Maternal mortality in the U.S. has gotten worse in recent decades, a study shows, particularly for Native and Black women.
Recent research indicates efforts to improve maternal health in the U.S. have largely failed, with the maternal mortality rate more than doubling over the past two decades amid vast disparities between racial and ethnic groups.
Findings from a novel state-by-state analysis of maternal deaths, published this month in JAMA, show the rate of death among people 10 to 54 years old who were either pregnant or had been pregnant within the past year rose from 12.7 deaths per 100,000 live births in 1999 to 32.2 deaths per 100,000 in 2019, with total maternal deaths increasing from 505 to 1,210. Between the decades of 1999 to 2009 and 2010 to 2019, the study found increases in maternal mortality rates across nearly all states and among all racial and ethnic groups.
Across the five racial and ethnic groups included, the study’s estimates show American Indian and Alaska Native females, as well as Black females, had the highest maternal mortality rates in 2019, along with the largest absolute mortality rate increases since 1999. Among American Indians and Alaska Natives, the national maternal mortality rate more than tripled over the two decades studied – from 19 deaths per 100,000 live births in 1999 to 69.3 per 100,000 in 2019 – while maternal mortality among Black women more than doubled, from 31.4 to 67.6.
Among whites, the maternal mortality rate also roughly tripled, from 9.2 to 27.9. Similar patterns were found when examining median maternal mortality rates across states.
“While maternal mortality remains unacceptably high among all racial and ethnic groups in the U.S., American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states where these inequities have not been previously highlighted,” the study says.
Between the first and second decades of the century, Florida, Kansas, Illinois, Rhode Island and Wisconsin were home to the largest percentage increases in maternal mortality rate for the American Indian and Alaska Native population, all topping 162%, according to the study. For the Black population, Louisiana, New Jersey, Georgia, Arkansas and Texas all saw rate increases greater than 93%.
Researchers said the findings illustrate a lack of progress that has been made in reducing maternal deaths in the U.S., where maternal mortality has been significantly worse than in other wealthy countries.
“Maternal mortality persists as a source of worsening disparities in many U.S. states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis,” the study says.
Dr. Abdulla al-Khan, co-director of the Fetal Care Center at Hackensack University Medical Center in New Jersey, says reducing maternal mortality rates requires addressing root causes that fuel disparities, such as a lack of access to health care and the role bias can play in how clinicians diagnose and treat Black patients in particular.
“The tolerance for disparities should be zero in the health care profession,” al-Khan says.
AtHackensack University Medical Center, practitioners have worked to apply best practices for maternal care to all patients, and to use software that alerts clinicians of a potential issue in an expecting mother’s health – such as elevated blood pressure – before it becomes severe. The hospital had no reported maternal deaths in 2022.
The broader Hackensack Meridian Health network also reportedly has seen a reduced rate of deliveries performed through cesarean section, a procedure that can carry added risks of issues such as blood clots and blood loss. Previous research centered on women facing low-risk pregnancies found Black and Hispanic women were more likely than white women to deliver by C-section.
“Sadly, the individualization of medical care, the humanism of medicine, is something that is completely going away,” al-Khan says. “We are forgetting about paying attention to the details of what a patient is saying.”
Al-Khan says providing equitable services and resources to all mothers is the best way to eliminate maternal health disparities.
That can mean reaching mothers before or after they go to the hospital to give birth. Kathryn Kaintz, a nurse manager at Rush University Medical Center in Chicago, helps oversee its Family Connects Chicago program, which provides follow-up home visits by a nurse to mothers around four weeks after their child is delivered at the hospital.
Launched in March 2020, Kaintz says the program performs up to 900 home visits annually, offering medical checkups and counseling and making referrals to local social support services. She says the program helps reinforce the education new mothers receive at the hospital about looking out for health symptoms that could signal a serious condition.
“When you’re trying to give parents education while they’re still in the hospital, it can be like trying to teach someone after they just ran a marathon – it’s not always effective,” Kaintz says. “We come in at a time when they have had a chance to settle and reiterate that important education.”
Dr. Gregory Roth, a co-author of the maternal mortality study and associate professor at the University of Washington, says solutions to America’s maternal mortality problems will have to be widespread.
“Deaths related to women being pregnant is a persistent problem all over the country,” Roth says. “This is not a problem that’s restricted to just one region.”
Roth says the methods used for the new analysis can be used to create a database that would allow each state to track annual maternal mortality outcomes for various racial and ethnic groups, which he notes could help lawmakers formulate policy decisions that can ultimately lead to improving the health of underserved populations.
“A lot of the responsibility for health in the United States rests with the state,” Roth says. “No woman should die during pregnancy, and while surveillance has been expanded, the reporting has not been consistent across every state, so we wanted to create a level playing field.”
Source : USNEWS