Maternal Mortality Rates in the U.S. Rise Sharply in Two Decades, with Stark Disparities
A recently published study in the Journal of the American Medical Association reveals that maternal deaths in the United States have more than doubled over a twenty-year period, with significant racial and ethnic disparities. Black mothers experience the highest rates of maternal mortality, while American Indian and Native Alaskan mothers experienced the largest increases in deaths. The study, conducted by researchers from Mass General Brigham and the Institute for Health Metrics and Evaluation at the University of Washington, analyzed data from 1999 to 2019 for each state 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, emphasizes that the findings should prompt action to address the root causes of maternal mortality. While some factors, such as access to healthcare, contribute to the problem, structural racism also plays a significant role. The United States has the highest maternal mortality rate among wealthy nations, with causes of death including bleeding, infection, heart disease, suicide, and drug overdose.
The researchers utilized national vital statistics data on deaths and live births, along with modeling processes, to estimate maternal mortality rates per 100,000 live births. The study revealed widespread and expanding disparities, challenging the notion that high maternal mortality rates are confined to certain regions. States like Wyoming and Montana in the Midwest, along with the South, also exhibited high rates among multiple racial and ethnic groups in 2019.
Comparing the first and second decades of the study, the researchers identified the five states with the largest increases in maternal mortality rates. The increases ranged from 83% for Black mothers in Arkansas, Georgia, Louisiana, New Jersey, and Texas, to 162% for American Indian and Alaska Native mothers in Florida, Illinois, Kansas, Rhode Island, and Wisconsin.
Dr. Karen Joynt Maddox, a health services and policy researcher at Washington University School of Medicine, remarks that the study’s findings are not surprising given the growing anecdotal evidence on rising maternal mortality rates. She emphasizes the urgent need to understand the causes and take action. Maddox points out that the United States underinvests in social services, primary care, and mental health compared to other wealthy nations. Inadequate public health funding in states like Missouri also contributes to the problem.
The study highlights the disparity in maternal mortality rates between Black women and white women in Arkansas, where Black women are twice as likely to experience pregnancy-associated deaths. Dr. William Greenfield, the medical director for family health at the Arkansas Department of Health, acknowledges the significance and persistence of this disparity. Greenfield emphasizes the need for community-based solutions and greater understanding of the resources required to address the issue.
Maternal mortality rates were likely further impacted by the COVID-19 pandemic, according to Dr. Bryant. However, preliminary data suggests that maternal mortality fell in 2022 after reaching a six-decade high in 2021. Further research is needed to fully understand the demographic and geographic trends exacerbated by the pandemic.
In response to these findings, Arkansas is implementing telemedicine and other strategies to improve access to care. The state has also established a “perinatal quality collaborative” to help healthcare providers adopt best practices and prevent avoidable deaths during childbirth.
The study underscores the need for comprehensive efforts to address maternal mortality, with a focus on eliminating racial and ethnic disparities and improving healthcare access and quality nationwide.
AP Public Health Collaborations Editor Erica Hunzinger contributed to this report
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