Maternal deaths in the U.S. keep climbing

An increasing number of U.S. women are dying during pregnancy or soon after giving birth, according to the latest data on the maternal mortality rate.

In 2021, there were 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 March 16. The U.S. rate greatly exceeds those of other high-income countries. The total number of U.S. maternal deaths rose from 861 in 2020 to 1,205 in 2021.

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

The NCHS report doesn’t discuss the reasons behind the increase for 2021. But COVID-19 contributed to a quarter of maternal deaths in 2020 and 2021, the U.S. Government Accountability Office reported in October. The pandemic also contributed to the mortality disparity between Black and white women, the GAO found, worsening existing structural inequities that lead to such issues as barriers to getting health care (SN: 4/10/20).

The maternal deaths captured by the NCHS report are those that occur during pregnancy or within 42 days of the end of the pregnancy, “from any cause related to or aggravated by the pregnancy or its management.” These causes include hemorrhaging, infections and high blood pressure disorders such as eclampsia.

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

“We really do need to be able to care for our new moms beyond that six-week period,” says maternal fetal medicine specialist Cynthia Gyamfi-Bannerman, Chair of the Obstetrics, Gynecology & Reproductive Sciences Department at the University of California, San Diego School of Medicine.

One effort to expand coverage in the year after birth is through Medicaid insurance, which paid for 42 percent of U.S. births in 2020. States have the option to extend coverage from up to 60 days after birth to a full year through a provision of the American Rescue Plan Act of 2021.

The maternal mortality rate 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 like hemorrhaging, researchers reported in Obstetrics & Gynecology in 2021. Studies have found that in the majority of these homicide cases, an intimate partner is the killer, most often using a gun. Pregnant women are at higher risk of homicide than nonpregnant women of reproductive age.

Suicide is also a leading cause of death during pregnancy and one year after birth, but isn’t captured in the maternal mortality rate.

There have been improvements in managing pregnancy complications like hemorrhaging and blood pressure disorders, Gyamfi-Bannerman says. Implementing care bundles, which are akin to medical checklists, for these and other complications can reduce maternal mortality.

But since gun violence and poor maternal mental health “are also leading to maternal mortality,” Gyamfi-Bannerman says, addressing these issues is crucial too.