To the Editor:

Re “Mothers Are Dying. Does Anyone Care?,” by Kim Brooks (Sunday Review, Nov. 18):

Ms. Brooks’s stories of blame and shame remind us once again that health care in America is never just about receiving clinically correct medical treatment. Review committees that look hard at what went wrong — and right — in each case of maternal death or “near miss” will surely help reduce mortality and improve outcomes. In fact, the Centers for Disease Control reported last year that 60 percent of maternal deaths reviewed in nine states were preventable.

But our research interviewing both labor and delivery staff and recent parents of color in New York City reveals a far deeper human rights challenge. From stories women tell of fear and confusion, even coercion, of expectations crushed, and of humiliation experienced, there emerges a picture of a maternity care system in crisis.

Its literally sickening effects are expressed not only in our shameful national maternal mortality rate ( 46th in the world) but also in the shocking fact that black women die at a rate about four times higher than white women.

Ms. Brooks rightly condemns the apparent impulse to blame women for these stark facts. But it is also a huge mistake to blame this on the providers of obstetric care alone. They too express immense frustration with the perverse incentives and insurance-driven constraints of the system, and champions among them openly question current practice. Hospitals need to look inward to address the implicit biases that contribute to unequal and disrespectful care. Even more urgent, they need to look outward, to recognize how social injustice is reflected in the way maternity care in America is organized and delivered.