Maternal deaths in the US continue to climb

A growing number of US women are dying during pregnancy or soon after giving birth, according to the most recent data on maternal mortality.

In 2021, there will be 32.9 deaths per 100,000 live births, compared with 23.8 per 100,000 in 2020 and 20.1 in 2019, the National Center for Health Statistics reports on March 16. The US rate far exceeds that of other high-income countries. The number of US maternal deaths rose from 861 in 2020 to 1,205 in 2021.

There remains a large disparity in maternal mortality for black women, at 69.9 deaths per 100,000 live births, compared to white women, at 26.6 per 100,000. Many social determinants of health underlie this disparity, including differences in the quality of care that Black women receive before, during, and after pregnancy.

The NCHS report does not post increase rates for 2021. But COVID-19 contributed to a quarter of maternal deaths in 2020 and 2021, the US Accountability Office reported in October. The pandemic has also contributed to the mortality disparity between black and white women, the GAO found, exacerbating existing structural inequities that lead to such issues as barriers to accessing health care (SN: 4/10/20).

Maternal deaths reported by the NCHS are those that occur during pregnancy or within 42 days of the end of pregnancy, from any cause related to or aggravated by pregnancy or its management. These causes include bleeding, infection and high blood pressure disorders such as eclampsia.

The report excludes deaths after 42 days and up to the first year from birth. But 30 percent of pregnancy-related deaths occur during this time, the US Centers for Disease Control and Prevention reported in September, from an analysis of the years 2017 to 2019.

“We really need to be able to take care of our new moms beyond six weeks,” says maternal-fetal medicine expert Cynthia Gyamfi-Bannerman, chair of the Obstetrics, Gynecology & Reproductive Sciences Department at the University of California, San Diego.

One attempt to increase coverage a year after birth is through Medicaid insurance, which is paid for 42 percent of births in 2020. States have the ability to extend coverage from up to 60 days after birth to a full year through the provisions of the American Rescue Plan Act of 2011.

Maternal mortality also excludes maternal deaths due to homicide. In 2018 and 2019, homicide was the leading cause of death during pregnancy or within 42 days of the end of pregnancy, responsible for more than twice as many deaths as causes such as hemorrhage, researchers reported in Obstetrics & Gynecology 2021. Studies have found that in most of these homicide cases, a family member is the killer, most often using a gun. Pregnant women are at greater risk of homicide than pregnant women of childbearing age.

It is also the main cause of death during pregnancy and one year after childbirth, but is not included in maternal mortality.

There have been improvements in managing pregnancy complications like bleeding disorders and blood pressure, says Gyamfi-Bannerman. Implementing care packages that are related to the arms of the physician can reduce maternal mortality for these and other complications.

But because gun violence and poor maternal health “also lead to maternal mortality,” says Gyamfi-Bannerman, these issues also depend.