The risk of maternal mortality in the United States is much higher than nations with similar wealth, access to care, and infrastructure. However, increasing risk of maternal mortality is not distributed equally; Black mothers are three to four times more likely to die of pregnancy related conditions or causes than their White counterparts. Leading to the question, why are Black women predisposed to greater risk? It is not biology. So, what is it about being Black in the United States that has come to shape disparities in pregnancy related death (and nearly all other major disease outcomes)? This thesis will explore the preconditions of Black maternal mortality, developing two tools to capture fundamental causes: the Geography Index Score and the Maternal Perspectives Form. The hope is that these tools might be used to assess the causes of a maternal death and therefore will expose the fundamental causes of Black maternal mortality. Ultimately, by providing a multi-layered framework for determining a cause of death, the Geography Index Score and Maternal Perspectives Form will reflect geography and social determinants of health as informed by anti-Black social and political structures, while also exposing the interpersonal and obstetric racism experienced by Black mothers in medical settings and over the course of their lives. By including these tools in the review of maternal deaths, recommendations and legislation for prevention of Black maternal mortality will be reflective of its true fundamental causes.