The number of maternal deaths in the U.S. has more than doubled over a 20-year period, with significant disparities among different racial and ethnic groups. Black mothers had the highest rates of death, while American Indian and Native Alaskan mothers experienced the largest increases in mortality. These findings were presented in a new study published in the Journal of the American Medical Association. The study analyzed maternal deaths from 1999 to 2019, excluding the pandemic period, across all states and five racial and ethnic groups.
Dr. Allison Bryant, a senior medical director for health equity at Mass General Brigham and one of the study’s authors, emphasized that addressing the root causes of these disparities is crucial. She highlighted the role of structural racism and policies that hinder access to healthcare, emphasizing the need for action in these areas. Maternal mortality in the U.S. is the highest among wealthy nations and can be caused by various factors, including excessive bleeding, infection, heart disease, suicide, and drug overdose.
The study utilized national vital statistics data on deaths and live births to estimate maternal mortality per 100,000 live births. The researchers uncovered significant disparities, which were not limited to a specific region. States like Wyoming and Montana, as well as the Midwest region, had high rates of maternal mortality across multiple racial and ethnic groups in 2019. When comparing the first and second decades of the study, the researchers identified five states with the largest increases in maternal mortality for different racial and ethnic groups.
- American Indian and Alaska Native mothers saw a 162% increase in Florida, Illinois, Kansas, Rhode Island, and Wisconsin
- White mothers experienced a 135% increase in Georgia, Indiana, Louisiana, Missouri, and Tennessee
- Hispanic mothers had a 105% increase in Georgia, Illinois, Indiana, Minnesota, and Tennessee
- Black mothers had a 93% increase in Arkansas, Georgia, Louisiana, New Jersey, and Texas
- Asian and Pacific Islander mothers witnessed an 83% increase in Georgia, Illinois, Kansas, Michigan, and Missouri
Dr. Karen Joynt Maddox, a health services and policy researcher at Washington University School of Medicine, expressed her lack of surprise regarding the findings, citing anecdotal evidence of rising maternal mortality. Maddox emphasized the urgency of understanding and addressing the underlying issues contributing to these disparities, such as underinvestment in social services, primary care, and mental health. She also highlighted the need for sufficient public health funding, as demonstrated by Missouri’s recent expansion of Medicaid and budget allocation for maternal mortality prevention.
In neighboring Arkansas, a 2021 state report revealed that Black women are twice as likely to experience pregnancy-associated deaths compared to white women. Dr. William Greenfield, the medical director for family health at the Arkansas Department of Health, acknowledged the significant and persistent disparity, noting the challenge of pinpointing the exact causes of the increase in maternal mortality among Black mothers in the state.
The issue of maternal mortality disproportionately affects Black women and extends to individuals across different socioeconomic backgrounds. For instance, Olympic champion sprinter Tori Bowie tragically passed away from childbirth complications in May. The COVID-19 pandemic likely exacerbated the existing demographic and geographic trends, prompting the need for further investigation. Preliminary federal data indicates a decrease in maternal mortality in 2022 compared to the previous year, which saw a spike attributed to COVID-19.
Dr. Bryant emphasized the importance of understanding these disparities to develop community-based solutions and allocate appropriate resources to address the problem. Arkansas has already implemented telemedicine and other initiatives to improve access to care. The state also established a perinatal quality collaborative to educate healthcare providers on best practices for reducing cesarean sections, managing complications related to hypertensive disorders, and preventing childbirth injuries or severe complications.
Dr. Greenfield noted that many of the reviewed deaths, both in Arkansas and other areas, were preventable. This underscores the need for proactive measures and a comprehensive approach to maternal healthcare.
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