There are many disparities contributing to health outcomes in addition to race, and that’s certainly true in pregnancy. Researchers have explored how biology, environment, health, and disease affect fetuses as they develop — and how they affect pregnant women both during and after pregnancy. We also know there are many social factors that contribute to the health of a mother and child, such as access to care and the quality of the health care experience. Patient engagement with a system of care can vary by many factors, and race is one of them. Only about 20% of all health care outcomes are actually the direct consequence of health care interventions. The other 80% are related to other things, like the safety of the neighborhoods we live in, the availability of healthy foods to eat, and the opportunity for leisure time and physical activity. It’s said that our ZIP code is a greater predictor of our health and wellbeing than our genetic code. But in recognizing that social determinants contribute to adverse health outcomes, it’s also important to understand we have the ability to improve. We don’t get to change our genetics. But as a society, we do get to influence our structures and policies. We can become more fair in assuring good access to care.