Maternal deaths in the U.S. spiked in 2019, with significant disparities by race and age, federal data showed.
The U.S. maternal mortality rate was 20.1 per 100,000 live births in 2019, up from 17.4 per 100,000 the year before, reported Donna Hoyert, PhD, of the National Center for Health Statistics (NCHS), in NCHS Health E-Stats.
Black people died from pregnancy-related causes at a rate that was 2.5 times that of non-Hispanic white people and 3.5 times that of Hispanic people, underscoring the continued racial disparities that persist in maternal health outcomes.
The maternal mortality rate increased with age, with people age 40 and older experiencing the highest ratio of deaths.
In 2019, deaths of 754 women in the U.S. were classified as maternal, compared with 658 in 2018. The maternal mortality rate was 44 per 100,000 live births among non-Hispanic Black people, 17.9 per 100,000 among non-Hispanic whites, and 12.6 per 100,000 among those identified as Hispanic.
Rates of maternal mortality increased with age: 12.6 per 100,000 live births for people under age 25, 19.9 for those 25–39, and 75.5 for those 40 and over.
Data for the analysis came from the National Vital Statistics System mortality file. The WHO defines a maternal death as the death of a woman while pregnant or within 42 days of pregnancy termination, regardless of the duration or site of pregnancy, and from any cause related to pregnancy or its management. In this study, people who identified as Native American or multi-racial were not included.
Rose Molina, MD, MPH, an assistant professor of ob/gyn at Harvard Medical School in Boston, who was not involved with this research, said that the increase in maternal deaths between 2018 and 2019 highlights the vast inequities among racial and age groups. Molina noted that maternal mortality for Black Americans over age 40 was similar to that seen in low-income countries.
“Despite the national spotlight on racism as a driving factor in maternal health in recent years, we have not yet moved the needle on reducing maternal deaths,” Molina told MedPage Today in an email. “Structural, institutional, and interpersonal racism harms us all and needs to be addressed directly in order to improve maternal health outcomes.”
Lauren Dungy-Poythress, MD, a maternal-fetal medicine specialist at Indiana University Health in Indianapolis, who was also not involved with this research, said that she was struck by the smaller disparity in maternal mortality between white and Black people. While previous reports have shown that maternal mortality among Black people is three to four times that of whites, this report showed only a 2.5-fold difference.
“But when you read further, you see that there was an increase in the white mortality,” she said. “That’s why the disparity decreased, not necessarily because there was an improvement in the Black mortality rate.”
Dungy-Poythress said that “a clinical takeaway is that we still have significant rates of maternal mortality, and it’s still higher for Blacks than whites.” Allocating more resources to communities for access to transportation, healthy food and medical services, she said, is necessary to reduce this disparity.
The U.S. had a vastly higher rate of maternal death than 10 other high-income countries — double that of France and more than five-fold higher than Germany’s, according to 2018 data analyzed by the Commonwealth Fund. The CDC has called two-thirds of maternal deaths preventable.
Legislators and public officials have begun to acknowledge this issue more frequently. In December, then-U.S. Surgeon General Jerome Adams, MD, released a Call to Action to improve maternal health. Speakers at a recent House hearing called the U.S. maternal mortality rate “a national disgrace,” demanding legislative action to increase the number of midwives in the maternal health care system, reduce racial disparities, and increase mental health access for people who are pregnant or in the postpartum period.
Hoyert noted that maternal mortality rates fluctuate from year to year because of the small number of these events, as well as potential issues with the reporting of maternal mortality on death certificates.
Molina said that despite increased awareness of maternal mortality and how it affects mothers of color at a disproportionate rate, the medical community must continue to “examine racial disparities with a magnifying glass to really understand all factors that drive these outcomes.”
“Providers in this field have a lot of work to do in looking internally at how pregnancy care is delivered, and externally at how inequitable policies shape the lived experience of our patients navigating pregnancy and postpartum transition,” she said.