Daily Briefing

Charted: The 'stunning' increase in maternal mortality rates during the pandemic

A new CDC report released Thursday found that maternal mortality rates rose significantly during the pandemic, increasing by around 40% from 2020 to 2021.

The 'stunning' rise in maternal mortality rates

According to the World Health Organization (WHO), maternal deaths take place during pregnancy or within 42 days of delivery. In 2021, the United States had one of the worst maternal mortality rates in its history, with 32.9 maternal deaths per 100,000 live births.

In total, the report found that 1,205 people died of maternal causes in the United States in 2021 — a 40% increase from 2020.

Overall, the mortality rate was highest among those older than 40, with 138.5 deaths per 100,000 live births, which was 6.8 times higher than the rate among those younger than 25. Still, the report found an increase in the maternal death rate for both groups in 2021.

According to Donna Hoyert, the author of the report and a health scientist at CDC's National Center for Health Statistics, the increase was "seen broadly across different age groups and race and Hispanic-origin groups."

However, the maternal mortality rate for non-Hispanic Black patients was 69.9 per 100,000 live births in 2021 — 2.6 times the death rate for non-Hispanic white patients, with 26.6 deaths per 100,000 live births. 

Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists, said the data in CDC's report "send a resounding message that maternal health and evidence‐based efforts to eliminate racial health inequities need to be, and remain, a top public health priority."

While provisional data from the Government Accountability Office showed a spike in maternal death rates largely driven by the pandemic, "confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning news," Hoskins said.

Still, while "the COVID‐19 pandemic had a dramatic and tragic effect on maternal death rates ... we cannot let that fact obscure that there was -- and still is -- already a maternal mortality crisis to compound," Hoskins added. "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."

What is driving the increase in maternal mortality in the US?

The U.S. maternal mortality rate is over 10 times the estimated rates of other high-income countries, including Australia, Austria, Israel, Japan, and Spain, which all reported rates between 2 and 3 deaths per 100,000 in 2020. Overall in 2020, the average maternal mortality rate was 12 per 100,000 live births in high-income countries and 430 per 100,000 in low-income countries, according to WHO data.

While international comparisons of maternal deaths can be challenging due to differences in methodology in data tracking, Hoyert noted that the United States is "usually not faring all that well" on maternal mortality.

"There is just no reason for a rich country to have poor maternal mortality," said Eileen Crimmins, a professor of gerontology at the University of Southern California. A CDC compilation of data from state committees found around 84% of pregnancy-related deaths in the United States are preventable.

According to CDC, cardiovascular conditions, uncontrolled bleeding, and problems associated with hypertension are the leading causes of pregnancy-related deaths in the United States.

Many experts have also suggested that some pregnancy and postpartum complications likely stem from rising obesity and decreasing heart health. Roughly 42% of U.S. adults are considered obese, almost half have high blood pressure, about 11% have diabetes, and 38% have prediabetes, CDC noted. 

In addition, Hoyert connected the increase in maternal deaths to the COVID-19 pandemic. "We had some forewarning with the increase between 2019 and 2020 that it looked like maternal mortality rates were increasing during this pandemic period," she said. "With the overall COVID deaths that occurred in 2021, there was a shift towards younger people, so those would be in the age groups where people would be more likely to be pregnant or recently pregnant."

However, she noted that provisional data suggest the deaths peaked in 2021 and started declining in 2022. "So hopefully that's the apex," Hoyert said. (Hassanein, USA Today, 3/16; Frieden, MedPage Today, 3/16; Johnson, Washington Post, 3/16; Rabin, New York Times, 3/16; Simmons-Duffin/Wroth, "Shots," NPR, 3/16; Stobbe, AP/STAT, 3/16; Toy, Wall Street Journal, 3/16)


The maternal health crisis is getting worse — it's time to act

By Amanda Okaka

This marks the third consecutive year the United States has seen a rise in maternal mortality rates — and many fear that this trend will continue to worsen in a post-Roe world.

Still, the pandemic's role in this increase cannot be overstated. Black, Hispanic, and Indigenous communities experienced the highest rates of COVID-19 deaths, compounding existing maternal health disparities.

However, maternal mortality is a hugely complex issue with many contributing factors. To address rising maternal mortality rates, stakeholders should implement a comprehensive, multi-sectoral approach. Ultimately, every stakeholder in the healthcare industry has a role to play in advancing maternal health.

To improve the maternal health crisis, healthcare leaders need to answer questions related to these four components of maternal health:

1. Delayed and inadequate access to prenatal care: Many Americans, particularly people of color, face barriers to timely and adequate prenatal care — an issue that can result in undiagnosed or poorly managed pregnancy-related complications.

Questions to consider:

  • How can my organization advocate for changes in clinical policy to promote equity and reduce structural barriers to prenatal care?
  • How can my organization partner with community service providers to design initiatives that expand access to maternal health education?

2. C-sections and maternal health complications: The United States has a high rate of C-section deliveries, which are associated with increased risks of maternal health complications, including hemorrhage and infection.

Questions to consider:

  • How can my institution develop an effective strategy to limit unnecessary C-sections and promote vaginal birth?

3. Lack of standardized protocols: There is no standardized protocol for managing pregnancy-related complications in the United States, and healthcare providers may not receive adequate training in managing these emergencies.

Questions to consider:

  • How can my institution improve clinical training to manage pregnancy-related complications?
  • As an industry, what steps can we take to increase health literacy within the birthing population?
  • How can stakeholders improve patient-provider communication and shared decision-making?

4. Healthcare fragmentation: The U.S. healthcare system is fragmented. There are multiple providers, payers, and EHR systems — this fragmentation can lead to challenges coordinating care for pregnant people.

Questions to consider:

  • How can my organization collaborate with stakeholders to advance interoperability and integrated models in care delivery?

The industry has been talking about the maternal health crisis and health disparities for years. The time to stop talking and start acting to address these issues is now.






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