The latest data on the maternal mortality rate in the United States are troubling. More and more American women are dying during pregnancy or shortly after giving birth. According to the National Center for Health Statistics report, there were 32.9 deaths per 100,000 live births in 2021, up from 23.8 in 2020 and 20.1 in 2019. The U.S. rate far exceeds that of other high-income countries.
The report also highlights a significant disparity in the maternal mortality rate for black women, which is 69.9 deaths per 100,000 live births, compared with that for white women, which is 26.6 per 100,000 live births. This gap is due to many social determinants of health, including differences in the quality of care black women receive before, during, and after pregnancy.
COVID-19 has contributed to a quarter of maternal deaths in 2020 and 2021, the U.S. Government Accountability Office reported in October. The pandemic has also worsened structural inequities, such as barriers to obtaining health care, contributing to the mortality disparity between black and white women.
Importantly, the NCHS report does not explain the reasons for the increase in 2021, but the causes are known to include hemorrhage, infections, and high blood pressure disorders such as eclampsia. In addition, the report excludes deaths after 42 days and up to the first year postpartum, a period when 30% of pregnancy-related deaths occur, according to the U.S. Centers for Disease Control and Prevention.
“We really need to be able to care for our new moms beyond that six-week period,” says maternal-fetal medicine specialist Cynthia Gyamfi-Bannerman. One of the efforts to expand coverage in the year after birth is through Medicaid insurance, which paid for 42% 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 in the American Recovery Plan Act of 2021.
It is also important to note that the maternal mortality rate excludes maternal deaths from homicide, which was the leading cause of death during pregnancy or within 42 days after the end of pregnancy in 2018 and 2019, responsible for more than twice as many deaths as causes such as hemorrhage. Studies have revealed that in most of these homicide cases, the killer is the intimate partner, who in most cases uses a firearm.
To reduce the maternal mortality rate, it is necessary to improve the quality of care women receive before, during, and after pregnancy. In addition, efforts are needed to expand healthcare coverage in the year after birth, through initiatives such as the provision of the American Rescue Plan Act of 2021.