Between 2017 and 2019, 185 women died while pregnant, or within one year of pregnancy, in Missouri. The majority of these deaths were preventable, a recent study found.
Death during or soon after pregnancy is known as maternal mortality. In a three year period studied by the state, it was determined that Black women in Missouri are three times more likely to die during or in the year after pregnancy than white women. The study was done by the Pregnancy-Associated Mortality Review board, a state health panel.
The report published Monday shows that mental health and cardiovascular disease remain are among the leading causes of death for scores of Missouri mothers. The study focuses on deaths between 2017 and 2019. This is the first time the board has looked at data across multiple years.
Maternal mortality rates in the United States are some of the worst among developed countries. According to the Centers for Disease Control and Prevention, about 700 women in the U.S. die for reasons related to pregnancy each year.
In recent years, Missouri has been among the deadliest states to be pregnant or give birth.
Monday’s report determined that 75% of the deaths in the three-year period were preventable. The board in turn has a laundry list of solutions directed toward lawmakers and medical providers in the hopes of reducing Missouri’s fatal outcomes.
“Maternal mortality in the state of Missouri is exceptionally complex,” the report reads. “It touches the societal issues of rampant obesity, health inequity, and the ongoing opioid epidemic. Seeking to understand this problem brings to light a variety of other concerns rooted in the systems that are intended to help.”
Mental health, particularly overdoses and poisonings, was the leading cause of death in this time frame, followed by cardiovascular disease.
The study also found that half of the pregnancy-related deaths due to cardiovascular disease happened more than six weeks after birth, which is after the standard 6-week period of postpartum care, as well as after when the 60 days of Medicaid coverage ends.
Women on Medicaid were also eight times as likely to die from a pregnancy-associated death than women with private insurance, the study found.
The board, as it’s done in the past, again recommended that the Missouri Legislature extend Medicaid coverage to one-year postpartum for all health conditions.
Under the traditional Medicaid program and an additional state health initiative, pregnant women receive health coverage if they make up to 300% of the federal poverty level — a little over $38,600 a year — and lose it 60 days after giving birth.
Despite approval from lawmakers more than two years ago, Missouri has not implemented an extension of coverage for postpartum depression and other mental health conditions to low-income women in the year after they give birth.
When it comes to mental health, the board recommends that providers give full depression and anxiety assessments, screen for substance use disorders and make referrals for services as needed. They also are asking Missouri lawmakers to create a statewide Perinatal Psychiatry Access Program to help mothers struggling with their mental health. The study also found that often, people stopped taking prescribed antidepressants when they became pregnant.
In the U.S., one in eight women who recently gave birth experience postpartum depression symptoms, according to the CDC.
Homicides made up 14% of all pregnancy-related deaths that were studied. More than half of the eight victims were killed with a gun. Five were Black women.
Of the women who died due to injury, the majority were killed as the result of violence, including physical or emotional abuse. The board recommended that health care workers complete trauma-informed care and implicit bias training, and find more innovative ways for women to safely report domestic violence.
The report also noted that too few women are receiving timely prenatal care.
Between 2017 and 2019, only 65% of new mothers said they visited a doctor in the year before becoming pregnant; 28% said they didn’t begin seeing a doctor for prenatal care until after the first trimester. For Black mothers, that number was 57%.
Many of the women who died as the result of pregnancy in this time were experiencing a stressor, the study found. The most common stressors were a history of substance abuse, many without a history of treatment, and a quarter of the women who died had a history of domestic violence or unemployment.
This year’s report was the third since 2019, when the General Assembly tasked the health department and a panel of state-appointed medical specialists to produce an annual assessment of maternal mortality. Gov. Mike Parson in 2018 called for a bipartisan solution as maternal mortality gained nationwide attention.
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