Racism Creates Inequities in Maternal and Child Health, Even Before Birth

July 2021 correction note: On page 14, the authors removed language referring to a specific group prenatal care model but added a reference to a pilot evaluation of this model in our description of what group prenatal care can achieve. We also modified the citations associated with these sentences.

The State of Babies Yearbook aims to bridge the gap between science and policy with national and state-by-state data on the well-being of America’s babies. The data are clear: The state in which a baby is born makes a big difference in their chance for a strong start in life. However, location is only one factor to consider in ensuring that our youngest children have a healthy start. Another critical factor is the influence of race, ethnicity, and racism on the quality of care that parents and babies receive. Wherever possible, the State of Babies Yearbook disaggregates national and state averages for key indicators of infant well-being by race/ethnicitya to explore disparities and better identify areas that warrant further examination and action.

Whether babies are born healthy and with the potential to thrive as they grow greatly depends on their mother’s/birthing person’s well-being—not just before birth, but even prior to conception. To have a healthy pregnancy and positive birth outcomes, mothers require access to appropriate health care services before, during, and after pregnancy. The well-being of mothers and babies are intrinsically interdependent, although they are often considered separately. The connection between maternal and child well-being is particularly important among women of color and their babies due to the intergenerational effects of and lived experiences with institutional and interpersonal racism. Racism influences maternal health before and throughout pregnancy and affects babies’ starts in life. Institutional and interpersonal racism are pervasive and present in the policies, practices, and systems of care that families of color encounter.

In addition to disparities in maternal and child health within the United States, the nation stands alone among its peers in markers of maternal and child health: The United States is the only high-income country in which the maternal mortality rate has risen over the past two decades.1 Relatedly, the United States has a shortage of maternity care providers (Ob/Gyns and midwives),b an overrepresentation of Ob/Gyns to midwives,c no paid family leave, and inadequate postpartum support (e.g., home visits).2 Similarly, the overall infant mortality rate in the United States is twice the rate in the European Union, on average; for Black infants in the United States, the infant mortality is nearly four times the overall rate in the European Union.3,4


To inform maternal and child health policy and practice, this brief applies a racial and ethnic equity lens to the review of data from the State of Babies Yearbook: 2021. Specifically, this brief aims to explore why there are disparities in maternal and child health; what disparities exist, and for whom; and how policymakers and practitioners can promote racial and ethnic equity to improve maternal and child health. We use racial and ethnic equity to refer to the process of involving those most impacted by institutional racism in the creation and implementation of policies and practices that impact their lives, and to outcomes in which race and ethnicity do not predict a person’s life course.5 This approach offers recommendations that are discussed in detail in the Recommendations section.

Recommendations for policymakers and practitioners to promote equity and improve maternal and child health

  • Increase support and access to culturally responsive promising models (e.g., midwifery, doula care, group prenatal care, and breastfeeding support).
  • Expand Medicaid coverage through the first year postpartum.
  • Remove administrative and other barriers to support participation in the Women, Infants, and Children (WIC) nutrition program.
  • Expand access to paid family leave.


Footnotes and References