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In the United States, more than 50,000 women per year experience severe maternal morbidity (SMM; life-threatening pregnancy complications)(American College of Obstetricians and Gynecologists, 2016). The incidence of SMM was 166% higher for non-Hispanic Black women compared with White women (Admon et al., 2018). (The non-Hispanic Black terminology is used to be consistent with Center for Disease Control and vital statistics reporting.). Non-Hispanic Black (referred to hereafter as Black) women also have higher rates of emergency department visits and hospital readmissions in the first 6 weeks after birth, also indicators of maternal morbidity, than Whites (Johnson et al., 2019; Matas et al., 2021; Wang et al., 2020). A recent systematic review reported that Black women had an adjusted risk ratio (RR) for SMM of 1.2–5 compared with Whites (Wang et al., 2020). Black women have a higher risk for SMM even within the same hospital regardless of the type of insurance and other maternal factors compared with White women (Howell et al., 2020; Mujahid et al., 2021). Although maternal characteristics (e.g., older maternal age, pre-pregnancy obesity, preexisting chronic medical conditions, and cesarean delivery) relate to SMM, emergency department visits, and hospital readmissions after birth, these factors do not explain the racial disparities in maternal morbidity among Black women. The experience of Black women demands that we look upstream from maternal characteristics and clinical parameters to investigate structural racism and discrimination as causes of racial disparities. Research on the association between racism and maternal health outcomes has been focused primarily on interpersonal racism experienced by women. The toll of structural racism, defined as “the totality of ways in which societies foster discrimination, via mutually reinforcing systems of discrimination (e.g., housing, education, employment, earnings, healthcare) that in turn reinforce discriminatory beliefs, values, and distribution of resources” (Krieger, 2014) on maternal health has not received the same attention. A key marker of structural racism is residential segregation of Blacks with its correlates of concentration of poverty, poor housing conditions, increased population density, lack of access to services and goods, inequality in the workplace, and lack of access to quality health facilities and providers (Bailey et al., 2017; Krieger, 2014; Taylor et al., 2019). Historical residential segregation and redlining, the legal practice which involved marking maps with red lines to delineate neighborhoods where mortgages were denied to people of color to steer them away from White neighborhoods, discouraged investment in these communities (Bailey et al., 2017). Discrimination in the rental and housing markets against Blacks remains pervasive (Bailey et al., 2017). As a result, in 2019, 19% of Blacks lived in high-poverty neighborhoods compared with 7% of Whites (US Census Bureau, n.d.). Thus, residential segregation, the foundation of structural racism (Bailey et al., 2017), remains a powerful predictor of Black disadvantage (Williams et al., 2019). Racism, not the race itself, is the driving force behind disparately high rates of maternal morbidity among Blacks. Long-standing systemic health and social inequities have now placed Blacks at increased risk of getting sick and dying from SARS-CoV-2 infection (Centers for Disease Control and Prevention, 2020). The COVID-19 pandemic gives a face to decades of structural racism and discrimination including limited educational and employment opportunities, high levels of poverty and environmental neglect, insufficient access to basic health care services, and police brutality. Black women are overrepresented in the low-wage essential workforce (e.g., food retail) (Bibbins-Domingo, 2020), and more likely to live in disadvantaged neighborhoods (e.g., crowded housing) (Laraia et al., 2006; Reagan & Salsberry, 2005; Ulmer et al., 2012), thus leading them to face more challenges in social distancing than Whites. Considering all of these factors together, Black women may be especially vulnerable during this pandemic. While maternal morbidity and mortality can be linked to direct causes (e.g., infections and hemorrhage) (Taylor et al., 2019), we must investigate factors further upstream if we are to reduce maternal morbidity among Blacks. We need to examine the association of structural racism and discrimination with maternal morbidity among Black women. Understanding the factors contributing to maternal morbidity for Black women will build an evidence base for interventions to improve the health of Black women. 1043942WJNXXX10.1177/01939459211043942Western Journal of Nursing Research editorial2021