US maternal mortality rates have doubled in 20 years.

US maternal mortality rates have doubled in 20 years.

The Rising Crisis of Maternal Mortality in the United States

Pregnant woman

The number of pregnant and postpartum women who are dying in the United States has more than doubled over the past two decades. This alarming rise is particularly affecting specific racial groups, according to new research. The findings reveal sharp increases in maternal death rates between 1999 and 2019, with Black, American Indian, and Alaskan Native women being disproportionately affected. Moreover, women residing in the South, the Mountain States, and the Midwest face a higher risk of maternal mortality.

The research, conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and Mass General Brigham, analyzed government data on deaths and live births. The study authors used computer modeling to estimate the number of maternal deaths over the specified time periods. The study’s senior medical director for health equity at Mass General Brigham, Dr. Allison Bryant, expresses concern and states, “Maternal mortality is a crisis in the United States. These rates have been increasing over the past several decades and were exacerbated by the pandemic. Our study sheds light on the wide disparities within maternal mortality rates – the specter of maternal death differentially burdens some ethnic and racial populations.”

Maternal deaths are categorized as those that occur during pregnancy or within one year after giving birth. The U.S. Centers for Disease Control and Prevention identifies several causes, including mental health conditions such as suicide, excessive bleeding, cardiac and coronary conditions, infection, blood clots, cardiomyopathy, and high blood pressure-related disorders. The disparities in maternal mortality rates reflect the overall health risks faced by populations in states where such deaths are more prevalent. Dr. Greg Roth, director of the Program in Cardiovascular Health Metrics at IHME, explains, “In the U.S., maternal deaths are often caused by vascular diseases like severe high blood pressure or blood clots. So, maternal deaths share many of the same drivers as heart attacks, strokes, and heart failure. Our state-by-state research emphasizes where we need to focus our prevention efforts and which groups are suffering the most.”

Although maternal deaths have doubled for all racial and ethnic groups over the past 20 years, they have significantly risen for American Indian and Alaskan Native women. However, Black women still have the highest rates among any group. Interestingly, the average state-level rates for Black women began to plateau before the pandemic, around 2015. Dr. Laurie Zephyrin, senior vice president of advancing health equity at the Commonwealth Fund, highlights the fragmented nature of the U.S. healthcare system when it comes to maternal and women’s health. She underscores that any system failure ultimately affects those who are most vulnerable and marginalized.

According to the study, maternal deaths among southern women occur at alarming rates across all racial and ethnic groups, but Black women are particularly impacted. The states in the Northeast also had elevated rates for Black women, which tripled over the 20-year period. Dr. Bryant urges us to consider the disparities between populations within even the “best” states, emphasizing that it is vital to get a complete picture of the situation. The study was funded by the U.S. National Heart, Lung, and Blood Institute, the U.S. National Institutes of Health, and Gates Ventures LLC. It was published in the Journal of the American Medical Association on July 3, 2023.

It is crucial to acknowledge that this research has limitations. The researchers did not always have access to information about the causes of maternal death, and the recording of such deaths on death certificates changed over the study period. Furthermore, maternal deaths increased even further in 2020 and 2021, exacerbated by the challenges of accessing healthcare and slowed prevention efforts during the pandemic. These circumstances likely widened the disparities observed in this study.

The senior medical director, Dr. Bryant, reminds us of the significance of their findings, stating, “Our findings provide important insights on maternal mortality rates leading up to the pandemic, and it’s likely that we’ll see a continued increase in the risk of maternal mortality across all populations if we analyze data from subsequent years. Black individuals would likely still have the highest rate, but there may be a higher uptick in some of the other groups in the last few years. As we emerge from the pandemic, we must renew our focus on addressing maternal mortality.”