For Vogue’s September issue, Beyoncé talks about delivering her twins, Rumi and Sir, in June last year by emergency Caesarean section. Prior to giving birth, the artist was bedridden for a month because of “toxemia,” a condition better known as preeclampsia.

Preeclampsia causes high blood pressure and can damage organs such as the liver and kidneys, according to the Mayo Clinic. The only cure for preeclampsia is delivering the baby.

“My health and my babies’ health were in danger, so I had an emergency C-section,” said the artist, who was also on the cover of the issue. “We spent many weeks in the NICU,” referring to a neonatal intensive care unit. “I was in survival mode and did not grasp it all until months later. Today I have a connection to any parent who has been through such an experience.”

Beyoncé openness mirrors that of Serena Williams, who almost died giving birth to her daughter, Olympia, in September.

By publicly sharing the darker, and often traumatic, sides of their pregnancies, the women have reignited concerns surrounding maternal mortality rates, a trend that is especially high among black mothers, Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California at San Francisco, told The Washington Post in an email.

“People tend to think about pregnancy as a universally happy experience,” Grossman wrote. “But the reality is that pregnancy is inherently risky, and while some of these risks can be mitigated by good prenatal care, many cannot. Black women face significantly higher risks during pregnancy, and Beyoncé and Serena Williams help to put a very well-known face to these risks.”

‘You can’t educate your way out of this problem’

According to the Centers for Disease Control and Prevention, about 700 women in the United States die each year as a result of pregnancy or delivery complications. However, data gathered by the CDC’s Pregnancy Mortality Surveillance System showed that “considerable racial disparities in pregnancy-related mortality exist” and that black women are three to four times as likely to be at risk of pregnancy-related deaths as white women.

While the general public may assume that black women have higher risks of complications during pregnancy solely because of factors such as poverty or education, Grossman said that assumption is incorrect.

In 2016, the New York City Department of Health and Mental Hygiene published an analysis of five years’ worth of data, which revealed that black college-educated mothers who gave birth in local hospitals were still more likely to suffer serious pregnancy- or childbirth-related complications compared with women of other races or ethnicities who never graduated from high school.

“It tells you that you can’t educate your way out of this problem,” Raegan McDonald-Mosley, chief medical officer for Planned Parenthood Federation of America, told ProPublica in 2017. “You can’t health-care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”

Racial disparities in health care

Many studies have shown that racial disparities exist in health care. For example, doctors largely disregard or discount complaints of pain by black patients more frequently than they do for white patients.

A 2011 paper published in Clinical Orthopaedics and Related Research, a peer-reviewed journal, found that “racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity.”

Another study in 2016 conducted by researchers from the University of Virginia revealed that white people are more likely than black people to be prescribed strong pain medications for similar ailments. Researchers found that the reason for the disparity largely stemmed from people’s long-held beliefs about biological differences between black and white people. These beliefs are “associated with the perception that black people feel less pain than do white people and with inadequate treatment recommendations for black patients’ pain,” according to the study.

Even Williams, a high-profile athlete, told Vogue that she was not taken seriously when she first alerted hospital staff to the embolism. She said she told a nurse “between gasps” that she needed a CT scan with contrast and a blood thinner, but the nurse thought Williams’s pain medication might have been confusing her.

Despite insisting, Williams said a doctor still performed an ultrasound of her legs, which didn’t reveal anything, before sending her for a CT scan. The scan revealed that there were several small blood clots in her lungs, and soon she was receiving blood-thinning medication on a drip.

“I was like, listen to Dr. Williams!” she recalled.

Grossman said doctors and nurses have been “slow to acknowledge the role that racism plays in poor outcomes,” which include placing unnecessary barriers to care and making unwarranted assumptions about patients.

“Until we address the problem of racism in the health care system, we will not be able to fully address the problem of maternal mortality among black women,” he wrote.

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