Abstract for: Unpacking the Drivers of Severe Maternal Morbidity among Non-Hispanic Black Women: Clinical, Social, and Policy Perspectives

Severe maternal morbidity (SMM) rates among non-Hispanic Black women (NHBW) have been rising in the United States. SMM is defined as unexpected complications of pregnancy, labor, or delivery with serious short- or long-term health consequences. SMM imposes an enormous risk to the well-being of women and their health during their lifetime. This study explores the causal mechanisms underlying this health outcome using a system dynamics group model building approach. As a result, a causal loop diagram (CLD) was developed integrating insights from stakeholders and reinforcing findings with existing literature. The analysis identified five interconnected subsystems along with their interactions influencing the rising trends in SMM among NHBW: health and healthcare; housing policies and neighborhood quality; the criminal justice system; the education system; as well as racism and advocacy efforts. The results highlight how structural racism, socioeconomic inequities, and institutional bias create reinforcing feedback loops that worsen maternal health outcomes. This is the outcome of the initial phase of a multi-year project focused on addressing rising SMM rates among NHBW in Texas. By mapping the intricate and dynamic relationships, this paper provides a framework for targeted interventions and policy changes aimed at reducing SMM rates and promoting maternal health equity.