Black patients in Canada have an increased risk for severe maternal morbidity (SMM) — serious complications that can occur during pregnancy, labor, delivery, or postpartum period — compared with White patients, according to new research. The findings support the need for equity-driven policies and care models centering Black communities, the authors stated.

Major disparities in maternal health between Black and White patients have been documented in Europe, Australia, and the US. The extent of these disparities in Canada is unclear, given the differences in history, immigration patterns, and healthcare systems as well as the limited race-disaggregated health data.

“We know from other countries that Black people experience higher rates of these severe maternal complications, but in Canada, we haven’t had equivalent numbers to assess these differences,” lead author Giulia Muraca, PhD, associate professor of obstetrics and gynecology at McMaster University in Hamilton, Ontario, told Medscape News Canada. “We wanted to know if the same inequities exist here, and whether they persist in different social and clinical groups. If the inequities were true, we wanted to start working toward improvements. It’s an important question to ask because people sometimes confuse Canada’s universal healthcare system with universal access.”

The data were published on October 5 in CMAJ.

Rates Stable Over Time

The study included 108,365 in-hospital deliveries to Black patients and 1,385,810 in-hospital deliveries to White patients between 2012 and 2023. SMM was defined using a composite of diagnoses and procedures developed by the Canadian Perinatal Surveillance System, including cerebrovascular accidents, severe hemorrhage, severe uterine rupture, cardiac conditions, and sepsis.

The rate of SMM per 1000 live births was 47.8 among Black patients and 27.7 among White patients. After accounting for differences in sociodemographic and clinical characteristics, Black patients had a 66% increased risk of experiencing SMM compared with White patients. Rates of SMM events were consistently higher among Black patients during the antepartum, intrapartum, and postpartum periods. 

In both groups, the most common SMM type per 1000 live births was severe preeclampsia (Black, 11.1 and White, 6.7). The next most common SMM types in both groups were severe hemorrhage and sepsis. Rates were consistently higher among Black patients across SMM types.

Rates of SMM were stable over time but varied by province or territory. New Brunswick had the largest disparity by race (odds ratio, 2.28). In addition, rates of SMM declined with increasing income among White patients but increased with increasing income among Black patients.

Addressing these inequities will require strengthening accountability and investment in equity-informed and culturally responsive care models, supported by the responsible collection and use of race-based health data, according to the researchers.

“If these events called SMM aren’t managed and treated immediately, they’re likely to result in a fatality or long-term disability. They’re also highly associated with long hospital stay and fatality,” said Muraca.

What Are the Mechanisms?

Commenting on the findings for Medscape Medical News, Sukhbir Singh, MD, chair of obstetrics and gynecology at the University of Ottawa, Ottawa, Ontario, said that these are long-standing disparities and have resulted in gaps in care. “We must be comfortable talking about race. We have to say that the experience of Black women regarding health is different. Let’s be comfortable talking about our differences because that would improve healthcare outcomes. Discussing this has become such a taboo.” Singh did not participate in the research.

When Singh lectures for the Interdisciplinary Centre for Black Health in Ottawa, he makes the point that color sometimes matters in the treatment of disease. “People always say, ‘I don’t see color,’ but they should because, in fact, a Black woman is at increased risk for certain conditions,” he explained.

Much more work must be done to identify the mechanisms underlying the gaps revealed in the study, and this effort requires support from the government, healthcare partners, and Black communities, Muraca noted. “Now that we have hard evidence of these inequities, we can start to find out where they’re arising in care pathways, which is an exciting idea. We also need to partner meaningfully with Black communities in designing and evaluating services.”

“The fact that Black patients are experiencing less equitable outcomes should prompt action from our health systems, and we certainly shouldn’t place blame on patients,” concluded Muraca.

The Canadian Institutes of Health Research supported this study. Muraca and Singh reported no relevant financial relationships. 

Evra Taylor is a widely published freelance medical writer and reporter with 20 years of experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.