It’s Black Maternal Health Week, and the Policy Center is shedding light on the link between cardiovascular conditions, mental health and chronic stress.

Maternal mortality in the United States continues to be among the highest of all developed countries, a critical issue, especially for Black women. Persistent racial disparities remain stark, with Black women still facing significantly higher risks of pregnancy-related complications and death. Black women are still more than three times as likely to die from pregnancy-related causes than White women. 1

These inequities are driven by multiple factors, including changes in biology due to chronic stress and systemic factors, including access to care, quality of care, and racism.

The Leading Causes of Maternal Mortality for Black Women

Research consistently shows that a handful of conditions drive the majority of maternal deaths among Black women, many of which are preventable with timely, equitable care.

Top Causes of Maternal Mortality (Black Women)1

Cause of DeathWhy It Matters
Cardiovascular Conditions (including cardiomyopathy, hypertension, stroke)A leading cause overall; Black women face significantly higher rates of death from these conditions
Hypertensive Disorders (preeclampsia, eclampsia)Occur more frequently and with greater severity among Black women
HemorrhageOften preventable with rapid response protocols
EmbolismBlood clots that can become fatal without early detection

Cardiovascular conditions, including postpartum cardiomyopathy and hypertensive disorders, are among the leading causes of maternal death for Black women, with mortality rates several times higher than those of White women. Alarmingly, cardiovascular-related maternal deaths have more than doubled in recent decades.2

An Overlooked Driver of Maternal Heart Health: Mental Health and Chronic Stress

Maternal mortality is often framed as a physical health issue, but growing evidence shows that mental health is deeply connected to these outcomes, particularly cardiovascular complications.

In fact recently, the American Heart Association emphasizes that screening for depression, anxiety, and psychological stress should be a core part of maternal cardiovascular care, noting a critical “mind-heart” connection during pregnancy and postpartum.

How Mental Health Impacts Physical Outcomes

  • Chronic stress increases cortisol levels, which can elevate blood pressure and contribute to heart disease3
  • Long-term exposure to stress, especially from systemic racism, can lead to “biological weathering,” accelerating cardiovascular deterioration4
  • Untreated mental health conditions can worsen the management of chronic diseases like hypertension and diabetes5

Together, these pathways can provide added explanation as to why cardiovascular conditions are both a leading cause of death and closely tied to mental health and lived experience.

Black Women Suffer from Mental Health Challenges at High Rates

Black women are twice as likely to experience maternal mental health conditions as white women, yet are significantly less likely to receive adequate screening, diagnosis, and treatment.6

Key Drivers of Elevated Risk

1. Chronic Stress and Racism
 Higher exposure to structural inequities, including racism, economic instability, and barriers to care, creates sustained stress that impacts both mental and physical health.7

2. Pre-existing Health Inequities
Black women are more likely to experience conditions like hypertension prior to pregnancy, conditions that are exacerbated by stress and untreated mental health disorders.8

3. Gaps in Care and Bias
Even when controlling for income and education, disparities persist, highlighting the role of implicit bias and unequal treatment in healthcare settings.9

4. Added Vulnerability During the Perinatal Period

Pregnancy 

Mental health conditions equally onset prior to pregnancy, during pregnancy and in the postpartum.10 Untreated maternal depression and anxiety is a leading cause of preterm birth11 and provides an explanation for the high rates of preterm birth in the Black population. It’s critical then that screening for stress, depression and anxiety begin during pregnancy.   

Postpartum 

Most maternal deaths occur weeks to months after delivery, when maternity care has typically ended, which we refer to as the postpartum care cliff.12 As discussed at our 2026 FORUM, the Policy Center advocates for ongoing obstetric provider care in the postpartum using the community midwifery framework of 5-8 visits in the first six weeks postpartum and ongoing care as needed based on patient health.13

Integrating Mental Health into Maternal Care

If government, payors and health systems  are serious about reducing Black maternal mortality, they must:        

  • Embed mental health screening and treatment into maternity care starting in pregnancy and throughout the postpartum period, using evidenced based tools such as the Perceived Prenatal Maternal Stress Scale.
  • Treat cardiovascular health and mental health as interconnected, not separate, issues.
  • Expand access to culturally competent care including community-based care. 
  • Address the root causes of chronic stress, including systemic racism and provide support basic needs like food, transportation, housing, child care and paid leave. 

More than 80% of pregnancy-related deaths are preventable.14 But prevention requires a shift from reactive care to proactive, whole-person care.

Moving Forward

Black Maternal Health Week is both a moment of awareness and a call to action. By recognizing the connection between mental health, stress, and physical outcomes like cardiovascular disease, we can begin to close the gap.

References
  1. Centers for Disease Control and Prevention. (2026, March). Maternal mortality rates in the United States, 2024. National Center for Health Statistics. https://www.cdc.gov/nchs/data/maternal-mortality/2024-data.pdf ↩︎
  2. American Heart Association. (2026, January 21). 2026 heart disease and stroke statistics update: A report from the American Heart Association. Professional Heart Daily. https://professional.heart.org/en/science-news/2026-heart-and-stroke-stat-update ↩︎
  3. American Psychological Association. (2023, March 8). The mind-body connection: How mental health affects physical health. https://www.apa.org/topics/health-disparities/mind-body-connection ↩︎
  4. Scaccia, A. (2023, April 3). How stress affects heart health in Black people. Verywell Health. https://www.verywellhealth.com/heart-disease-and-stress-in-black-people-5221197 ↩︎
  5. Cohen, B. E., Edmondson, D., & Kronish, I. M. (2015). State of the art review: Depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension, 28(11), 1295–1302. https://doi.org/10.1093/ajh/hpv047 ↩︎
  6. Policy Center for Maternal Mental Health. (2023, December 8). Black maternal mental health issue brief. https://policycentermmh.org/black-maternal-mental-health-issue-brief/ ↩︎
  7. Geronimus, A. T., Bound, J., & Colen, C. G. (2021). Excess mortality among Black and White populations in the United States over the life course, 1999–2018. Proceedings of the National Academy of Sciences, 118(46), e2104139118. https://doi.org/10.1073/pnas.2104139118 ↩︎
  8. National Institutes of Health. (2024, July 3). NIH-funded study highlights stark racial disparities in maternal deaths. https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths ↩︎
  9. Howell, E. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387–399. https://doi.org/10.1097/GRF.0000000000000349 ↩︎
  10. Wisner, K. L., Sit, D. K. Y., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry (Chicago, Ill.), 70(5), 490. https://doi.org/10.1001/jamapsychiatry.2013.87 ↩︎
  11. Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction. Archives of General Psychiatry, 67(10), 1012–1024. https://doi.org/10.1001/archgenpsychiatry.2010.111 ↩︎
  12. National Institutes of Health. (2024, July 3). NIH-funded study highlights stark racial disparities in maternal deaths. https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths ↩︎
  13. Bixby Center for Global Reproductive Health. Community midwifery model of postpartum care as a path toward equity and better health. (2024, April 12.). University of California San Francisco. https://bixbycenter.ucsf.edu/news/community-midwifery-model-postpartum-care-path-toward-equity-and-better-health ↩︎
  14. Centers for Disease Control and Prevention. (2024, May 15). Working together to reduce maternal mortality. https://www.cdc.gov/womens-health/features/maternal-mortality.html ↩︎