Maternal Mortality Rates Rise in the US

Improved health outcomes have marked many domains in recent decades, but sadly the opposite has been true for maternal mortality ratios in the United States. A study published in JAMA last year found that between 1999 and 2019, maternal mortality rates doubled, particularly among communities of color. In every year studied, Black mothers had the highest overall rates of maternal mortality while Native American populations saw the greatest 20-year increase. The study found that Black mothers experienced maternal mortality rates at two-to-four times that of white mothers, and that every state experienced an increase in maternal mortality ratios during the 20-year period, although the risk was greatest in Southern states or Midwest/Northern states with high populations of Native Americans.

Previous reports of annual maternal mortality rates by the CDC had shown that maternal mortality was increasing, but this study was the first to provide long-term data and details. The study defined maternal mortality as a death that occurred within one year of giving birth, reflecting a trend among researchers to extend the timeline of what qualifies as maternal mortality. The World Health Organization  and Center for Disease Control and Prevention have historically qualified maternal mortality as deaths occurring within 42 days of birth. However, researchers believe that by cutting off  the time frame at sex weeks postpartum, we are missing important data. Between 2017-2019, the CDC found that 53% of maternal deaths occurred within seven-365 days postpartum. The study found that the leading cause of maternal mortality was mental health conditions, followed by hemorrhage, cardiac conditions, and then infection. 

Many Deaths Preventable

By examining the differences in maternal mortality ratios immediately following birth versus for an entire year postpartum, a clearer picture emerges of why the rates are increasing in the U.S. The maternal mortality rate for hospitalized births has gone down between 2008-2021, pointing to increased safety in birthing protocols. But it appears that many women continue to suffer from long-term complications, as well as lack of a social safety net that can impact new mothers in dangerous ways. The CDC believes that up to 80% of maternal mortality cases could be prevented, and compared to other high-income countries, the U.S. spends more on health care while seeing poorer outcomes.

Dr. Elizabeth Cherot, chief medical and health officer at the maternal health nonprofit March of Dimes, spoke with NPR about the difference in postpartum care provided by other wealthy countries: “They wrap services around new mothers. They give them [support for] everything from mental health, cardiovascular, diabetic, pelvic health. These things are just considered standard.” Many Americans do not have access to the same comprehensive care.

The higher maternal mortality rate for Black and Native communities can also be linked to wider disparities in healthcare justice for those communities. Dr.Monique Rainford, the author of “Pregnant While Black: Advancing Justice for Maternal Health in America,” highlights that Black women have a biological age (a measurement of the pace of the body’s aging) 10 years older than white women due to chronic stressors like racism, and also often experience implicit bias from medical providers. Tennis star Serena Williams had a history of blod clots, but she had to beg her medical team to test her for postpartum clots when she started experiencing symptoms she recognized from previous medical incidents. She survived, but many Black mothers do not.

To combat the crisis, policymakers are trying out a few solutions. Thirty-five states have expanded Medicaid postpartum coverage to cover new mothers for up to a year instead of the previous 60-day limit. This change has been found to lower maternal mortality, particularly for Black mothers. Additionally, some states have launched a doula reimbursement program for Medicaid participants. Access to doula services can halve the rate of birth complications and potentially reduce racial and socioeconomic disparities in maternal mortality rates. Thus, despite the dismal statistics, hope remains that perhaps we can reverse rising mortality rates in the coming years.