After ‘stunning’ 40% rise in maternal deaths, health leaders demand action

Health experts worried that America’s maternal mortality rate, already higher than other nations, would worsen in the COVID-19 pandemic.

New federal statistics show those fears appear to have been well-founded.

Maternal deaths rose 40% in 2021 compared to the previous year, according to figures released this week by the National Center for Health Statistics. Nationwide, 1,205 women died of pregnancy-related complications in 2021, up from 861 in 2020.

Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists, said in a statement Thursday that her organization had been “greatly concerned” that maternal mortality would rise in the pandemic.

“Still, confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning news,” she said.

The figures are even more jarring compared to the years preceding the pandemic.

In 2019, the year before the arrival of the COVID-19 pandemic, 754 women died of maternal causes, according to federal data. From 2019 to 2021, maternal deaths rose 60%. And compared to 2018, the maternal mortality rate has risen 89%, according to the new federal data.

The spike in pregnancy-related deaths should send a message that reducing maternal mortality must be one of the nation’s top health priorities, Abbasi Hoskins said. More than four out of five maternal deaths are preventable, according to the U.S. Centers for Disease Control and Prevention.

“The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was—and still is—already a maternal mortality crisis to compound,” Abbasi Hoskins said.

“Just as concerning are worsening racial health inequities and the fact that pregnant and postpartum Black people continue to make up a disproportionate number of maternal deaths at growing and alarming rates. This trend must be stopped.”

Racial disparities

Black women continue to be at a higher risk of deaths from pregnancy-related complications. The new data reveal Black women are 2.6 times more likely to die of maternal causes than white women.

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The maternal mortality rate for all women in 2021 was 32.9 deaths per 100,000 live births. Among Black women, the mortality rate was 69.9 deaths per 100,000 live births.

Maternal mortality rose across different racial groups in 2021.

• Among Black women from 2020 to 2021, the maternal mortality rate rose from 55.3 to 69.9 deaths per 100,000 births. From 2019 to 2021, the mortality rate among Black women rose from 44 to 69.9, a 59% increase.
• Among Hispanic women from 2020 to 2021, the maternal mortality rate rose from 18.2 to 28. From 2019 to 2021, the mortality rate more than doubled (12.6 to 28).
• Among white women from 2020 to 2021, the maternal mortality rate increased from 19.1 to 26.6 per 100,000 births. From 2019 to 2021, the mortality rate rose from 17.9 to 26.6, a 49% increase.

Elizabeth Cherot, the chief medical and health officer of the March of Dimes, said in a statement Thursday that more research must be done to understand the circumstances of pregnancy-related deaths.

“We have long known the threat of maternal mortality and morbidity is especially acute for women of color,” Cherot said in a statement.

“The fact remains that the U.S. healthcare system has historically failed people of color, including during the crucial times of pregnancy and postpartum. It’s imperative that we have reliable and consistent tracking measures in place across our country to help us evaluate and address maternal deaths.”

Mortality rates rose substantially based on age. In 2021, the mortality rate for women under the age of 25 was 20.4 deaths per 100,000 live births. For those 40 and older, the mortality rate was 138.5 per 100,000 births, almost seven times higher than those under the age of 25.

Vague state laws

Some fear the maternal mortality rate could rise due to the Supreme Court decision upending the constitutional right to an abortion. Some states have moved to prohibit abortions in most cases, and doctors and health advocates say state laws allowing for interventions in emergencies to save the mother are too vague, leaving doctors unsure when they can act.

ECRI, a non-profit organization focused on patient safety, identified maternal care as one of the top concerns in its annual report on patient safety concerns.

Because of the lack of clarity in the laws in some states, Marcus Schabacker, CEO of ECRI said, “It will delay treatment and it will cause patient harm. That's what we're concerned about.”

Many Americans live in maternity care deserts. More than 1 in 3 U.S. counties have no hospitals offering obstetrics care and have no obstetric providers, according to a March of Dimes report released last October.

A report released by the Government Accountability Office last October indicated an additional 400 maternal deaths occurred in 2021, compared to 2020. The latest federal figures released this week offer more evidence that the pandemic contributed to more deaths related to pregnancy.

Researchers have said the COVID-19 pandemic led to a rise in pregnancy-related complications. A study published by Jama Network Open found higher rates of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage. Researchers said it’s possible pandemic disruptions to prenatal care could have contributed to the rise in complications.

America has long had a poor track record on maternal health compared to other countries. A Commonwealth Fund analysis of 2018 data showed America’s maternal mortality rate was more than twice as high as other high-income countries.

President Biden’s 2024 budget proposal includes provisions aimed at improving maternal health. Biden is proposing $471 million across the federal government toward programs to reduce maternal deaths.

The administration’s plan would also require all states to provide Medicaid coverage for 12 months postpartum. Some states don’t offer such coverage, and the American College of Obstetricians and Gynecologists has been pushing all states to provide a full year of postpartum coverage.

The American College of Obstetricians and Gynecologists said that there are several sources of maternal mortality data, and the group called for “the standardization of maternal mortality data in order to develop more effective interventions and strategies to save lives.”