Maternal mortality in the US continues to rise

According to recent maternal mortality data, more and more women in the United States are dying during pregnancy or shortly after childbirth.

In 2021, there were 32.9 deaths per 100,000 live births, compared with 23.8 per 100,000 in 2020 and 20.1 in 2019, the National Center for Health Statistics reports March 16. The US rate far exceeds that of other high-income countries. The total number of maternal deaths in the US rose from 861 in 2020 to 1,205 in 2021.

There remains a large disparity in the maternal mortality rate for black women, at 69.9 deaths per 100,000 live births, compared to white women, at 26.6 per 100,000. Many social determinants of health underlie this gap, including disparities in the quality of care Black women receive before, during, and after pregnancy.

The NCHS report does not discuss the reasons for the increase for 2021. However, COVID-19 contributed to a quarter of maternal deaths in 2020 and 2021, the US Government Accountability Office reported in October. The pandemic also contributed to the inequality in mortality between black and white women, GAO found, exacerbating existing structural inequalities that lead to problems such as barriers to accessing health care (SN: 04/10/20).

The maternal deaths recorded in the NCHS report are those occurring during pregnancy or within 42 days of the termination of pregnancy “from causes related to or aggravated by the pregnancy or its treatment.” These causes include bleeding, infection, and high blood pressure disorders such as eclampsia.

The report excludes deaths after 42 days and up to the first year after birth. But 30 percent of pregnancy-related deaths occur during this period, the US Centers for Disease Control and Prevention reported in September from an analysis of 2017 through 2019.

“We really need to be able to care for our new mothers beyond that six-week period,” says Cynthia Gyamfi-Bannerman, maternal fetal medicine specialist and chair of the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Diego School of Medicine.

One attempt to expand coverage in the year after birth is Medicaid insurance, which paid for 42 percent of US births in 2020. States have the option to extend coverage from up to 60 days after birth to a full year through a provision of the American Bailout Plan Act of 2021.

The maternal mortality rate also excludes maternal deaths due to homicide. In 2018 and 2019, homicide was the leading cause of death during pregnancy or within 42 days of termination of pregnancy, and was responsible for more than twice as many deaths as bleeding, researchers reported in Obstetrics & Gynaecology in 2021. Studies have found that in most of these murder cases, an intimate partner is the killer, who most often uses a gun. Pregnant women are at a higher risk of dying than non-pregnant women of childbearing age.

Suicide is also a leading cause of death during pregnancy and one year after childbirth, but is not included in the maternal mortality rate.

There have been improvements in treating pregnancy complications like bleeding and blood pressure disorders, says Gyamfi-Bannerman. Implementing care bundles, similar to medical checklists, for these and other complications can reduce maternal mortality.

But since gun violence and poor maternal mental health “also lead to maternal mortality,” Gyamfi-Bannerman says, tackling these issues is also crucial.