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Beyoncé is one of millions of women who have developed preeclampsia during pregnancy. Getty Images

In 2018, Beyoncé made history as the first black woman to headline the music festival Coachella.

In a new documentary that premiered last month on Netflix, the artist describes her efforts to prepare for the performance while recovering from an “extremely difficult” pregnancy.

“My body went through more than I knew it could,” Beyoncé says at one point in the film, before sharing details about her experience of carrying and delivering twins.

While she was pregnant, Beyoncé developed a complication known as preeclampsia.

This condition can cause dangerously high blood pressure.

It can restrict fetal growth and increase the risk of pre-term delivery.

In severe cases, it can also cause life-threatening seizures, known as eclampsia.

When one of her twins showed signs of distress in the womb, Beyoncé had to undergo an emergency cesarean delivery.

This left her with a deep incision in her abdomen, from which it took time to heal.

“I had to rebuild my body from cut muscles,” she said in the film. “There were days that I thought, you know, I’d never be the same. I’d never be the same physically. My strength and endurance would never be the same.”

Beyoncé is one of millions of women who have developed preeclampsia during pregnancy.

According to the Preeclampsia Foundation, preeclampsia and related disorders affect an estimated 5 to 8 percent of births in the United States.

Black women are more likely than white women to develop preeclampsia, as well as eclampsia.

Among those who gave birth in 2014, 7 out of 100 black women developed preeclampsia. The reported rate in white women was 40 percent lower.

Many other complications of pregnancy and adverse birth outcomes also affect black women at higher rates than white women.

“Black women are three to four times as likely to die from pregnancy-related causes as white women, and their babies are twice as likely to die before their first birthday as white babies,” Katy B. Kozhimannil, PhD, MPA, an associate professor of health policy and management at the University of Minnesota, told Healthline.

“Rates of preterm birth are higher among black women, and quality of maternity care is lower,” she added.

American Indian and Alaskan Native women also face higher risk of pregnancy-related complications and maternal death, compared to white women.

Some populations of Hispanic and Asian women experience disparities in these outcomes, too.

Many factors contribute to racial and ethnic disparities in maternal health outcomes, Dr. Elizabeth Howell, MPP, director of the Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai, told Healthline.

“I wish I could tell you that if we just controlled women’s high blood pressure, we wouldn’t have these issues, but it’s much more complex,” she said.

“Patient-level factors, community neighborhood factors, provider factors, and system factors — they all seem to contribute to these disparities,” she added.

At a patient level, for example, black women are more likely than white women to live in poverty and less likely to have a college-level education.

This can negatively affect their ability to access high-quality healthcare, health information, and other resources during pregnancy.

However, even when researchers control for socioeconomic factors, they find that racial disparities in maternal health outcomes persist.

“It’s very important for people to realize that these disparities, they go beyond class,” Howell said.

For instance, the New York City Department of Health and Mental Hygiene has found that black women are at higher risk of maternal morbidity than white women even when they’ve attained a higher education level.

“They stratified it by education level and showed again, a college educated black woman is two to three times more likely to have a severe maternal morbidity event during her delivery hospitalization, as compared to a white woman with less than a high school education,” Howell said.

According to Kozhimannil and Howell, structural racism contributes to the disparities that black women face in maternal healthcare and outcomes.

Structural racism refers to the unequal distribution of resources and opportunities based on race. Many experts believe it has deep roots in a country where black people have been subject to slavery, segregation, and the intergenerational effects of those institutions.

“Black women enter pregnancy in poorer health, owing to the accumulation of stress and disease that comes from experiencing years, even generations, of discrimination and structural racism,” Kozhimannil said.

She added, “A black woman can do everything right, can care for herself during her pregnancy by following every bit of medical advice, and still be at greater risk because of structural racism,” she added.

In order to address structural racism and its health effects, she suggested that change is needed at a societal level.

To promote change in the healthcare system, Howell and Kozhimannil have helped to develop a conceptual framework for achieving equity in maternal health outcomes.

Among other strategies, the authors of the framework recommend that healthcare providers be educated on the existence and root causes of racial and ethnical inequalities.

They encourage providers to develop mechanisms for identifying and addressing individual instances of bias, discrimination, and inequitable care.

They also suggest it’s important for hospitals to stratify the data they collect on patient outcomes, in order to identify racial disparities and opportunities for improvement.

“This provides concrete, actionable steps that can help health systems start to address racial inequities in birth outcomes,” Kozhimannil said.

“[However], none of these steps is a panacea, and more comprehensive action will be needed to ensure greater equity in childbirth,” she added.