Maternal health has been declining in the United States – and it is only getting worse. But what are the causes and what can be done about it?
Every two minutes, a pregnant woman dies around the globe – that’s a shocking takeaway from a recent report by several United Nations agencies including the WHO. The report points to severe setbacks for women’s health in recent years due to humanitarian crises, struggling healthcare systems and restricted reproductive control. Most of these deaths would be preventable and treatable with appropriate care, such as those resulting from severe bleeding, high blood pressure, infections and complications from unsafe abortions.
While most maternal deaths happened in the poorest parts of the world, nearly all WHO regions observed either stagnating or increasing death rates – and that includes Europe. While maternal mortality is still very low in Western Europe (approximately between 2 to 10 deaths/100,000 live births, depending on the country) compared to the world average of 223/100,000, it is nevertheless food for thought.
This concerning trend is also visible in the United States of America. As research indicates, mortality rates in the US have increased from 2015 to 2019 for pregnant and recently pregnant women – in combination with a general trend of worsening maternal health in the last years. A study in JAMA Network Open sheds some further light on this development.
The cross-sectional study examined mortality rates among recently pregnant women from 2019 to 2020. The researchers looked at all-cause, as well as cause specific mortality in datasets obtained from the National Center for Health Statistics and the US Centers for Disease Control and Prevention.
In total, 4,535 women died during their pregnancy or within one year of the end of their pregnancy. Most of them were aged 34 or younger (2,904; 64 %) and about half of them were non-hispanic white (2,291; 50,5 %). In general, mortality increased by 29 % (95 % CI 1.21–1.37) from 53.9 to 69.6/100,000 live births. Further analysis showed that while the mortality rate increased across the board, the magnitude differed between different causes of death.
Pregnancy-associated causes accounted for approximately half of all deaths and were thus the leading cause of death for pregnant women. Here, the mortality rate rose from 27.5/100,000 live births in 2019 to 33.6/100,000 – an increase of 22 % (95 % CI 1.12–1.32). Even bigger jumps were observed for non-pregnancy-associated causes such as traffic accidents (mortality rate ratio (MRR) 1.31; 95 % CI 1.02–1.58) and homicides (MRR 1.33; 95 % CI 1.03–1.60). Accidental drug poisonings – the second leading cause of death – increased the most by 42 % [95 % CI 1.22–1.63]. Of all the specific death causes the researchers considered, only suicides did not see a significant change.
Comparison of the mortality rates among recently pregnant women in the US from 2019 to 2020 due to different causes. Credit: Susanne Alef
Bad news as is, but there’s more: For some ethnicities the trend is even more severe. When the researchers analyzed the mortality rates according to the women’s heritage, they found that compared to non-hispanic white women, non-hispanic black women’s mortality rates rose even higher for all causes, except for drug poisoning and suicides. The disparity is especially striking for homicides, where the mortality rate of black women increased five times more than among white women (MRR 5.3; 95 % CI 4.12–6.81).
Native American women were at an even higher risk. Among them, mortality rates increased markedly for every single cause of death the researchers considered. Compared to white women, their death rates were consistently found to be three to fivefold higher. On the other hand, pregnant women of hispanic and especially asian or pacific islander descent were the safest and showed lower mortality risks across all categories.
Comparison of the mortality rate ratios for different causes of death in accordance to ethnicity. Non-Hispanic white women were used as the control group, as this was the largest group represented in this study. Credit: Susanne Alef
These results are truly disheartening, but unfortunately not particularly surprising. While the study authors don’t speculate on the reasonings behind their findings, it is likely that systemic racism plays a key role. It is a well-known fact that ethnic minority groups regularly face discrimination in healthcare and thus don’t receive the best possible (pregnancy) care – resulting in increased pregnancy-associated morbidity and mortality. Furthermore, black and native communities are often exposed to economic disadvantages, which takes a toll on their health in general and further obstructs their access to proper healthcare.
Inaccuracies and misclassification of the data could, of course, limit the validity of the study results. Nevertheless, it draws much needed attention to the vulnerability of these groups and clearly signals a need for better medical care for pregnant women in general and for women of color specifically.
Image source: Matheus Ferrero, Unsplash
