a direct correlation to the physical health of the mother through reproduction, pregnancy and birth, which provides further evidence of poor maternal health resources and care received by black mothers. racial bias in 2020 the american public health association declared structural racism a public health crisis, which was attributed to historical forces as well as current events. there has been thousands of studies analyzing the racial bias against black people in the healthcare system. overall, blacks are less likely to receive the same quality care as their white counterparts. clinician bias is one of the largest contributors to this disparity. this bias can be either implicit or explicit, but both are harmful to the well-being of black patients. explicit biases have generally been measured with self-reports while implicit biases are measured through "validated tests of unconscious association". a lot of empirical evidence strongly suggests that white physicians hold negative implicit racial biases and negative explicit racial stereotypes, which causes them to be influenced by these biases when it comes to making medical decisions for their patients. in turn, this contributes to the racial inequities prominent in the healthcare system. in general, black americans are under-treated for pain when compared with white americans. black patients are less likely to receive pain medication, and when they do, they are more likely to receive a lower quantity than their white counterparts. this phenomenon contributes to black maternal mortality, aiding in the dismissal of black women's pain by medical professionals. a harvard school of public health publication discussed this phenomenon by collecting numerous examples of medical professionals being dismissive or providing delayed care to black mothers expressing pain or problematic symptoms. the publication tells the story of shalon irving, a black woman who experienced symptoms such as high blood pressure, blurry vision, and hematoma after childbirth. however, her doctors advised her to not take further action, and irving died soon after. according to the author, this was just one instance of medical caregivers being less likely to take black women's concerns seriously, contributing to maternal death. demonstrator for abortion rights maternal morality is connected to racism, with black women dying from medical issues that are preventable yet not being listened to when they complain about pain. more specifically along the lines of black maternal health, black women are also seen to receive birth control-related distrust in higher frequencies compared to white women. although the likelihood of poor black women are more susceptible to the reality of maternal mortality, the risk still exists for other black women with better resources. for example, world-renowned tennis athlete serena williams almost suffered a fatality postpartum when she got a pulmonary embolism. this was a result of the doctors not listening to her when she expressed her health concerns, and not considering those concerns serious enough to be acted upon urgently. according to a study done by the robert johnson fund, over 22% of black women report discrimination from medical professionals when they are seeking help. abortion access unsafe abortion is a major contributing factor to maternal mortality and morbidity and black women, who are more likely to have unplanned pregnancies and be of lower socioeconomic status, are more likely to undergo unsafe abortions. black women have consistently had higher abortion rates than white women, which means that restrictions to safe abortions will disproportionately affect them. and over the last couple of years, access to safe abortions in the united states has become increasingly restrictive. these restrictions include bans on particular methods of abortion care, targeted restriction of abortion provider (trap) laws, and specifically trigger laws which have banned abortion in some states immediately after roe v. wade was overturned in 2022. the lack of access to safe abortions have been exacerbated within the past decades as states pass strict regulations around abortion especially in southern states with higher proportions of african americans. the world health organization recognizes that in order to help decrease maternal mortality, access to safe abortions must be increased. and while few studies have inquired as to whether there is a direct link between unsafe abortion and maternal mortality, the studies that have been done support this link. preventative measures medical in order to prevent maternal deaths from occurring, methods have been identified which decrease maternal mortality overall along with the accompanying health disparities. researchers believe that by improving the quality of care within hospitals, maternal mortality would be properly addressed and accounted for. it has been suggested that higher quality hospitals, that have multiple layers of care such as administrative and patient advocates, are consistent with their collection of feedback from patients which allows for further improvement in regards to addressing maternal mortality. additionally, maternal health-related services, such as an intensive care unit, 24-hour anesthesia, and ob/gyn specialists, contribute to the decrease of maternal mortality rate. with the prioritization of standardized care and early risk factors, issues that may lead to maternal mortality in black women, such as hypertension, hemorrhaging, and eclampsia, would be directly addressed. the new study