Black women in the United States face a maternal mortality rate which is nearly three times higher than that of their non-Hispanic white counterparts. This disproportionately high mortality rate is due to a myriad of factors, many of which are the consequence of structural racism, such as a lack of access to well-performing hospitals, a lack of affirming care when pain is expressed, and more.

One factor that frequently contributes to the elevated Black maternal death rate is hypertension (also known as high blood pressure). Hypertension and hypertension-related illnesses (specifically eclampsia and preeclampsia) persist as one of the leading causes of Black maternal death. Black American women not only are 50 percent more likely to suffer from hypertension compared to non-Hispanic white women, but are also five times more likely to die from eclampsia and preeclampsia during their pregnancy journey.

These vast disparities in maternal health outcomes due to the prevalence of hypertension among Black people present a challenge to the American health care system. If the United States is to successfully lower the Black maternal mortality rate, then it is imperative that national efforts, strategies, and policies acknowledge the role that hypertension plays in the pregnancy experience of many Black women and birthing people.

Black Americans Have a Racialized Relationship with Hypertension

Hypertension is a condition in which the force of blood pushing against one’s artery walls is consistently too high. This condition can develop over time, due to sedentary lifestyle habits, poor nutrition, or pre-existing conditions such as diabetes or obesity. While it may seem as if the development of this condition is altogether caused by an individual’s poor personal choices, such a perspective does not take into consideration what are known as social determinants of health—many of which are heavily influenced by systemic racism and oppresion. For Black people, social determinants of health may manifest as a lack of access to adequate health care, a lack of healthy food options, higher cortisol levels due to stress, and a lack of safe exercising spaces.

However, the effect of these social determinants of health on Black people is particularly evident with regard to hypertension. With about 55 percent of Black American adults suffering from hypertension, the prevalence of this disease within Black American communities is among the highest in the world. Not only does systemic racism create the preconditions for hypertension, but also—because systemic racism itself is violent, traumatic, stressful, and permeating—research suggests that being subjected to its experiences and perpetrators can, on its own, physically manifest as hypertension in its victims.

Black Americans with hypertension also suffer from systemic racism’s legacy once the disorder is diagnosed. The historical mistreatment of Black Americans within the health care system and a lack of trust in medical professionals has resulted in a lower adherence to blood pressure medication for Black patients compared to other racial groups.

These social determinanats of health significantly impact the ability of Black Americans to follow the most common pieces of medically sound advice administered for managing and avoiding hypertension: stay active, eat a healthy, balanced diet, manage stress, and take prescribed medications properly. As a result, Black Americans are 30 percent more likely to have high blood pressure compared to non-Hispanic, white Americans. For pregnant Black people, this inequity is often lethal.

Hypertension Can Be a Life-or-Death Matter during Pregnancy

Many of the conditions that lead to pregnancy-related morbidity and mortality are caused or worsened by high blood pressure. In fact, hypertension is one of the three major complications that account for 75 percent of all maternal deaths. Hypertension also increases the risk of maternal and infant death associated with pregnancy by creating less blood flow to the placenta, leading to placental abruption, causing intrauterine growth restrictions, injury to other organs, or premature delivery, and possibly leading to future cardiovascular diseases.

For instance, postpartum cardiomyopathy (a form of heart failure that Black women are at risk for at a rate that is six times higher than that for white women) is more common among individuals who have hypertension, have a history of hypertension, or are simply of African descent. In addition to being at greater risk for postpartum cardiomyopathy, Black women are also two times more likely than white women to die of pregnancy-associated hemorrhage—a form of severe bleeding for which the primary risk factor is pregnancy-induced hypertension. It is important to note that pregnancy-associated hemmorhage is a factor in more than 10 percent of all U.S. maternal deaths and the leading cause of maternal mortality.

Hypertension and Black Maternal Deaths Are Preventable—with the Appropriate Measures

With the high rate of Black hypertension contributing to the high rate of Black maternal mortality, it can be easy to assume that Black maternal death caused by hypertension or hypertension-related illnesses is to be expected, or even inevitable. However, this perception is harmful as well as misinformed. According to the Centers for Disease Control and Prevention, 80 percent of pregnancy-related deaths are preventable. Research also supports the preventability of hypertension so long as an individual commits themselves to regular exercise, manages their stress, maintains a healthy weight, and eats a diet that emphasizes fresh fruits and vegetables, whole grains, healthy fats such as olive oil, lean proteins, and low-fat dairy products. Once again however, these factors are most often not decided at the individual level—they are part of the social determinants of health, which are greatly impacted by factors like structural racism and poverty.

For Black women who face food insecurity at higher rates than any other race and sex, lowering or preventing hypertension becomes exponentially more difficult without assistance. This is why the following advancements within health care and policy are critical if America is to reduce hypertension and maternal mortality among pregnant Black people:

Additionally, the American College of Obstetricians suggests that “all women with cardiovascular risk factors should meet with a cardiologist or primary care physician for a screening exam within three months of delivery. This includes Black women who had gestational hypertension or pre-eclampsia.” These additional visits should be covered underneath new maternity care payment models as well.

Though lowering hypertension among pregnant Black people is vital—seeing as this condition is responsible for a sizable portion of Black maternal deaths—it is not the only avenue worth pursuing. It is equally important that policies, research, and health care initiatives address the ways in which a standardization of care can also greatly reduce Black maternal deaths—and, in turn, lower the U.S. Black maternal mortality rate.

A Look to the Future

While the current state of Black maternal health is unacceptable, there is hope to be found in holistic reform initiatives that prioritize those conditions and experiences that may make a Black person’s pregnancy disproportionately high-risk. Furthermore, progressive policies that support Black maternal health are also capable of changing the Black maternal mortality landscape. In order for these efforts to work, however, the American health care system must address the underlying conditions such as hypertension, food insecurity, and low quality of care that contribute to and even intensify the disproportionate Black maternal mortality rate. Lowering this rate is not an impossible task, but it will require consistent dedication, attention, and progressive action. In the meantime, the lives of pregnant Black people continue to be at stake.