Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Minority women in the United States face a maternal mortality crisis fueled by systemic inequities, with Black and Indigenous mothers shouldering disproportionate risks. Nationally, pregnancy-related mortality is highest among American Indian/Alaska Native (AIAN) women –nearly 3.8 times higher than for White women – and non-Hispanic Black women, whose mortality is approximately 2.8 times that of White women. Mental health disorders, including suicide and substance use, now account for nearly one in four maternal deaths nationally. The intersection of racial trauma, chronic stress from discrimination, and historical mistrust in healthcare systems contributes to higher rates of perinatal mood disorders, including PTSD. This condition is particularly prevalent among Black women, who experience PTSD at two to three times the rate of White women and face increased risk for adverse pregnancy outcomes such as preterm birth.
In Arizona, the situation reflects and amplifies these disparities. Between 2016-2017 and 2018-2019, pregnancy related deaths in Arizona rose by 44%, with mental health conditions accounting for 32.6% of these deaths. AIAN and Black mothers experienced mortality ratios of approximately 234 and 167 per 100,000 live births, respectively, far exceeding the rates for white mothers. Nearly half of Arizona’s pregnancy-related deaths were associated with mental health or substance use disorders, and 98% were deemed preventable. Contributing factors include limited access to perinatal mental health specialists – eight counties lack such specialists – and systemic barriers disproportionately affecting BIPOC communities such as underdiagnosis, insufficient culturally sensitive screening tools, and insurance inequities.
Addressing these critical disparities requires expanding access to culturally competent and trauma-informed care. Evidence shows that provider bias and lack of culturally appropriate screening exacerbate risks for minority mothers, leading to under-treatment of perinatal depression, anxiety, and PTSD. In Arizona, initiatives such as the Arizona Medicaid (AHCCCS) extension of postpartum medical coverage to one-year after birth aims to close care gaps, while community-led programs like Arizona Birth Workers of Color deliver culturally resonant support and translate evidence-based practices into meaningful language. Ensuring equitable outcomes hinges on systemic investment in providers trained in cultural humility, trauma-informed approaches, and ongoing mental health screening – particularly for mothers from historically marginalized communities.