The Evidence Room: Racism Is Not an American Export

Ethnic disparities in childbirth are not just an American failure—they are a global stain on wealthy nations that claim to value equality. New evidence shows these lives can be saved.

Surprise, surprise: the United States is not the only racist country.

That might shock Americans who like to believe that racial disparities in healthcare are a uniquely American sin. But a new systematic review in BJOG (2025) shows that the injustice runs far deeper and far wider. From London to Sydney to Stockholm, women from minority backgrounds face higher risks of losing their babies—or their lives—simply because of who they are.

In the UK, Black women are still almost three times as likely as White women to die in pregnancy or childbirth. In the U.S., the maternal death rate for Black women is more than double that for White women. And in Australia, First Nations women carry staggering risks that reflect centuries of colonization and neglect. The pattern is too consistent to ignore: ethnicity predicts outcomes, even in wealthy nations that pride themselves on universal healthcare.

What the Review Shows

The BJOG study reviewed 36 interventions, involving over 72,000 women across the U.S., UK, Australia, Canada, Denmark, and Sweden. These programs tried everything from extra fetal surveillance, to midwifery continuity, to nutrition support and cultural education.

The results? Some worked, some didn’t. Extra monitoring at 39 weeks reduced stillbirths in South Asian women by nearly two-thirds. Nutrition programs in the U.S. cut infant death rates for Black babies in half. An Australian program, “Birthing in Our Community,” lowered preterm birth risk by more than 50 percent for First Nations women. These are not marginal gains; they are life-and-death transformations.

But other efforts fell flat. Training midwives in cultural competence made providers feel more “aware” but did little to improve outcomes. Bilingual doulas in Sweden were warmly received but didn’t change the hard numbers. Group prenatal care models improved satisfaction in some cases but didn’t erase disparities in mortality or preterm birth.

This is the messy truth: equity in maternal health can be achieved, but it isn’t cheap, it isn’t simple, and it certainly isn’t uniform.

The Ladder Analogy

Think of healthcare as a ladder. For some women, the rungs are close together, sturdy, and well lit. For others—often minorities—they’re broken, uneven, and spaced too far apart.

Adding more midwives, providing transportation, offering interpreters, or running nutrition programs aren’t luxuries. They are repairs to the ladder. Yet policymakers often treat these fixes as “extras,” too costly or too targeted. And so, women fall. Babies die. Families grieve.

Politics, Not Medicine

Here’s the rub: medicine can identify solutions, but only politics can deliver them. In the U.S., Medicaid finances nearly half of all births, disproportionately for women of color. When lawmakers cut funding in the name of “fiscal responsibility,” they are, in practice, deciding which mothers get to survive childbirth.

In the UK, austerity has eaten away at midwifery continuity programs that once showed promise. In Australia, successful First Nations programs survive on fragile, short-term funding. It’s as if we run small pilot projects, prove they save lives, and then shrug.

Let’s not pretend this is ignorance. It’s a choice.

What We’ve Learned

The review teaches a blunt lesson: one-size-fits-all medicine is a failure. Interventions must be tailored. South Asian women, Black women, First Nations mothers—each face different risks, and each require specific strategies. Universal slogans like “patient-centered care” or “inclusive practice” are cheap. Concrete, tailored investments are not.

When nutrition support halves infant mortality in one group, and extra fetal surveillance slashes stillbirth risk in another, it becomes impossible to argue that disparities are some mysterious inevitability. They are fixable. They persist because governments and health systems choose not to fix them.

The Ethical Bottom Line

Every stillbirth, every maternal death among ethnic minority women in high-income countries is not just a tragedy—it is a policy failure. Or, put more starkly, a policy decision.

The evidence is clear: targeted, culturally appropriate, socially grounded care saves lives. The question is whether we are willing to pay for it and to scale it.

That’s the uncomfortable truth, the one hiding in plain sight. Racism in healthcare is not an American export. It is built into the structures of wealthy nations everywhere. Which leaves us with one final, haunting question:

How many more mothers and babies must die before we stop treating justice in childbirth as optional?