African Americans suffer disproportionately high rates of maternal and infant death in part as a result of the stress caused by institutional racism and sexism, an issue brief from the finds. Based on a literature review, the brief, Exploring African Americans' High Maternal and Infant Death Rates (, 13 pages, ), found that African-American mothers die at three to four times the rate of white mothers, and their infants at twice the rate of those born to white mothers. The racial gap is driven by higher rates of preterm births and low birth weights among African-American women that cannot be explained by differences in educational attainment, income, maternal age and health status, gestational age, or access to prenatal care. According to the brief, studies have shown that, long before pregnancy, the cumulative effects of systemic racism can expose women to environmental toxins and high levels of stress that lead to poor birth outcomes. The brief also found that African-American women often receive lower-quality health care and suffer from implicit bias among healthcare workers. The brief calls for closing the data gap on maternal and infant deaths in order to develop prevention efforts and quality improvement programs.