include conditions such as acute kidney failure, adult respiratory distress syndrome, sepsis, severe hemorrhage requiring transfusion, and hysterectomy.

Black women experience severe maternal morbidity at 2.1 times the rate of White women. Hispanic women experience rates 1.3 times higher than White women, American Indian/Alaska Native women experience rates 1.7 times higher, and Asian/Pacific Islander women experience rates 1.2 times higher.

Population-based data from New York City documented severe maternal morbidity rates of 4.2% for Black women, 2.7% for Hispanic women, and 1.5% for White women. Research shows that Black women are significantly more likely to deliver in hospitals with higher risk-adjusted severe maternal morbidity rates. Seventy-five percent of Black deliveries occur in just 25% of U.S. hospitals, and these hospitals had elevated morbidity rates for all patients.

How Common Is Birth Asphyxia and HIE Among Different Racial Groups?

Birth asphyxia occurs when a baby does not receive enough oxygen before, during, or immediately after birth. Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage that occurs when an infant’s brain does not receive adequate oxygen and blood flow, often as a result of birth asphyxia.

Data from the National Inpatient Sample covering 2010-2018 documented significant disparities in HIE rates:

• African American neonates had a 60% higher likelihood of developing HIE (adjusted odds ratio 1.60)
• African American neonates were twice as likely to experience severe HIE (adjusted odds ratio 2.06)
• Overall mortality was significantly higher among African American infants (adjusted odds ratio 2.14)

California data showed Black infants were 28% more likely than White infants to be diagnosed with birth asphyxia. National studies found Black infants were 23% more likely than White infants to have a diagnosis of birth asphyxia.

Native American infants had significantly lower rates of receiving hypothermia therapy for HIE treatment compared to Caucasian infants (adjusted odds ratio 0.48). Hypothermia therapy, also called therapeutic cooling, is a standard treatment that can reduce the severity of brain injury in infants with HIE.

How Do Cesarean Delivery Rates Compare Across Racial Groups?

Black women consistently experience the highest cesarean delivery rates across all racial and ethnic groups. In 2023, the total cesarean delivery rate for non-Hispanic Black women was 37.0%, compared to 31.2% for non-Hispanic White women.

The 2023 cesarean delivery rates were:

• Non-Hispanic Black: 37.0%
• Non-Hispanic Asian: 34.2%
• Hispanic: 32.0%
• Non-Hispanic White: 31.2%
• Non-Hispanic American Indian/Alaska Native: 29.9%

Low-risk cesarean deliveries, which exclude factors such as prior cesarean, breech presentation, or multiple gestations, also showed disparities. In 2023, Black women had a low-risk cesarean rate of 30.8%, compared to 25.6% for White women.

Throughout the period from 2000 to 2009, risk-adjusted cesarean delivery rates remained consistently higher for Black women than White women. The rate for Black women increased from 225.1 per 1,000 deliveries in 2000 to 330.8 per 1,000 in 2009, compared to 197.5 to 303.0 per 1,000 for White women during the same period.

What Are the Obstetric Trauma Rates by Race?

Obstetric trauma refers to physical injuries to the mother or baby that occur during childbirth. These injuries most commonly include third or fourth degree perineal lacerations (tears that extend through the anal sphincter) and birth trauma to neonates.

From 2000 to 2009, obstetric trauma rates declined for both Black and White women, though disparities in baseline rates existed. For vaginal deliveries with instrumental assistance, rates per 1,000 deliveries were:

• 2000: White women 201.9, Black women 140.4
• 2009: White women 145.7, Black women 90.9
• Overall decline: 28% for White women, 35% for Black women

For vaginal deliveries without instrumental assistance, the rates per 1,000 deliveries were:

• 2000: White women 43.7, Black women 23.5
• 2009: White women 24.3, Black women 12.3
• Overall decline: 44% for White women, 43% for Black women

Birth trauma to neonates declined 21% for White infants and 6% for Black infants from 2004 to 2009.

How Does Cerebral Palsy Prevalence Differ by Race?

Cerebral palsy is a group of permanent movement disorders that appear in early childhood and result from abnormal brain development or damage to the developing brain. Black children have a significantly higher prevalence of cerebral palsy compared to White children.

The prevalence of cerebral palsy per 1,000 children is 3.9 for Black children and 2.7 for White children. Studies published since 1993 have documented prevalence differences ranging from 15-29% higher for Black children compared to White children.

Summary of Documented Disparities

The data documents persistent disparities across all measured birth outcomes. Black infants experience infant mortality rates 3.2 times higher than Asian infants and 2.4 times higher than White infants. Black women experience maternal mortality rates 4.7 times higher than Asian women and 3.5 times higher than White women. Preterm birth rates are twice as high for Black mothers compared to Asian mothers, and low birthweight rates are 2.1 times higher for Black infants compared to White infants.

Research identifies multiple contributing factors to these disparities, including structural barriers in healthcare access, concentration of Black births in hospitals with elevated complication rates, reported mistreatment during maternity care, and unequal access to quality prenatal and delivery care. Black women report experiencing mistreatment during maternity care at twice the rate of White women, including ignored symptoms and refused or delayed treatment.