As women continue to die due to pregnancy or childbirth each year in the United States, new federal data shows the nation’s maternal mortality rate rose sharply again in 2021, with rates among black women more than double than those of white women.
Experts said the ongoing maternal mortality crisis in the United States is being compounded by Covid-19, which is leading to a “dramatic” increase in deaths.
The number of women who died of maternal causes in the United States increased to 1,205 in 2021, according to a National Center for Health Statistics report released Thursday by the U.S. Centers for Disease Control and Prevention. This is a sharp increase from previous years: 658 in 2018, 754 in 2019 and 861 in 2020.
That means the U.S. maternal mortality rate for 2021 — the year for which the most recent data is available — was 32.9 deaths per 100,000 live births, compared with levels of 20.1 in 2019 and 23.8 in 2020
The new report also notes significant racial disparities in the nation’s maternal mortality rate. In 2021, the rate for black women was 69.9 deaths per 100,000 live births, 2.6 times higher than the rate for white women, 26.6 per 100,000.
Data show that levels increase with maternal age. In 2021, the maternal mortality ratio was 20.4 deaths per 100,000 live births for women under 25 and 31.3 for those aged 25 to 39, but was 138.5 for those aged 40 and over. That means the rate for women 40 and older is 6.8 times higher than for women under 25, according to the report.
Maternal mortality in the United States has risen steadily over the past three decades, and this increase has continued through the Covid-19 pandemic.
Questions remain about how the pandemic may have affected maternal mortality in the United States, according to Dr. Elizabeth Cherot, chief medical and health officer of the infant and maternal health nonprofit March of Dimes, who was not involved in the new report.
“What happened in 2020 and 2021 compared to 2019 is Covid,” Cherrot said. “This is kind of my reflection on this period of time, Covid-19 and pregnancy. Women are at increased risk of morbidity and mortality from Covid. And that’s actually been well established in some studies showing an increased risk of death, but also intensive care unit ventilation, preeclampsia, and blood clots, all of these things increase the risk of morbidity and mortality.
The American College of Obstetricians and Gynecologists previously expressed “great concern” that the pandemic will worsen the maternal mortality crisis in the U.S., ACOG President Dr. Ifat Abbasi Hoskins said in a statement Thursday.
“Interim data released at the end of 2022 in the US Government Accountability Office report showed that maternal mortality in 2021 jumped – largely due to COVID-19. Still, the confirmation of an estimated 40 percent increase in preventable deaths compared to the previous year is stunningly new,” Hoskins said.
“New data from the NCHS also shows a nearly 60 percent increase in maternal mortality in 2021 compared to 2019, just before the pandemic began. The COVID-19 pandemic has had a dramatic and tragic effect on maternal mortality, but we cannot allow that fact to obscure the fact that there was already – and still is – a maternal mortality crisis to compound.”
Health officials stress that people who are pregnant should get vaccinated against Covid-19 and that this provides protection for both mother and baby.
In the early days of the pandemic, in 2020, there was limited information about the risks and benefits of the vaccine during pregnancy, which led some women to refrain from getting vaccinated. But there is now growing evidence of the importance of vaccination to protect against serious illness and the risks of Covid-19 during pregnancy.
The Covid-19 pandemic may also have exacerbated existing racial disparities in maternal mortality among black women compared to white women, said Dr. Chasity Jennings-Nuñez, California-based site director at Ob Hospitalist Group and chair of perinatal/gynecology department at Adventist Health-Glendale, which was not involved in the new report.
“In terms of maternal mortality, this continues to highlight those structural and systemic problems that we saw so clearly during the Covid-19 pandemic,” Jennings-Nunes said.
“So in terms of issues of racial health disparities, of structural racism and bias, of access to health care, all of those factors that we know played a role in maternal mortality in the past continue to play a role in maternal mortality ,” she said. “Until we start addressing these issues, even without a pandemic, we’re going to continue to see the numbers go in the wrong direction.”
Some policies have been introduced to address the maternal health crisis in the United States, including the Black Mothers Omnibus Act of 2021, a wide-ranging bipartisan package of bills that aims to provide prenatal and postpartum support for Black mothers, including extending eligibility for certain benefits after childbirth.
As part of Momnibus, President Biden signed the bipartisan Protecting Mothers Act of 2021 into law, and other provisions passed the House.
In the United States, about 6.9 million women have little or no access to maternal health care, according to the March of Dimes, which advocates in support of Momnibus.
The US has the highest maternal mortality rate of any developed nation, according to the Commonwealth Fund and the latest data from the World Health Organization. Although maternal mortality rates are either stable or rising in the United States, they are declining in most countries.
“High cesarean section rates, inadequate prenatal care, and increased rates of chronic diseases such as obesity, diabetes, and heart disease may be contributing factors to the high maternal mortality rate in the United States.” Many maternal deaths are the result of missed or delayed treatment opportunities,” Commonwealth Fund researchers wrote in a report last year.
The continued rise in maternal deaths in the United States is “disappointing,” said Dr. Elisabeth Langen, a high-risk maternal-fetal medicine physician at the University of Michigan’s Von Voigtlander Women’s Hospital. She was not involved in the latest report, but cares for people who have had serious complications during pregnancy or childbirth.
“Those of us who work in maternity care have known that this has been a problem in our country for quite some time. And every time new statistics come out, we hope that some of the efforts being made will change the direction of this trend. It’s really disappointing to see that the trend is not going in the right direction, but at some level it’s going in the worst direction and at a slightly faster rate,” Langen said.
“In the health care system, we must take ultimate responsibility for the women who die in our care,” she added. “But as a nation we also have to take some responsibility. We need to think about: How do we provide adequate maternity care to people? How do we allow people to have time off to see their midwife or doctor so they can get the care they need? How do we all make it possible to live a healthy life while pregnant so that you have the opportunity to have the best possible outcome?’