In Canada, 47.8 of every 1,000 Black people who gave birth suffered a severe complication such as hemorrhage, sepsis or severe preeclampsia. Among white people the figure was 27.7. After researchers accounted for social and clinical differences, Black people still had a 66% higher risk.
The numbers come from a study in the Canadian Medical Association Journal (CMAJ) published Oct. 5, led by Dr. Giulia Muraca, a perinatal epidemiologist at McMaster University. It linked the 2021 Census to national birth, hospital, immigration and tax records and followed nearly 1.5 million births between 2012 and 2023: 108,805 to Black people and 1,388,090 to white people. Race was self-reported on the census.
The finding that matters most for Black families is what did not explain the gap. The disparity held across income levels. It held among immigrants and among people born in Canada. It held when the researchers set aside preeclampsia, sickle cell disease and HIV. According to the study’s summary, higher household income went with lower rates of severe complications among white people and with higher rates among Black people. Money, in other words, did not buy the same safety.
That cuts against a common reflex, in medicine and in the press, to explain Black health outcomes through poverty, immigration or biology. The authors reject the biology argument directly: “Being Black is not a cause of severe pregnancy complications. Race is a social rather than biological construct.” What is left is how Black patients are treated. Earlier research the authors cite documents Black patients being dismissed, objectified and given unequal care.
The study has limits, and they matter. It excluded Quebec, so it says nothing about the large Black communities of Montreal. It is observational, so it shows a disparity but cannot prove its cause. And it exists only because Canada can link the census to health records. Most of the country’s health systems do not routinely collect or publish race data, which is why Black mothers’ outcomes have gone largely unmeasured for so long.
The researchers recommend responsible race data collection in health systems, public reporting of race-disaggregated health data, anti-racism training for providers, accountability mechanisms to track progress, and care programs designed with Black communities. We agree, and would put the first two at the front: no province can fix a gap it refuses to count.
The study appears in CMAJ, volume 198, issue 34.
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