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Blue Cross Blue Shield Association study finds higher childbirth complication rates for Black and Hispanic women regardless of age

In Philadelphia region, severe maternal morbidity rates are nearly 190 percent higher for Black women compared to white women

In the greater Philadelphia region, Black women are at substantially higher risk for childbirth complications than white women, according to new data from the Blue Cross Blue Shield Association (BCBSA), an association of independent Blue Cross and Blue Shield Plans. The latest Health of America study examines the rate of childbirth complications as measured by the CDC’s Severe Maternal Morbidity Measure (SMM)—21 different adverse events or unexpected outcomes from labor and delivery with significant short- or long-term consequences to a woman’s health, and in some cases, may lead to death.

In Philadelphia, SMM rates are nearly 190 percent higher for Black women compared to white women. Nationally, SMM rates are 63% higher for women in majority Black communities when compared to majority white communities.

The report also looked at risks for SMM and found that women in majority Black communities have up to twice the prevalence of risk factors, such as hypertension or anemia than women in majority white communities.  For example, using the risk ratio for preexisting diabetes, women with this condition are three times as likely to have an SMM indicator(s) as women without. Risk ratios for 15 health conditions can be found on page 5 of the report.

In Philadelphia, Black women had nearly a percentage point higher prevalence of cardiac disease than whites, 2.4 per 100, compared to 1.5 per 100. This is significant considering cardiac disease has a risk ratio of 14, meaning women with cardiac disease are at a 14 times higher risk of developing a SMM.  Black women also had a much higher rate of anemia than white women, 26.1 per 100, compared to 10.6 per 100.

The data also shows that Black women under the age of 24 are more likely to experience severe childbirth complications than white women over the age of 35 – an age group usually considered high risk, according to new data from the Blue Cross Blue Shield Association (BCBSA).  Similarly, in the last two years, the rate of Hispanic women with severe childbirth complications increased 19%.

“Maternal health disparities in our region are among the highest in the nation. We cannot and should not accept these gross disparities, especially in one of the most advanced regions for health care. We must address these issues immediately to ensure that women of all races experience healthy pregnancies and babies.” – Dr. Richard Snyder, executive vice president Facilitated Health Networks and chief medical officer at Independence Blue Cross.

BCBSA also surveyed approximately 750 women about their pregnancy and childbirth care experience in the last year, representing commercial, Medicaid, Medicare, and uninsured individuals. The survey found 62% of Black mothers were able to complete all recommended prenatal visits, citing transportation barriers or scheduling conflicts.

Compared to white women, Black and Hispanic women reported feeling less confident they would receive the care they need. Fewer Black mothers reported feeling they can speak openly with their provider or felt that their provider spent enough time with them.

To help confront racial health disparities in southeastern Pennsylvania, Independence Blue Cross (Independence) continues to develop and support localized solutions that help improve maternal health, including working with Project HOME and AmeriHealth Caritas to address significant health disparities experienced in North Philadelphia through the Keystone Connection to Wellness initiative, announced in January 2020. Through this initiative, expectant mothers in North Philadelphia are participating in Project Home’s Centering Pregnancy program – a national, evidence-based maternal health model.

Other Independence initiatives include:

  • Baby Blueprints: Using predictive modeling in the Independence maternal care program to better understand how social determinants of health impact high-risk maternity patients. This work includes behavioral health screenings and social need assessments for factors including transportation, food security and financial wellbeing.
  • Bright Start Maternity Program: Independence’s medical assistance managed care subsidiary, Keystone First, operates this maternal health program that is dedicated to ensuring members receive early and ongoing prenatal care to achieve healthy outcomes:
      • Nurse care managers to facilitate access to specialists, screenings and support;
      • Maternity navigators, including SDOH assessments and referrals;
      • A cell phone program for moderate-to high-risk pregnant women;
      • Community partnerships to support home visiting programs from pregnancy through age 6;
      • A behavioral health/substance abuse disorder integrated care program; and
      • Nutrition programs and services.

Through the BCBSA National Health Equity Strategy, Blue Cross and Blue Shield (BCBS) companies are also encouraging industry initiatives to develop national standards for the collection of race, ethnicity and language (R/E/L) data, partnering with providers to offer unconscious bias training and exploring opportunities for collaborating with community stakeholders and providers to reduce risk factors for SMM and promote efforts to improve quality and safety.

BCBSA is actively leaning into new and longstanding relationships with community organizations to address root causes of inequities. BCBSA continues to advocate for public policies at the state and federal levels to improve access to health coverage and supports efforts like the Momnibus Act of 2021 – a set of bills that will save the lives of new and expecting moms.

Read the full report “Racial Disparities in Maternal Health,” part of the Blue Cross Blue Shield, The Health of America Report® series.

For more information about the BCBSA National Health Equity Strategy and maternal health programs, visit The National Health Equity Strategy is part of the Blue Cross Blue Shield Pledge to Make Meaningful Change. The pledge speaks to BCBS companies’ broad commitment to addressing racial disparity in health and all its forms.

Media contact:
Ruth Stoolman
215-667-9537 (mobile)