In America, data consistently shows that black women experience the highest rates of maternal and infant mortality compared to other ethnicities.

An estimated 2 maternal deaths occur daily among black women in America, according to an Amnesty International report, which also considered that disparities in health outcomes are driven by unequal access to health services.

However, pregnancy and childbirth in America remains a relatively safe experience compared to other world regions. Of the 1000 women who die daily from preventable pregnancy-related causes, 99 percent die in developing countries. Similarly, most neonatal deaths occur in developing countries.

Yet, this safety is not seen in data among black women. Black women in America also have the poorest pregnancy-related outcomes.

The Centers for Disease Control (CDC) encourages research to understand the reasons for ethnic disparities in pregnancy-related outcomes. But evidence as to whether, and how much, racism plays a role in determining these disparities is not readily available.

“African-American women are often made to feel marginalized, stigmatized, and stereotyped because of racism practiced against them,” the authors of a paper on African-American women’s childbirth preparation argue. “Especially important is identifying ways to decrease racism’s negative impact on childbearing families and their preparation for birthing.”

Academic literature describing how black American women prepare for childbirth remains very limited, say some researchers.

For black women in Oregon, poor treatment from health providers during pregnancy is suggested as a contributor to poor pregnancy outcomes in preliminary results from the International Center for Traditional Childbirth (ICTC) and Portland State University.

“Many [women] are in the public health care system. They don’t have access to or support to take birthing classes or maintain breastfeeding. They often give birth alone with no support besides hospital staff. And, some expressed fear during their time in the hospital based on their treatment,” said Shafia Monroe, CEO of ICTC.

ICTC’s mission is to increase the number of midwives, doulas, and healers of color, and to empower families in order to reduce maternal and infant mortality.

New findings released this year show the risks and benefits of home birthing in America. The data was compiled from over 2 million live births and presented at the 2012 Society for Maternal-Fetal Medicine.For births initially planned to be done at home, there were higher risks of seizure or problems with the baby’s breathing and movement immediately following delivery. However, births done at home carried less of a risk of ending with obstetrical intervention such as caesarean deliveries.

“This trade-off between maternal benefit and neonatal risk of deliveries outside of hospitals should be weighed in the decision regarding birthing facility preferences,” said lead author Yvonne Cheng of the University of California.

“Black women only accounted for around 2 percent of women who had planned home births,” Cheng told theGrio. “We were not able to examine race or ethnic-specific outcomes.”

Even with home birthing as an option, some women will need hospital intervention during their pregnancy and deliveries, and may have to face these reported concerns.

“These are issues that need to be exposed, explored and understood by the healthcare, public services and non-profit sectors so that we can collectively work towards equity in the provision of healthcare services for pregnant and parenting black women,” said Monroe.

The preliminary Oregon data, taken from a study of 245 women, showed nearly two-thirds of pregnant black women did not attend birth education classes prior to giving birth. In addition, only a quarter of women continued to breastfeed infants after six months, compared to the Oregon average of over 60 percent, and the national average of over 40 percent. The majority of women in the study also received government-paid health insurance coverage.

”[We need] community-based, direct healthcare services that can lead to big changes, and ultimately equity, in how black women are treated throughout the birth process,” added Monroe.

While women of all ethnicities report varying experiences during prenatal care, few studies attempt to address the pregnancy-related outcome disparities, specifically related to black women’s experiences. In order to offer more support to pregnant women, alternatives like group prenatal care are being integrated into healthcare systems.

Moms-to-be often wish to be active participants in their care and cherish the opportunity to meet with groups of other pregnant women, according to the authors of a small study: authors http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085399/?tool=pubmed looking at black women’s experience with such groups.

Women in the study expressed enthusiasm about choosing group prenatal care over individual care for future pregnancies, said the authors. However, they warned that the informal way in which physical examinations were conducted could lead some women to worry that group care was second rate.

“Because unpleasant experiences of care might occur more frequently among low-income and minority women,” argued the authors, “group prenatal care might provide a unique opportunity to nurture strong, positive relationships between women from vulnerable populations and their clinicians.”

The reasons for pregnancy-related health disparities among black women and infants are unanswered questions. Advocacy groups call for interventions that better support black women and infants.