Severe birth complications 66% likelier for Black people

Black people in Canada had a 66 per cent higher risk of severe complications during pregnancy, labour and the postpartum period than White people, even after researchers accounted for social and clinical differences, according to a national study published Oct. 5 in the Canadian Medical Association Journal.

The study, titled “Racial inequities in severe maternal morbidity among Black and White people in Canada: a population-based cohort study, 2012 to 2023,” examined almost 1.5 million births. Of those, 108,805 were to Black people and 1,388,090 were to White people.

The rate of severe maternal morbidity was 47.8 per 1,000 births among Black people, compared with 27.7 per 1,000 among White people, according to a news release from the journal. After adjusting for sociodemographic and clinical characteristics, Black people had a 66 per cent increased risk.

Rates were consistently higher among Black people across all types of severe maternal morbidity the researchers studied, the release said.

The researchers drew on Canada’s 2021 long-form census, linked to national birth, hospitalization, immigration and tax records in all provinces and territories except Quebec. The work was carried out through CanHEAL, the Canadian network for Health Equity using Advanced Data Linkage, in partnership with the Black Reproductive Health Working Group in Ontario.

Race in the data is self-reported on the census, which allowed the team to link it to health records at the population level. CBC News also reported on the study, under a headline saying it followed years of calls for such data.

The gap did not disappear when the researchers looked at income or immigration. The disparity persisted across income levels and immigration groups, the release said. The findings also held when the team excluded people with preeclampsia-related conditions, sickle cell disease and HIV.

Dr. Giulia Muraca, a perinatal epidemiologist and associate professor of obstetrics and gynecology at McMaster University in Hamilton, said the results should not be read as a biological finding.

“Being Black is not a cause of severe pregnancy complications. Race is a social rather than biological construct, and the higher rates of severe maternal morbidity observed among Black people should not be interpreted as reflecting inherent biological differences,” Muraca said in the release. “The findings point instead to the need for further investigation of social, structural, and health care factors that may contribute to inequities in maternal health.”

Muraca and her co-authors wrote that their results are consistent with a broader body of evidence that structural and systemic factors, including anti-Black racism, contribute to inequities in maternal health. They noted that prior research has documented experiences of dismissal, objectification and inequitable care among Black people in a range of health-care settings.

Dr. Cynthia Maxwell, co-lead of the Black Reproductive Health Working Group in Ontario, said the pattern points to the systems around patients. Maxwell is a maternal-fetal medicine specialist at Women’s College Hospital and Mount Sinai Hospital and a professor of obstetrics and gynaecology at the University of Toronto.

“Black race is not a biological risk factor for severe pregnancy complications,” Maxwell said in the release. “When these inequities persist across income levels, immigration groups, and different medical conditions, we need to ask what it is about our health and social systems that is producing different outcomes. Black communities need to be part of answering that question and shaping the solutions.”

The release does not identify a cause for the gap, and the authors called for further investigation rather than naming one. It also does not state how the study was funded. Because the data exclude Quebec, the findings describe the rest of the country and not the whole of it.

The findings add to a growing body of Canadian evidence on Black health outcomes. Canada News Media has reported on a survey in which nearly half of Black women said they delay health care over fears of racism, and on federal funding announced this week, when Ottawa announced more than $6 million for Black communities’ health. Earlier this autumn the government also committed $135.7 million to Black Canadian groups.

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