Maternal deaths across the US have more than doubled over the course of two decades, with the most deaths occurring among Black women, researchers said on Monday.
The findings were laid out in a new study published on Monday in the Journal of the American Medical Association (Jama). Researchers looked at maternal deaths between 1999 and 2019 – but not the pandemic spike – for every state and five racial and ethnic groups.
Researchers found an estimated 1,210 maternal deaths in 2019, compared with 505 in 1999, according to a study published in Jama.
The toll was not distributed equally, with some racial and ethnic groups faring worse than others. While Black mothers died at the nation’s highest rates, the greatest increases over time were seen among Native American and Alaska Native women, the researchers said.
“It’s a call to action to all of us to understand the root causes – to understand that some of it is about healthcare and access to healthcare, but a lot of it is about structural racism and the policies and procedures and things that we have in place that may keep people from being healthy,” said Dr Allison Bryant, one of the study’s authors and a senior medical director for health equity at Mass General Brigham.
Among wealthy nations, the US has the highest rate of maternal mortality, which is defined as a death during pregnancy or up to a year afterward. Common causes include excessive bleeding, infection, heart disease, suicide and drug overdose.
Bryant and her colleagues at Mass General Brigham and the Institute for Health Metrics and Evaluation at the University of Washington started with national vital statistics data on deaths and live births. They then used a modeling process to estimate maternal mortality out of every 100,000 live births.
Overall, they found rampant, widening disparities. Southern states had high maternal mortality rates across all race and ethnicity groups, but especially for Black individuals, while midwest and great plains states had the highest rates for Native American and Alaska Native women.
The study showed high rates of maternal mortality aren’t confined to the south but also extend to regions like the midwest and states such as Wyoming and Montana, which had high rates for multiple racial and ethnic groups in 2019.
“I hate to say it, but I was not surprised by the findings. We’ve certainly seen enough anecdotal evidence in a single state or a group of states to suggest that maternal mortality is rising,” said Dr Karen Joynt Maddox, a health services and policy researcher at Washington University School of Medicine in St Louis who wasn’t involved in the study. “It’s certainly alarming, and just more evidence we have got to figure out what’s going on and try to find ways to do something about this.”
Maddox pointed to how, compared with other wealthy nations, the US underinvests in things like social services, primary care and mental health.
Rates among Black women have long been the worst in the nation, and the problem affects people of all socioeconomic backgrounds. For example, US Olympic champion sprinter Tori Bowie, 32, died from complications of childbirth in May.
The pandemic likely exacerbated all of the demographic and geographic trends, Bryant said, and “that’s absolutely an area for future study.” According to preliminary federal data, maternal mortality fell in 2022 after rising to a six-decade high in 2021 – a spike experts attributed mainly to Covid-19. Officials said the final 2022 rate is on track to get close to the pre-pandemic level, which was still the highest in decades.
Bryant said it’s crucial to understand more about these disparities to help focus on community-based solutions and understand what resources are needed to tackle the problem.
“Most of the deaths we reviewed and other places have reviewed … were preventable,” Greenfield said.
