Maternal mortality rates in the United States have reached an alarming high. According to a Center for Disease Control (CDC) report published in the spring of 2019, over 700 women die each year due to complications relating to a pregnancy — and 60 percent of those fatalities, they estimate, could have been prevented.
The rate of pregnancy-related deaths (i.e., deaths that occur either during pregnancy or occurring as the result of complications up to one year following delivery) has more than doubled over the last three decades. The CDC reports that since its Pregnancy Mortality Surveillance System was instituted in 1987, the number of annual pregnancy-related deaths has grown from 7.2 deaths per 100 live births to 16.9 deaths per 100 live births in 2016. Some of the increase may be attributed to improved reporting systems; however, better recording cannot entirely account for the growth.
These numbers are shocking, but not surprising in context. When considered against a list of similarly wealthy countries, the United States falls notably short in addressing maternal morbidity. On the 2015 State of the World’s Mothers’ global index, the United States ranked 33rd — just two spots higher than Serbia, #35, and five higher than Saudi Arabia, #38.
One 2018 report from the Commonwealth Fund found that out of 11 studied high-income countries, women in the U.S. shoulder the greatest burden of chronic illness, have the highest rates of forgoing care due to cost, and are the least satisfied with their care. The researchers found that female patients in the U.S. also experience the highest rate of maternal mortality resulting from pregnancy or childbirth and have more cesarean sections than women in any other surveyed country. Leading causes of death include cardiovascular conditions (33%), infections (13%), and hemorrhage (11%).
Many of these reported deaths are preventable and often occur disproportionately across racial and ethnic lines. One 2016 study entitled “Timing and Adequacy of Prenatal Care in the United States” reported that 15% of women surveyed received “inadequate” prenatal care. Researchers further found that “younger women, women with less education, women having a fourth or higher-order birth, and non-Hispanic Native Hawaiian or Other Pacific Islander women were the least likely to begin care in the first trimester of pregnancy and to have at least adequate prenatal care.”
Maternal mortality rates skew heavily towards women of color. The above study notes that black, non-Hispanic women and American Indian/Alaskan Native women experienced 42.5 and 30.4 deaths per 100,000 live births, respectively, while white non-Hispanic women reported a comparatively low 11.3 deaths for the same metric.
There are many theories for why this disproportion occurs. Limited access to care is often driven by socioeconomics, leaving communities of color with less ability to obtain high-quality care. As the Committee on Health Care for Underserved Women wrote in a 2016 brief, “Many health disparities are directly related to inequities in income, housing, education, and job opportunities.”
That said, the committee also notes that other patient-level, provider-level, and system-level factors can also heavily influence care disparities. They indicate implicit bias as one such factor, writing; “for example, social and demographic biases have been shown to affect practitioners’ recommendations for long-acting reversible contraceptive methods to women at risk of unintended pregnancies. It is unclear whether these biases also affect practitioners’ recommendations for cesarean delivery or referrals for infertility.”
Some women’s health providers believe that another significant factor lies in the effects of racism itself. As Emily Peterson, a co-author of the CDC’s above-mentioned 2019 report, recently commented for the Washington Post, “one emergent theory is the effect of weathering or early aging of the body due to chronic stress-related to structural racism or systemic racism and its impact on health. There’s also a growing body of research on the role of structural racism […] in health care and its impact on patient care and outcome.”
There is no single solution to the soaring maternal mortality rate in the United States. However, it seems clear that those in the women’s health sector must actively work to improve access, reduce unconscious bias, and increase outreach to women of color to boost the likelihood that pregnant women will be able to have their children safely.