Abstract
Pregnant and postpartum women who are Black live at the intersection of three of the gravest public health
threats confronting the 21st century US: (1) the maternal morbidity and mortality epidemic; (2) the behavioral
health crisis; and (3) intersectional discrimination. In a nation with the highest maternal mortality rate of all
high-income countries, Black women are three times more likely to die while pregnant or postpartum than their
White counterparts. Maternal behavioral health conditions – such as anxiety, perinatal and postpartum
depression, and birth-related PTSD – are the most common complications of pregnancy and childbirth,
affecting 1 in 5 women, and disproportionately afflict Black women. Overdoses, substance use disorders, and
related harms are surging among Black women. According to maternal mortality review committees (MMRCs),
behavioral health conditions are one of the leading causes of maternal deaths and are the leading
preventable cause of maternal deaths. Despite their size and impact, the US is ill prepared to mobilize to
address these crises because of longstanding legacies of intersectional discrimination whereby behavioral
health problems are neglected within the field of maternal health and the field of behavioral health neglects
maternal health. Black women in particular have suffered: historically and presently, approaches to address
Black maternal mortality and behavioral health have systematically failed to engage communities with lived
experience. Led by a partnership of Morehouse School of Medicine, Emory, and a robust network of
community-based organizations, and guided by principles of Reproductive Justice, Research Justice, and the
NIMHHD Mental Health framework, the Center to Advance Reproductive Justice and Behavioral Health among
Black pregnant/postpartum women (CORAL) will generate actionable evidence about the multilayered
determinants of maternal behavioral health conditions in close and equitable partnerships with Black women,
and the community-based organizations that serve them, with the goal of ending the maternal behavioral
health crisis in Georgia and beyond. Georgia is an essential site for this work as it has among the highest
pregnancy-related mortality ratios in the US, and Black women experience a rate that is 2.3 times that of White
women. The state MMRC has found that behavioral health conditions are a leading – and growing – cause of
maternal death. Leveraging an outstanding infrastructure spanning 2 major universities and a strong network of
community organizations, CORAL will mobilize academic and community partners to support Black maternal
behavioral health by developing and sustaining a robust transdisciplinary community-drive research
infrastructure; conducting rigorous, ethical transdisciplinary research in partnership with communities; building
the capacity of the next generation of investigators; and collaborating with academic, governmental, and
community to disseminate and translate discoveries.
