Adding Black maternal-health statistics to data on gestational carriers and calling the sum mine doesn’t make it so. The numbers don’t work that way.
I’ve carried three pregnancies for other families. I’m also a Black woman.
Put those facts beside two well-documented findings and people start doing arithmetic. Black women in the United States experience severe maternal morbidity at substantially higher rates than white women. Some studies have also found higher rates of certain complications in gestational-carrier pregnancies.
Once those findings sit side by side, an even higher rate of complications for Black carriers starts to sound inevitable. I nearly wrote this article that way. It would have sounded cautious, even protective of women like me, while making the numbers say far more than they actually do.
When I went looking for a number that described Black gestational carriers themselves, I couldn’t find one I could confidently use. The research on Black maternal health makes the question urgent, as does the research on carrier pregnancies. The trouble starts when findings about two different populations are added together and presented as though researchers measured the overlap.
The first mistake is treating different populations as interchangeable
Gestational carriers aren’t a random sample of pregnant people. According to clinical guidance from the American Society for Reproductive Medicine, a carrier should ideally have had at least one uncomplicated term pregnancy. The guidance also recommends limits on prior deliveries and cesarean births, along with medical and psychosocial evaluation before treatment.[13]
A carrier enters pregnancy after a selection process that changes who is in the group being measured. Screening can’t account for every source of risk, especially discrimination or unequal treatment, but it does make carriers different from the much broader population represented in national delivery statistics.
It also matters how race is interpreted. The National Academies warns against treating federal racial categories as biological or genetic classifications and urges researchers to investigate the social and structural forces those categories can obscure.[14] In other words, carrier screening may change the clinical profile of the population. It doesn’t screen racism out of prenatal care, labor, or delivery.
In 2021, the rate of severe maternal morbidity among delivery hospitalizations for non-Hispanic Black women was 91 percent higher than the rate for non-Hispanic white women, according to an analysis from the federal Healthcare Cost and Utilization Project.[12] That’s a damning national disparity. The figure comes from a broad population of delivery stays and doesn’t isolate women who passed carrier screening and then carried pregnancies conceived through assisted reproductive technology.
That 91 percent figure tells us something urgent about Black maternal health overall. Once it’s presented as a figure for Black gestational carriers, though, it’s being asked to describe a narrower group it was never calculated to describe.
When I turned to research on carrier pregnancies, the answer shifted depending on where the study took place, which outcomes it counted, and what comparison group the researchers chose.
A large Ontario study found severe maternal morbidity in 7.8 percent of gestational-carrier pregnancies, compared with 2.3 percent of pregnancies conceived without assistance.[8] The study didn’t provide the race-stratified result I was looking for. A later correction addressed a figure label and two preterm-birth percentages; the authors said those errors didn’t change the study’s overall results or conclusions.[9]
Then I turned to the U.S. research, and the picture became murkier. A national hospital analysis of deliveries from 2017 through 2020 found higher rates of postpartum hemorrhage and certain placental complications among gestational carriers. Yet its overall rate of severe maternal morbidity was statistically similar for carrier and non-carrier deliveries.[2]
A 2026 study of 15,822 IVF pregnancies in a Southern California health system, including 997 surrogate pregnancies, found no increased adjusted risk of preterm birth, placenta previa, or placental abruption among the surrogate pregnancies studied. It found lower adjusted risks of several other selected outcomes, including gestational diabetes and preeclampsia or eclampsia.[10]
A systematic review and meta-analysis of six comparator studies landed between those findings. Compared with pregnancies in the general population, gestational-carrier pregnancies had higher odds of hypertensive disorders. Compared with other pregnancies conceived through assisted reproductive technology, carrier pregnancies had comparable rates of hypertensive disorders, preterm birth, and low birth weight, and lower odds of cesarean delivery.[11]
At first glance, those findings look contradictory. Once I followed the comparison groups, the differences made more sense. A carrier pregnancy can look riskier against one baseline and similar, or less risky, against another. Without knowing higher than whom, for which outcome, and in what setting, the phrase “higher risk” tells us very little.
The numbers know pieces of me
The federal fertility-surveillance system records information about gestational carriers, including age, ethnicity, and race.[1] Hospital records can separately identify a delivery involving a gestational carrier through the ICD-10-CM code Z33.3, while also recording complications such as hemorrhage, transfusion, or intensive-care admission.[2]
My information is there, although pieces of it sit in systems built to answer different questions.
