Maternal death rates surged by nearly 40% during the second year of the pandemic, widening disparities as Black women again faced alarmingly high, disproportionate rates, a new federal analysis shows.
In 2021, there were about 33 maternal deaths per 100,000 live births – a 38% increase from the year before, according to the report released Thursday from the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Experts say COVID-19 likely contributed to the increases, but that the sobering rates continue to reveal deep flaws in health systems, such as structural racism, implicit bias and communities losing access to care.
“A roughly 40% increase in preventable deaths compared to a year prior is stunning news,” Dr. Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists, said in a statement to USA TODAY.
The rates “send a resounding message” that maternal health and evidence-based efforts to eliminate racial inequities must remain at the forefront of public health priorities, Hoskins said.
‘Staggering’: More than 80% of US maternal deaths are preventable
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Most maternal deaths – which happen during pregnancy, labor or within 42 days of birth – are preventable. The United States’ maternal death rate continues to be higher than other wealthy, developed countries, and the new data shows a roughly 60% increase in overall rates 2021 from 2019, the year before the start of the pandemic.
“This is quite devastating,” said maternal health scholar Ndidiamaka Amutah-Onukagha, founding director of the Tufts University Center for Black Maternal Health and Reproductive Justice.
“This is more lives broken. This is more lives shattered. This is more lives destroyed for largely preventable deaths.”
‘Inequities are increasing’
In total, 1,205 women died of maternal causes in 2021, an increase from 861 in 2020 and 754 in 2019.
Maternal death rates among all racial groups saw statistically significant increases, according to the analysis:
- Black women again saw the highest rates at almost 70 deaths per 100,000 births, up from about 55 in 2020.
- White women’s rates also saw concerning increase, jumping from 19 to 26.6 deaths per 100,000 in 2021.
- Hispanic women’s rates surged from about 18 to 28 deaths per 100,000. Prior to the the pandemic, Hispanic women had lower rates than white women.
While Black women gave birth less in 2021 compared to 2020, they died at higher rates.
“That inverse relationship really underscores the enormity of the problem,” said Amutah-Onukagha, noting rates could be underestimates due to flaws in death certificate reporting and backlogging in data collection. “You’re seeing the highest (rate) of deaths in a smaller population. …The inequities are increasing.”
The analysis also found women aged 40 and older were almost 7 times higher than those among women younger than 25.
COVID-19 and maternal mortality
Pregnant people are more vulnerable to COVID-19, and the virus can contribute to severe complications in pregnancy, according to the CDC.
“While we are still working to better understand the drivers of this increase, we know that pregnant or recently pregnant persons are more likely to get severely ill from COVID-19 compared to people who are not pregnant,” Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health, told USA TODAY.
A report from the U.S. Government Accountability Office last year found COVID-19 contributed to about a quarter of maternal deaths.
“The pandemic has brought in a pathophysiology that puts those women more at risk,” said Dr. Idalia Rosado-Torres, obstetrician and gynecologist at Chesapeake Regional Medical Center and site director of Ob-Hospitalist Group.
Preeclampsia risk, for example, increases when a patient has COVID-19, she explained.
Barfield said other factors at play also include chronic conditions during pregnancy, access to quality care during and after pregnancy, and structural racism and implicit bias.
Reports have shown disparities persist even when accounting for education or income, reflecting potential bias in care. For example, Black women with college education still died at higher rates than white women with the same education level. Research has also found Black babies are more likely to survive when cared for by Black doctors.
More:COVID-19 contributed to a quarter of maternal deaths from 2020 to 2021
Dr. Veronica Gillispie-Bell, senior site lead of women’s services at Ochsner Kenner in Louisiana, said systems need to prioritize equity and implement evidence-based practices, such as patient safety strategies from the Alliance for Innovation on Maternal Health.
“We must also think about the different areas within the health system that our patients enter care throughout pregnancy and the postpartum period, including the emergency room,” she said.
Improving access to care, Gillispie-Bell said, “cannot be limited to our birthing facilities.”
Maternity care is disappearing
The increase in deaths comes amid the nation’s crisis of disappearing maternal health care.
Half of the nation’s rural counties have no obstetric care or OB-GYN practitioner, for example, and researchers found Black communities are more likely to lose their obstetric units.
About 2 million rural women of childbearing age live in at least 25 miles away from a labor and delivery unit, a USA TODAY analysis found. Some urban communities are also losing their labor and delivery units.
“These maternity care deserts are very problematic because that means people have to travel farther to get care. People have to wait longer for appointment times,” Amutah-Onukagha. There’s a “depleting of resources, of infrastructure, in Black and brown spaces where we are already seeing more increased likelihood or prevalence of chronic conditions.”
The disappearing care, coupled with the pandemic, exacerbates the problem for people who are already at high-risk, said Rosado-Torres.
The dearth is “isolating them from the care that they need,” she said.
Reach Nada Hassanein at firstname.lastname@example.org or on Twitter @nhassanein_.
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