As women in the United States continue to die every year from pregnancy or childbirth, new federal data shows the country’s maternal mortality rate rose significantly again in 2021, with rates among black women more than twice those of white women .
Experts said the ongoing maternal mortality crisis in the United States has been exacerbated by Covid-19, leading to a “dramatic” rise in deaths.
The number of women who died from maternal causes in the United States rose to 1,205 in 2021, according to a National Center for Health Statistics report released Thursday by the US Centers for Disease Control and Prevention. That’s a sharp increase from previous years: 658 in 2018, 754 in 2019 and 861 in 2020.
That means the US maternal mortality rate for 2021 – the year for which the latest data is available – was 32.9 deaths per 100,000 live births, compared to rates of 20.1 in 2019 and 23.8 in 2020.
The new report also finds significant racial disparities in the country’s maternal mortality rate. In 2021, the rate for black women was 69.9 deaths per 100,000 live births, which is 26.6 per 100,000, 2.6 times the rate for white women.
The data showed that rates increased with maternal age. In 2021, the maternal mortality rate was 20.4 deaths per 100,000 live births for women under 25 and 31.3 for those aged 25 to 39, but 138.5 for those aged 40 and over. That means the rate for women aged 40 and over was 6.8 times higher than the rate for women under 25, according to the report.
The maternal mortality rate in the United States has steadily increased over the past three decades, and this increase has continued during the Covid-19 pandemic.
Questions remain about how the pandemic may have affected maternal mortality in the United States, according to Dr. Elizabeth Cherot, chief medical and health officer of the infant and maternal health nonprofit March of Dimes, who was not involved in the new report.
“What happened in 2020 and 2021 compared to 2019 is Covid,” Cherot said. “This is sort of my reflection on this period, Covid-19 and pregnancy. Women had an increased risk of morbidity and mortality from Covid. And that’s actually well documented in some studies that show an increased risk of death, but also ICU ventilation, pre-eclampsia and blood clots, all of those things increase the risk of morbidity and mortality.”
The American College of Obstetricians and Gynecologists previously expressed “great concern” that the pandemic would exacerbate the US maternal mortality crisis, said ACOG President Dr. Iffath Abbasi Hoskins in a statement on Thursday.
“Preliminary data released in late 2022 in a US Government Accountability Office report indicated that maternal death rates had skyrocketed in 2021 — in large part due to COVID-19. Still, the confirmation of an approximately 40% increase in preventable deaths compared to last year is startlingly new,” Hoskins said.
“The new data from the NCHS also shows a nearly 60 percent increase in maternal mortality in 2021 compared to 2019, just before the pandemic began. The COVID-19 pandemic has had a dramatic and tragic impact on maternal mortality rates, but we cannot hide the fact that there has been – and is still being – a maternal mortality crisis.”
Health officials are emphasizing that pregnant women should get vaccinated against Covid-19 and that this will protect both mother and baby.
In the early days of the 2020 pandemic, there was limited information about the risks and benefits of the vaccine during pregnancy, prompting some women to wait to get vaccinated. But now there is growing evidence of the importance of getting vaccinated to protect against serious illnesses and the risks of Covid-19 during pregnancy.
The Covid-19 pandemic may also have exacerbated existing racial disparities in maternal mortality among black women compared to white women, said Dr. Chasity Jennings-Nuñez, a California-based Ob Hospitalist Group site manager and chair of Perinatal/Gynecology at Adventist Health-Glendale, who was not involved in the new report.
“Regarding maternal mortality, it continues to highlight the structural and systemic issues that we have seen so clearly during the Covid-19 pandemic,” Jennings-Nuñez said.
“In terms of issues of racial health inequality, structural racism and bias, access to health care, all of these factors that we know have played a role in relation to maternal mortality in the past continue to play a role in the Maternal mortality,” she said. “Until we start addressing these issues, even without a pandemic, we will continue to see the numbers go in the wrong direction.”
Some policies have been introduced to deal with the maternal health crisis in the United States, including the Black Maternal “Momnibus” Act of 2021, a sweeping bipartisan legislative package aimed at providing support to Black mothers before and after childbirth, including extending eligibility for certain services after the birth.
As part of the momnibus, President Biden signed the bipartisan Protection of Mothers in Servant Act into law in 2021, and other provisions were passed in the House of Representatives.
In the United States, about 6.9 million women have little or no access to maternal health care, according to the March of Dimes, which works to support Momnibus.
According to the Commonwealth Fund and the latest data from the World Health Organization, the US has the highest maternal mortality rate of any industrialized country. While maternal mortality rates are either stable or rising in the United States, they are declining in most countries.
“High rates of cesarean sections, inadequate prenatal care, and increased rates of chronic diseases such as obesity, diabetes, and heart disease may be factors contributing to the high maternal mortality rate in the United States. Many maternal deaths result from missed or delayed treatment options,” researchers at the Commonwealth Fund wrote in a report last year.
The continued rise in maternal deaths in the United States is “disappointing,” said Dr. Elizabeth Langen, physician specializing in high-risk maternal-fetal medicine at the University of Michigan’s Health Von Voigtlander Women’s Hospital. She was not involved in the most recent report but does care for people who have had serious complications during pregnancy or childbirth.
“Those of us who work in midwifery have known for some time that this is a problem in our country. And every time the new stats come out, we hope that some of the efforts that have been made will change the direction of this trend. It’s really disappointing to see that the trend is not going in the right direction, but in some ways in the worst direction and at a slightly faster pace,” Langen said.
“In the healthcare system, we must take ultimate responsibility for the women who die in our care,” she added. “But as a nation we also have to take responsibility. We need to think: how do we provide proper maternity care to people? How do we give people time off work to visit their midwife or doctor to get the care they need? How do we make it possible for all of us to live healthy lives during pregnancy so that you have the opportunity to have the best possible outcome?”