Background: Disparities in maternal child health often focus on infant mortality and low birth weight. However, racial disparity in pregnancy related mortality (PRM) has increased over time. The US Black/White PRM risk ratio increased from 1.76 in 1915, to 2.59 in 1945, and 4.11 in 1990. The MMWR report of PRM between 1991 and 1999 noted a Black/White risk ratio of 3.70.

Methods: The Bureau of Maternal, Infant, and Reproductive Health in the NYC Department of Health and Mental Hygiene (DOHMH) conducts enhanced maternal mortality surveillance. Medical records, infant birth certificates, maternal death certificates, and medical examiner reports are reviewed to determine demographics including race, cause of death, pregnancy outcome, and related morbidity. Data from 1998-2000 are presented.

Results:

Race	% Live births (LB)	% Maternal Deaths	Maternal Mortality Ratio (deaths/100,000 LB)
White	29	11	16
Black	27	56	95
Hispanic	32	25	38
Asian/ Pacific (API)	11	7	26

The OR for maternal mortality for Black women with White women as the referent group is 5.84 (p<.01, CI 3.45,10.00), for Hispanic women 2.19 (p< .01, CI 1.23, 3.94), and 1.6 for API women (not significant). Hemorrhage as a cause of death also showed racial disparity (64% Black, 21% Hispanic, 8% white, and 8% API). There were no racial differences in comparisons of age, concomitant morbidity, delivery mode, and parity.

Conclusions: There is significant racial disparity in overall maternal mortality and in preventable causes of death. DOHMH is working with clinicians in minority communities to prevent MM.