Maternal Health
Published April 07, 2022

Improving Black maternal health starts with listening

Brianna Keefe

In North Carolina, only 68% of pregnant women receive prenatal care in their first trimester – the most crucial for a baby’s development.[1][2] Women of color are greatly overrepresented among those missing this early care. When they do receive early care, they often face implicit bias that negatively impacts the quality of patient education they will receive as expectant mothers and increases their risk for complications throughout pregnancy.[3] Faced with these disparities and many more – lack of access to care, lower quality care and other consequences of structural racism – Black mothers in the state die from pregnancy-related complications at more than twice the rate of white mothers.[4]

A Bold Goal

To address this public health and human rights crisis, the state’s largest insurer, Blue Cross and Blue Shield of North Carolina (Blue Cross NC), has developed a multi-year, multi-pronged strategy aimed at reducing racial disparities in maternal and infant health care by 50% in five years.

In an effort to better understand the lived experience of Black mothers in their state and inform this strategy, Blue Cross NC conducted in-depth, qualitative research with both mothers and public health experts in November 2021. The aim of this research was to assess the challenges women of color face during and after pregnancy, learn if and how the current health system is addressing these challenges, uncover gaps in care and identify what changes are needed to reduce disparities.

Key Insights

Among Blue Cross NC’s findings were various accounts from participants expressing dismissal and feeling undervalued as women of color in the health care space: 

  • Many participants felt that doctors and nurses made assumptions about them rather than treating them as individuals, leading to poorer quality care. These assumptions included the dangerous notion that, because they are Black, they are strong and have a high pain tolerance.
  • Most women found comfort and trust in providers who looked like them and understood their experiences and cultures. They found these providers talked to them rather than over them, were better at listening and treated them as individuals rather than stereotypes.
  • The majority of participants were aware of the statistic that Black women have 3x higher rates of maternal mortality than white women.[5]  This created a prominent sense of fear and unease, especially during labor and delivery. Most participants tried to manage the controllable - going to scheduled doctor's appointments, eating healthily, educating themselves and seeking advice from friends, family, apps and the internet to avoid becoming a statistic.

Today, Blue Cross NC is putting these insights into action. They are partnering with providers, hospitals, local and state governments and community organizations, investing $2 million to advance evidence-based initiatives across the state, and innovating their own product offerings to improve care for their members.

Learn more about Blue Cross NC’s commitment to maternal health equity and the strategy behind this work.

Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.


[1] Early-Prenatal-Care.pdf (

[2] Pregnancy, the three trimesters (

[3] How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States (

[4] NC congresswoman tackles maternal health disparities (

[5] Maternal Mortality Rates in the United States, 2020 (

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