9.2.1: Maternal Mortality
At the time of this writing, maternal mortality rates in the U.S. have recently received a lot of media attention. According to the CDC, maternal mortality rates rose significantly between 2019 (20.1 deaths per 100,000 live births) and 2021 (32.9 deaths per 100,000 live births). Using data from death certificates collected by the National Vital Statistics System (NVSS), the CDC’s most recent report states that 754 women died of maternal related causes in 2019, 861 died in 2020, and 1205 in 2021. Mortality rates are higher with increased age: the rate for women 40 and over was 6.8 times greater than the rate for women under 25 years of age. Additionally, these mortality rates demonstrate clear racial disparities: the rates for non-Hispanic Black women were 2.6 times the rates for non-Hispanic White women (Hoyert, 2023). Although the absolute number of maternal deaths may be small in comparison to overall deaths in women, the fact that these rates are increasing, combined with stark racial disparities, indicates the need for improvements in prenatal and maternal healthcare.
A recent study published in the American Journal of Obstetrics and Gynecology questions whether this dramatic increase in maternal mortality rates was potentially caused by a change in surveillance methods. Could this spike in death rates be factual, or could it be influenced by how maternal deaths are defined, and how physicians record them on the death certificate? The researchers also questioned whether the increase in maternal deaths was due to an increase in deaths associated with pregnancy or the medical management of pregnancy, or whether other causes of death to women who have been pregnant at the time of death (or within the last year) were also included in the reporting - and thus skewed the data. When analyzing for specific causes of death, the rates of pregnancy and delivery-related mortality were essentially the same between 2018 and 2021. However, the research still confirmed that non-Hispanic Black women experience significantly higher mortality rates from pregnancy and delivery-related complications (Joseph et al., 2024). This research highlights the importance of care and attention to detail in epidemiological surveillance and in reporting health outcomes to the public.
If maternal mortality rates in the U.S. have remained stable over the last several years, they are still comparable or slightly higher than other countries with similar economic profiles and medical technology (OECD, 2023). Although medical advances have been made over the last century that have brought these rates down, there are still far too many deaths related to pregnancy and birth around the world. In low income countries the maternal mortality ratio (MMR - which is the number of maternal deaths per live births), can be as high as 430/100,00 live births. In high income countries the MMR is as low as 13/100,000 live births. Another way of comparing this is to consider the lifetime risk of a person who can become pregnant. The lifetime risk of a woman dying from pregnancy or birth-related complications is 1 in 49, compared to 1 in 5300 in high income countries (WHO, 2024b). Much of this risk has to do with access to healthcare- including a lack of skilled healthcare providers. Other risks include poverty, lack of education, and harmful gender norms and inequalities, as well as environmental issues that disrupt infrastructure and lead to other problems such as malnutrition or infection. The most common reasons for maternal deaths around the world are preventable, and include:
- severe bleeding (mostly bleeding after childbirth);
- infections (usually after childbirth);
- high blood pressure during pregnancy (pre-eclampsia and eclampsia);
- complications from delivery; and
- unsafe abortion (WHO, 2024b).
In the United States, a report published by the CDC states that 80% of maternal deaths are preventable. Causes include mental health conditions (including suicide and overdose/poisonings related to substance abuse), severe bleeding, infections, and other cardiovascular-related issues including pre-eclampsia and eclampsia (CDC, 2022c). Postpartum depression (PPD) is the most recognized mental health issue, and is generally considered to be depressive symptoms (feeling sad, down, irritable) within 4 weeks of delivery. However, research suggests that depression and anxiety are frequently experienced during pregnancy and within the first year of giving birth. According to recent research, PPD affects about 13% of American women after giving birth, and this rate can be significantly higher for teen mothers (between 53-61%). Other risk factors for PPD include a lack of social support, poverty, traumatic birth experiences, multiple births (such as twins or triplets), domestic violence, intimate partnership problems, as well as a prior or family history of depression and anxiety (NICHD, 2020). See Fig. \(\PageIndex{1}\) below for MMR by state 2018-2022.