Brooklyn has more Black pregnancies and births than any other NYC borough, which is precisely why the city’s Birth Equity Initiative began in Brooklyn before expanding citywide. The disparity concentrates in specific, named neighborhoods rather than spreading evenly across the borough — Brownsville and East Flatbush appear repeatedly in the city’s own data as areas with the highest rates of pregnancy-related complications, the same central Brooklyn corridor that shows up across nearly every health equity measure the city tracks. Woodhull Hospital, which serves much of this corridor, has become something of a public symbol of the effort to change outcomes here specifically.

Part of what’s driving the concentration is where care actually happens. Research presented at a maternal health symposium found that differences in hospital quality may account for nearly half of the overall disparity in maternal outcomes between Black and white women — meaning Black mothers in New York disproportionately deliver at a smaller subset of hospitals with worse outcomes across all patients, not only worse outcomes for Black patients specifically. That’s a structural, addressable pattern, not an inherent one.

New York’s broader clinical environment compounds it. The state’s cesarean section rate remains above the national average, and researchers have linked cesarean delivery to elevated risk of complications and death — the state’s own pregnancy-related mortality ratio for cesarean delivery runs roughly three times that of vaginal delivery. Severe maternal morbidity cases — life-threatening complications that don’t result in death — rose 22% in New York between 2008 and 2021, a citywide trend that lands hardest in the neighborhoods already carrying the greatest burden.