This week we honor Black Maternal Health Week by focusing on where our worlds intersect: Infections that affect patients during and after childbirth. Maternal sepsis, a severe and potentially life-threatening response to infection during pregnancy, childbirth, or the postpartum period, remains a significant contributor to pregnancy-related deaths in the United States. In fact, it is the third leading cause of such deaths, underscoring the importance of early detection, timely treatment, and equitable access to care. At the same time, data continues to show that maternal health outcomes are not evenly distributed across the population. Differences in risk and outcomes highlight broader challenges within the healthcare system and raise important questions about access, awareness, and quality of care.
Research indicates that Black women in the United States are about twice as likely to develop severe maternal sepsis compared to white women, and more than three times as likely to experience fatal pregnancy-related complications. (Other groups are also disproportionately affected. For example, American Indian and Alaska Native women face significantly higher rates of pregnancy-related mortality.) Insurance status also plays a role. A 2019 study found that individuals with public insurance or no insurance face higher risks of pregnancy-related sepsis, suggesting that financial barriers to care may influence both prevention and outcomes. Finally, pregnancy-related deaths are highest among rural populations, where access to healthcare can be limited. In fact, women living in rural areas are approximately 1.5 times more likely to die from pregnancy-related causes than those in non-rural settings.
The reasons behind these disparities are complex and interconnected. One factor frequently discussed in research is systemic bias within healthcare settings. Some studies suggest that patients from certain racial or ethnic backgrounds may have their symptoms taken less seriously or experience delays in diagnosis and treatment. While this is an area of ongoing study, it is widely recognized as one of several contributors to unequal outcomes.
Access to healthcare is another critical issue. Patients who have limited access to prenatal care, specialty services, or treatment for underlying health conditions may face higher risks during pregnancy. Geographic barriers can further complicate access. Individuals living in rural areas often must travel long distances to reach maternal healthcare facilities, which can delay diagnosis and treatment when complications such as sepsis arise.
Timeliness is particularly important in the case of sepsis. Early recognition and intervention are consistently associated with better outcomes, making delays in care especially consequential.
Although maternal sepsis disparities present a complex challenge, there are several areas where meaningful progress can be made.
Increasing patient awareness
Improving awareness of maternal sepsis symptoms can help individuals recognize warning signs earlier and seek care promptly. Greater awareness may also support more effective communication between patients and healthcare providers.
Enhancing clinical education
Maternal sepsis can be difficult to identify, particularly because many pregnant patients are otherwise young and healthy. This can sometimes lead to rapid deterioration after an initially stable presentation. Expanded training for healthcare professionals on early warning signs and progression may help improve detection and response across all patient populations.
Supporting policy and system-level changes
Policy initiatives can address some of the broader factors influencing maternal health. These may include investments in transportation, housing, and nutrition; efforts to expand the maternal healthcare workforce; and payment models that prioritize quality and outcomes. Expanding access to care and improving continuity of care before, during, and after pregnancy are also key areas of focus. A large part of this progress is the collection and distribution of quality data and research specifically looking at disparities along racial and socioeconomic lines, so working to keep (or restore) these lines of research is essential.
Maternal sepsis remains a serious but often preventable contributor to pregnancy-related mortality. Addressing disparities in outcomes requires a multifaceted approach that includes patient education, provider training, and systemic improvements in access and quality of care. Efforts such as Black Maternal Health Week serve as an opportunity to increase awareness, encourage collaboration, and highlight areas for progress. By continuing to examine the data and invest in targeted solutions, there is potential to improve outcomes for all pregnant patients across the United States.