Abstract for: Structural Drivers of Black Maternal Health Inequities: A Community-Engaged Systems Mapping Study in Cuyahoga County, Ohio

The United States continues to face persistently high maternal morbidity and mortality rates, with Black women experiencing pregnancy-related deaths at more than three times the rate of White women. These disparities reflect not only clinical risks but also deeper structural factors—such as racism, residential segregation, and inequitable access to resources—that shape maternal health outcomes across the life course. We conducted four Group Model Building sessions with community members, clinicians, public health practitioners, and community organizations to examine drivers of maternal and infant health outcomes. Participants collaboratively developed a causal loop diagram capturing structural, economic, healthcare, and psychosocial interactions, and identified priority interventions. Post-session surveys evaluated the inclusiveness, credibility, and usefulness of the participatory process. Stakeholders identified structural racism as a key upstream driver shaping neighborhood conditions, economic insecurity, and inequitable healthcare access. The systems map revealed reinforcing feedback loops linking these factors to maternal stress, chronic disease, and adverse birth outcomes. Participants highlighted cross-sector coordination, culturally responsive care, and community-based supports as key intervention opportunities. This study shows that maternal and infant mortality disparities among Black families in Cuyahoga County arise from interconnected structural, economic, healthcare, and psychosocial factors rather than isolated clinical risks. The systems map highlights how structural racism, poverty, stress, and fragmented healthcare reinforce one another, while also identifying community-based supports and cross-sector coordination as key leverage points for advancing maternal health equity. AI was used for text editing