Correlations are not causal, in many instances, they are related to other factors. So, higher MMR rates among black women are not "caused" by them being black, which seems pretty obvious.

Nor are black women receiving less medical care because they are black, that should seem pretty obvious, but sadly it's not. As someone who ran a large OB/GYN group delivering 1500-1800 babies per month, people got the same excellent care regardless of their race, ethnicity, etc.

So, when you discover a correlation between MMR rates and race, the first step should be to dig deeper, rather than make assumptions regarding causation. Assumptions treated as facts can perpetuate myths.

We do have a two-tier health care system, but it is not founded on "white supremacy" and repeating such lies simply perpetuate racial division.

I am sure racists exist but working in health care for more than 25 years with hundreds of physicians, I never met a physician that would not take a patient based on skin color. So, if that isolated racist physician won't accept a black patient, there is a good OB/GYN that will.

I have met physicians that would not take a patient based on their health insurance coverage and this can be a big factor influencing outcomes.

I know of a small town in rural Indiana where the local family practice physician at the time was the only doctor that would deliver women without good health insurance. The implications of that to poor minority women are pretty evident. The doctor was certainly capable of handling normal deliveries, but did not have the advanced training for complicated deliveries.

This can produce disparities in racial outcomes. And that leads to us having a two-tier health care system.

Our two-tier health care system is based on money and so while poor minority communities get poor care, it is their economic status rather than their skin color that is the culprit.

Affluent women get better health care than poor women. There are also social factors related to different outcomes like diet. There are also issues when the physician and patient don't form a trusting relationship, and the woman is experiencing a difficult pregnancy.

For the most part, affluent women have an OB/GYN like one of the physicians in our group. Our group had over 50 OB/GYNs and for the most part we had the perfect OB/GYN for every patient, though if you wanted that level of choice, you might have to drive to get to their office.

Women have definite preferences. If a black woman preferred a black OB/GYN we had black OB/GYNs. For some cultural reason, Hispanic women preferred male OB/GYNs and we had plenty of those. White women preferred female OB/GYNs and we had plenty of those. If for any reason you want an LGBTQ OB/GYN we had a few of them, also.

Because about half of women have no preference, it was relatively easy to ensure those women that had a preference could find an OB/GYN that would meet those particular preferences, but in the case of black or LBGTQ OB/GYNs it could mean driving as much as 20 miles.

All of our OB/GYNs that took care of wealthy women including my wife, served in the local hospital clinic providing poor women maternal care. My wife had our children in the same hospital as the poorest women in our county as well as the black women in our county.

My daughter who during her divorce lost her health care coverage accessed the clinic was able to see her private insurance OB/GYN but had to schedule her appointments on the days that physician worked in the clinic.

So, we do have a two-tier health care system where poor people who are disproportionately minorities get worse care. It is possible to get almost as good care, but it requires a lot more effort by the patient. And many poor women can't get the time off from work to go to those appointments.

Another serious issue with many women especially poor women is prenatal "self" care. Besides seeing on OB/GYN for appointments, following prenatal protocols can influence outcomes dramatically.

Lastly, many communities especially rural and inner-city neighborhoods do not have access to a perinatologist. These are highly trained OB/GYNS that specialize in tough pregnancies. These are the cases where women's lives are often most at risk. Yet they are simply not available to many women of all races living in rural areas or women living in poor inner-city neighborhoods.

We have issues with our health care system that work against poor and rural women, and we need to address them. Regarding midwives and doulas be careful. They can be a great choice for women likely to have a normal vaginal delivery. We employed many of them especially for women that want "at home natural" deliveries.

They are far better at being patient with women who are experiencing extended labor, whereas OB/GYNs are much quicker to opt for a Cesarian.

But should a woman need a Cesarian, that will need to be done by a doctor and if necessary, time can often be of the essence.

I am not a physician, but someone that spent his life around physicians and other health care clinical people running large medical organizations. I am not giving anyone medical advice, but I am recommending they get professional medical advice from a physician regarding whether they are a good candidate for midwife or doula delivery.

One way to view MMR is globally. On the spectrum of ideal maternal care and no access to maternal care, American women even those getting relatively poor care by American standards are getting great care by global standards.

None of this is an excuse for unequal MMR in America, but I do think the answer lies less in race and more in other factors. If we focus on race, we won't lower MMR among black women as much as if we focus on the underlying causes of higher MMR.