A new national study showing that Black people in Canada face a much higher risk of severe pregnancy complications raises questions for group benefits plan sponsors.
These cover disability coverage, extended health design, and the lack of data employers have to assess gaps in their own workforce.
The research, published October 5 in the Canadian Medical Association Journal (CMAJ), found severe maternal morbidity occurred at a rate of 47.8 per 1,000 live births among Black people, against 27.7 per 1,000 among white people. After adjusting for sociodemographic and clinical differences, the risk was 66% higher. The study covered nearly 1.5 million births between 2012 and 2023 in Canada outside Quebec.
The most common complications were severe preeclampsia, severe hemorrhage and sepsis. The gap persisted across income levels and among both immigrant and Canadian-born parents.
"Being Black is not a cause of severe pregnancy complications," said Dr. Giulia Muraca, a perinatal epidemiologist at McMaster University and the study's senior author. In the release accompanying the study, the researchers pointed to structural and systemic factors, including anti-Black racism, as contributors to the gap.
For employers, routine maternity leave is largely handled outside the benefits plan through federal Employment Insurance. Complications are where group coverage comes in. Short-term disability plans generally do not pay for a normal pregnancy, but they can respond when complications such as severe preeclampsia or hemorrhage prevent an employee from working before or after birth. Complications that extend recovery can lengthen absences and, in more serious cases, lead to long-term disability.
The CMAJ findings point to a larger burden than delivery-room statistics suggest. A March CMAJ study by the same research group found that more than 29% of severe complications in Ontario occurred after hospital discharge, in the six weeks following birth. Muraca has said that tracking the full period from conception to six weeks postpartum lifts the estimated rate of severe complications to 2.7% of pregnancies, nearly 10,000 a year nationally.
That postpartum window is also when extended health benefits are used: follow-up physiotherapy, mental health support and paramedical care for recovery.
The study highlighted a measurement problem for plan sponsors and insurers. Group claims data in Canada generally does not record race, so employers cannot tell whether the disparity shows up in their own disability or health claims. The researchers have called for routine collection of race-based health data to track whether interventions are working.
Race is not used as a rating factor in Canadian group or individual insurance. But the medical history that follows serious complications can matter for individual coverage. Severe preeclampsia, for example, is associated with higher long-term cardiovascular risk. That history can be relevant when someone later applies for individual life or critical illness insurance, which means an unequal risk of complications could carry through to insurance access long after the pregnancy itself.
For benefits advisors, the findings are likely to come up with employers that have diversity and inclusion commitments. Questions may cover whether STD plans handle pregnancy complication claims consistently and quickly, whether extended health plans cover postpartum mental health and recovery services adequately, and whether services such as midwifery and doula support, which some families use to navigate barriers in hospital care, should be included in plan design.
None of those changes need race data to put in place. Measuring whether they narrow the gap would.
