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The number of people who have died in the United States from pregnancy-related causes has more than doubled in the past 20 years, according to a new study published in JAMATHE Journal of the American Medical Association.
And although the study found that death rates remain “unacceptably high among all racial and ethnic groups across the United States”, the worst results were among black women, Native Americans and Alaska Natives.
The study examines state-by-state data from 2009 to 2019. Co-author Dr. Allison Bryant, an obstetrician at Massachusetts General Hospital in Boston, says maternal mortality rates in the United States are only getting worse.
“And that’s exacerbated in populations that have been historically underserved or where structural racism affects them greatly,” she says.
Maternal mortality rates have always been highest among black women, and these high rates have more than doubled in the past twenty years. For Native Americans and Alaska Natives, the rates tripled.
Dr. Gregory Roth of the University of Washington is also a co-author of the paper. He says efforts to stop pregnancy-related deaths haven’t just stalled in areas like the South, where rates are generally high. “We show that they get worse in places that are considered to have better health,” he says.
Places like New York and New Jersey have seen an increase in deaths among black and Latina mothers. Wyoming and Montana have seen more Asian mothers die. And while maternal mortality is lower among white women, it is also rising in some parts of the country.
“We’re seeing that for white women, maternal mortality is also increasing across the South, parts of New England, and parts of the Midwest and northern mountain states,” he says.
The steady rise in maternal mortality in the United States contrasts with other high-income countries that have seen their much lower rates drop even further.
“There’s this crystal clear graphic that’s been there that’s very striking,” Bryant says. With countries like the Netherlands, Austria and Japan with a sharp decline. “And then there’s the United States which is way above them all and going in the opposite direction,” she says.
Most maternal deaths are deemed preventable by state review boards. Dr. Catherine Spong, of the University of Texas Southwestern Medical Center, says pregnancy-related deaths can be caused by different things. The main risk factors are conditions such as cardiovascular disease, severe pre-eclampsia, maternal heart disease and hemorrhage, she says.
Persistent heart problems and mental health issues can also contribute to the death of a new mother.
The researchers say that doctors would be more likely to deal with these health problems if more women had access to health care after the birth of their babies.
About half of births in the United States are paid for by Medicaid, and “the majority of deaths occur in the immediate postpartum period,” Roth said. “If you don’t have easy access to health care during this time, you are at very high risk.”
For those who get their health care through Medicaid, medical coverage lasts at least two months after the birth of a child. As of 2021, states have the option to extend this coverage by one year. So far, 36 states and Washington DC have done so. States like Alabama and Mississippi, which have seen some of the largest increases in maternal deaths, have not.