Maternal deaths in the United States have more than doubled over two decades, and tragedy has unfolded unevenly.
Black mothers died at the highest rates in the nation, while the largest increases in deaths were seen among Native American and Alaska Native mothers. Some states – and the racial or ethnic groups within them – have fared less well than others.
The results were presented 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 peak of the pandemic – for each state and five racial and ethnic groups.
“It’s a call to action for all of us to understand the root causes – to understand that part of it is about health care and access to health care, but a lot of it is about structural racism and politics. and procedures and the things we have in place that can prevent people from being healthy,” said Dr. Allison Bryant, one of the study authors and senior medical director for health equity at the Mass General Brigham.
Among rich countries, the United States has the highest maternal mortality rate, defined as death during pregnancy or up to a year later. Common causes include excessive bleeding, infections, heart disease, suicide, and drug overdoses.
Bryant and his 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 per 100,000 live births.
Overall, they found endemic and growing disparities. The study showed that high maternal mortality rates are not limited to the South, but also extend to regions like the Midwest and states such as Wyoming and Montana, which had high rates for several racial groups. and ethnic in 2019.
The researchers also found dramatic jumps when they compared maternal mortality in the first decade of the study to the second, and identified the five states with the largest increases between those decades. These increases exceeded:
— 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 Asian and Pacific Islander mothers in Georgia, Illinois, Kansas, Michigan and Missouri.
“I hate to say it, but I wasn’t surprised by the results. Certainly we’ve seen enough anecdotal evidence in a single state or group of states to suggest that maternal mortality is increasing,” Dr Karen said. Joynt Maddox, a health services and policy researcher at Washington University School of Medicine in St. Louis who was not involved in the study. “It’s certainly alarming, and just more evidence than we have to figure out what’s going on and try to find ways to do something about it.”
Maddox pointed out how, compared to other rich countries, the United States underinvests in areas such as social services, primary care and mental health. She also said Missouri failed to fund public health adequately and, over the years of the study, did not expand Medicaid. They have since expanded Medicaid — and lawmakers passed a bill giving new mothers a full year of Medicaid medical coverage. Last week, Missouri Governor Mike Parson signed budget bills that included $4.4 million for a maternal death prevention plan.
In neighboring Arkansas, black women are twice as likely to have pregnancy-related deaths 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 “persisted over time”, and it’s difficult to determine exactly why there is. had an increase in the state’s maternal death rate for black mothers.
Rates among black women have long been the worst in the country, and the problem affects people from all socioeconomic backgrounds. For example, US Olympic champion sprinter Tori Bowie, 32, died after giving birth in May.
The pandemic has likely exacerbated all 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 hitting a six-decade high in 2021 — a spike experts attribute primarily to COVID-19. Officials said the final 2022 rate is on track to approach the pre-pandemic level, which was still the highest in decades.
Bryant said better understanding these disparities is crucial to help focus on community solutions and understand what resources are needed to address the issue.
Arkansas already uses telemedicine and is working on several other ways to increase access to care, said Greenfield, who is also a professor of obstetrics and gynecology at the University of Arkansas Medical Center in Little Rock. and did not participate in the study.
The state also has a “Perinatal Quality Collaborative,” a network to help healthcare providers understand best practices for things like reducing cesarean sections, managing complications of hypertensive disorders, and reducing serious injuries or complications related to childbirth.
“Most of the deaths we’ve looked at and other places have looked at…were preventable,” Greenfield said.