Congress created federal fertility-clinic reporting in 1992 around pregnancy success rates: Did assisted reproductive treatment result in pregnancy and live birth?[3] When the Centers for Disease Control and Prevention later expanded race and ethnicity reporting, it said those fields would help evaluate disparities in the use of assisted reproductive technology.[4]
The design follows the question Congress asked. A registry created primarily to measure treatment use and success collects a different story than one built around maternal outcomes. The CDC has itself described the fertility-surveillance system as containing limited information about women’s and children’s health outcomes.[5]
Hospital data capture the delivery and its complications, but they don’t contain the same detailed fertility-treatment information. The national hospital study shows that race, carrier status, and delivery outcomes can appear in the same dataset. What it doesn’t provide is a robust, publicly reported answer about outcomes for Black carriers specifically.
Recording my race is only the first step. The useful part comes when researchers connect that information to what happened during pregnancy and delivery, then publish enough detail for the rest of us to understand what they found.
I thought no one had asked. Then I found the paper.
For a while, I thought the story was that no one had bothered to ask the question at all. Then I found a paper that had.
In 2025, Fertility and Sterility published a short report titled “Racial and ethnic differences in gestational carriers: assessment of obstetric characteristics and outcomes.”[6] An earlier conference version stated that the researchers would examine pregnancy characteristics and obstetric morbidity at delivery.[7]
I remember finding it because the story suddenly became more complicated. Someone had looked. Now I needed to know what they found and why the answer was still so hard for the public to see.
But the report has no abstract in the public database, and I couldn’t access the full text while working on this piece. I could see the title and citation. I couldn’t see how many Black carriers were included, which outcomes the authors found, how large the differences were, or how certain those findings were.
With only a title and citation, all I could confirm was that someone had asked the question.
Roughly 31 severe outcomes, before dividing by race
The most detailed public U.S. hospital analysis identified an estimated 1,965 gestational-carrier deliveries over four years. Seventy percent of those carriers were white. The reported severe maternal morbidity rate was 1.6 percent.[2]
Apply 1.6 percent to 1,965 and you get roughly 31 deliveries involving severe maternal morbidity. I calculated that from the study’s weighted national estimates; the authors didn’t report it as a raw event count. I include it only to show how quickly the numbers become thin.
That leaves roughly 31 estimated events before any breakdown by race, let alone by individual complication. A table may still be possible, but whether it can support a stable conclusion depends on the actual event counts and how much uncertainty surrounds them.
The 2025 race-focused paper may have handled these limits in ways I can’t see. Its authors may have grouped outcomes differently or used another approach that allowed a stronger comparison. Until I can read it, I can’t tell. Sample sizes, event counts, racial groupings, and confidence intervals are the details that show whether a number can bear the weight people want to put on it.
I had assumed one more basic figure was missing too: the share of U.S. gestational carriers who are Black. It isn’t. The same national hospital study reports it. Of those estimated 1,965 carrier deliveries, about 150, or 7.6 percent, involved Black carriers.[2]
Having the number lets me run the same kind of illustration one more time, and it lands in the same place. Apply the overall 1.6 percent rate to 150 carriers and you get roughly two deliveries involving severe maternal morbidity. I calculated that myself; the authors didn’t report it as a count, and the 1.6 percent describes all carriers, not Black carriers specifically. I include it for the same reason as the last one: to show how quickly the numbers thin out. Two estimated events, spread across four years and every possible complication, can’t tell anyone whether Black carriers fare worse, better, or the same.
Knowing how many of us are represented is where a serious calculation has to start. What this study shows is that the count is real but far too small, once divided by race, to carry a conclusion about our risk.
What I’m willing to say
The research I could actually read doesn’t establish whether Black gestational carriers fare worse or better. I’m not willing to push the evidence in either direction just to produce a cleaner conclusion.
What I keep coming back to is the shortcut: borrowing a racial disparity from the general maternal-health population, borrowing a carrier-risk estimate from a different study population, and treating their sum as if researchers had measured Black carriers directly.
The publicly accessible results I found never reached that specific conclusion.
Researchers could start by making the 2025 findings available in a form the public can actually understand. Tell us how many carriers from each racial group were included, what happened to them, how large the differences were, and how much uncertainty sits around those numbers. Publish a fuller racial and ethnic picture of who becomes a carrier in the United States. Then study whether fertility records and maternal-health records can be connected reliably when the person undergoing treatment and the person carrying the pregnancy aren’t the same patient. The CDC’s SMART Collaborative has already linked fertility-surveillance data to other health records at high rates in other assisted-reproduction research.[5][15] We still need to know how well that approach works for carrier pregnancies.
The data also need an honesty label. Missing race and ethnicity information has been a documented limitation in federal fertility surveillance, and completeness for gestational carriers specifically has not been clearly reported in the sources I reviewed.[16][17]
These are basic, achievable steps in public-health accounting. Until they’re taken, the only honest answer is three words: We do not know.
I know what it feels like to be reduced to an equation. My Blackness becomes one risk factor, and my history as a gestational carrier becomes another. People add two true findings and hand me the total as if it belongs to my body. Until researchers measure that risk directly, nobody gets to call that number mine.
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