Maternal deaths across the United States have more than doubled over the course of two decades, and the tragedy unfolds unequally.
Black mothers die at the highest rates in the nation, while the greatest increase in mortality has been among American Indians and Alaska Natives. And some states – and the racial or ethnic groups within them – are worse off than others.
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The findings come in a new study published Monday in the Journal of the American Medical Association. The researchers looked at maternal deaths between 1999 and 2019 — but not the pandemic spike — for every state and five racial and ethnic groups.
“It is a call to action for all of us to understand the root causes – to understand that some problems are related to health care and access to health care, but most is about structured racism and policies and procedures and the things that we have in Dr. Allison Bryant, one of the study’s authors and senior medical director for equity health at Mass General Brigham said.
Among wealthy nations, the United States has the highest maternal mortality rate, defined as death during pregnancy or one year later. 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 vital national statistical data on deaths and live births. They then used a modeling process to estimate the maternal mortality rate per 100,000 live births.
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Overall, they noticed a widening disparity. Research shows that high maternal mortality rates are not limited to the South but also spread to areas like the Midwest and states like Wyoming and Montana, where rates are high for many racial and ethnic groups in 2019.
The researchers also found significant jumps when they compared maternal mortality rates in the first decade of the study with the second decade and identified the five states with the largest increases in those decades. . The excess increases:
- 162% for Native American and Alaska Native mothers in Florida, Illinois, Kansas, Rhode Island and Wisconsin;
- 135% for white mothers in Georgia, Indiana, Louisiana, Missouri and Tennessee;
- 105% for Hispanic mothers in Georgia, Illinois, Indiana, Minnesota and Tennessee;
- 93% for Black mothers in Arkansas, Georgia, Louisiana, New Jersey and Texas;
- 83% for mothers of Asian and Pacific Islander descent in Georgia, Illinois, Kansas, Michigan and Missouri.
“I hate to say it, but I’m not surprised by the findings. Karen Joynt Maddox, a health services and policy researcher at Washington University School of Medicine in St. did not participate in the study. “It’s certainly alarming, and we need more evidence to figure out what’s going on and try to find a way to address this.”
Maddox has shown how, compared to other wealthy nations, the United States is underinvested in things like social services, primary care, and mental health. She also said Missouri did not fully fund public health and, during the years of the study, did not expand Medicaid. Since then, they’ve expanded Medicaid — and lawmakers have passed a bill that provides health insurance for new mothers all year long. Last week, Missouri Governor Mike Parson signed budget bills that include $4.4 million for a plan to prevent maternal deaths.
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In neighboring Arkansas, Black women are twice as likely to die from pregnancy as white women, according to a 2021 state report.
Dr. William Greenfield, medical director of family health at the Arkansas Department of Health, said the disparity is significant and has “persistent over time,” and it’s difficult to pinpoint exactly why. The state’s maternal mortality rate is on the rise again. Black mothers.
Rates among Black women have long been the worst in the country, and the problem affects people of all socioeconomic backgrounds. For example, US Olympic champion sprinter Tori Bowie, 32, died of complications during childbirth in May.
The pandemic may have exacerbated all the demographic and geographic trends, Bryant said, and “that’s absolutely an area for future research.” According to preliminary federal data, maternal mortality fell in 2022 after rising to a six-decade high in 2021 — a spike that experts attribute mainly to COVID-19. Officials say the final rate in 2022 is on track to approach pre-pandemic levels, still the highest in decades.
Bryant said it’s important to understand more about these disparities to help focus on community-based solutions and understand what resources are needed to address the problem.
Greenfield, who is also a professor of obstetrics and gynecology at the University of Arkansas Medical Center in Little Rock and was not involved in the study, said Arkansas is already using telemedics and is working on a number of other ways to increase likelihood access to care.
The state also has a network of “perinatal quality improvement partnerships,” a network that helps health care providers understand best practices for things like reducing cesarean deliveries. , manage complications from hypertensive disorders and limit trauma or serious birth-related complications.
“Most of the deaths we looked at and elsewhere looked at… were preventable,” Greenfield said.