also found that these disparities were concentrated in a few causes of death. postpartum cardiomyopathy (heart failure) and the blood pressure disorders preeclampsia and eclampsia were the leading causes of maternal death in black women, with mortality rates five times higher than in white women. pregnant and postpartum black women were also more than twice as likely as white women to die from hemorrhage or embolism (blood vessel blockage). it is also important to recognize that only 87% of black women have health insurance and most have gaps in coverage at some point in their lives. to improve the health of black women, policies need to be implemented that focus on the expansion and maintenance of the care and coverage. in addition to improving medical care for black women, improving the living conditions of black families would also help to eliminate declining physical health conditions, as the health of communities has been proven to link directly to the overall health of the individuals who live thereinstitutional some have argued against the conventional classification of race as a risk factor in health, instead calling for the recognition of racism and poverty as the underlying factors contributing to black maternal mortality and other poor health outcomes for black individuals. to address the medical racism that exists within healthcare, which ultimately leads to maternal mortality, many states and cities have taken initiative by creating programs to address the high levels of black maternal mortality. most notably, in 2018, an initiative was created in new york city in which healthcare workers had to undergo implicit bias training. in addition, experts in multiple sectors, such as medicine, sociology, and law, have said that deliberately addressing racism, both within and outside of the medical field, is necessary to decrease the rate of black maternal mortality. according to “epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality,” screenings are a large component of prevention for severe maternal morbidity which directly correlates to the increase in black mortality during pregnancy as well as access to resources (holdt, 2017). this likely attributes to the also significant gap from black to white pregnancies to be readmitted post-pregnancy. using the national (nationwide) impatient sample from the healthcare cost and utilization project from 2012-2014 discovered that black women are found that women were more likely to be readmitted postpartum, to suffer severe maternal morbidity, and suffer life-threatening complications (aziz, 2019). by increasing screening before and during pregnancy and access to better maternal healthcare for those with medicaid, maternal mortality for black women and post-pregnancy complications could significantly decrease; in addition, new protocols regarding how often pregnant women, especially black women, should be screened for hypertensive disorders while pregnant and defended by institutionalization, possibly by litigation. pregnancy-related mortality ratio (prmr) data by state prmr is the number of pregnancy-related deaths per 100,000 live births. many states do not report maternal mortality data by race/ethnicity. state overall prmr cohort year(s) for prmr data non-hispanic black prmr cohort year(s) for non-hispanic black prmr data alabama 22 2016 data not available n/a alaska 24.3 2017-2018 data not available n/a arizona 18.3 2016-2017 data not available n/a arkansas data not available n/a data not available n/a california data not available n/a data not available n/a colorado 19.26 2016 data not available n/a connecticut 10.3 2015-2017 data not available n/a delaware 18 2014-2018 data not available n/a d.c. data not available n/a data not available n/a florida 16.3 2018 32 2018 georgia 25 2015-2016 40 2015-2016 hawaii data not available n/a data not available n/a idaho 18.7 2018 data not available n/a illinois 22.8 2015 72 2015 indiana 12.2 2018 data not available n/a iowa 9.4 2015-2018 36.9 2015-2018 kansas 11.3 2016-2018 data not available n/a kentucky data not available n/a data not available n/a louisiana 24.6 2017 53.6 2017 maine data not available n/a data not available n/a maryland 21.0 2017 28.5 2015-2017 massachusetts 4.2 2017 data not available n/a michigan 9.9 2017 21.3 2013-2017 minnesota 12.9 2016 data not available n/a mississippi 22.1 2013-2016 51.9 2013-2016 missouri 26 2017 53 2017 montana data not available n/a data not available n/a nebraska 13.7 2014-2018 data not available n/a nevada 25.1 2016-2017 63 2016-2017 new hampshire data not available n/a data not available n/a new jersey 15 2014-2016 44.5 2014-2016 new mexico 23 2015-2017 data not available n/a new york 14 2014 48 2014 north carolina data not available n/a 24.4 2012-2015 north dakota data not available n/a data not available n/a ohio 11.6 2016 29.5 2016 oklahoma data not available n/a data not available n/a oregon data not available n/a data not available n/a pennsylvania data not available n/a data not available n/a rhode island data not available n/a data not available n/a south carolina data not available n/a data not available n/a south dakota data not available n/a data not available n/a tennessee 27.2 2017-2018 57.8 2017-2018 texas data not available n/a data not available n/a utah 23.3 2018 data not available n/a vermont data not available n/a data not available n/a virginia 3.9 2015 4.6 2015 washington 11.2 2014-2016 9 2014-2016 west virginia 16.4 2018 0 2014-2018 wisconsin 5.9 2006-2010 22.5 2006-2010 wyoming data not available n/a data not available n/a