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The U.S. maternal mortality rate is declining, but racial disparities persist




The U.S. maternal mortality rate is declining, but racial disparities persist

aAfter years of increases, the US maternal mortality rate fell in 2022, new government data show. But maternal health experts warn there’s no reason to celebrate: The dip is a course correction after the Covid-19 pandemic, and mothers in the United States are still dying at dramatically higher numbers than mothers in other high-income countries.

Racial disparities also persisted, with black mothers in the U.S. dying at more than two and a half times the rate of white mothers, according to data released Thursday by the National Center for Health Statistics, part of the Centers for Disease Control . and Prevention.

“It’s just a shame for our country,” said Elizabeth Cherot, president and CEO of the March of Dimes. “Too many mothers are dying, and it doesn’t have to be this way.”

In 2022, there were 22.3 maternal deaths for every 100,000 live births in the U.S., up from 32.9 in 2021, according to the new CDC data. That data reflects 817 maternal deaths in 2022 and 1,205 in 2021.

The Black maternal mortality rate was 49.5 per 100,000 live births in 2022, up from 69.9 in 2021.

The US maternal mortality rate rose continuously from 2018 to 2021, and since Covid-19 was particularly dangerous for pregnant people, there was a particularly dramatic increase between 2020 and 2021. The decline in the 2022 figure resets the maternal mortality rate. about where it was in 2019, before the Covid-19 pandemic.

Although the CDC has not yet released maternal mortality rates for 2023, some researchers expect them to rise in states with abortion restrictions that followed the Supreme Court’s Dobbs ruling in mid-2022.

“This crisis is far from over for us,” Cherot said.

For example, the U.S. maternal mortality rate is more than six times higher than rates in Spain, Japan, Australia or Germany, according to an analysis of 2021-2022 data by Birth by numbers, a group led by Eugene Declercq, professor of community health sciences at Boston University School of Public Health.

The reasons behind the high maternal mortality rate in the US are complex, but a CDC analysis of data from 2017 through 2019 indicates that more than 80% of pregnancy-related deaths in the US are preventable. In that analysis, the top three causes of death were mental health problems, such as suicides and drug overdoses; profuse bleeding; and heart and coronary disease.

Part of the reason for the high maternal mortality rate in the US is that the rates of some of these health problems, such as drug overdoses, are particularly high in the United States. Another reason is poor health care for many pregnant people in the US. In 2022 approximately 1 in 7 babies were born to a mother who received inadequate prenatal care, according to the March of Dimes.

While there is some controversy about how maternal mortality is calculated in the US, the… March of Dimes and other experts say that no matter how the percentage is measured, it is still higher than it should be.

“No matter how you structure a comparison, the US fares poorly in international comparisons,” according to Birth by the Numbers, which has conducted an extensive analysis of the different reporting methods.

The situation in the US is particularly bad for black mothers, with a maternal mortality rate 2.6 times higher than that of white women, according to the new CDC data. The CDC says several factors contribute to this stark racial disparity, including disparities in health care quality and underlying chronic conditions, as well as systemic racism and inherent biases.

“Structural racism does not emerge in the birth experience as one bad actor – it is not a nurse or a midwife who is just a racist person, but it is the entire healthcare system that has policies and procedures that are put in place and enforced, really to make racism worse,” said Ndidiamaka Amutah-Onukagha, professor of Black Maternal Health and founder of the Center of Black Maternal Health and Reproductive Justice at Tufts University School of Medicine.

She added that doctors and nurses can feel that I provide the same standard of care to all my patients, [that] We treat everyone here the same. But then you talk to patients, or you do observational data, or you look at their emergency department or discharge notes and you realize that there are huge disparities in healthcare in the way people are treated when they come into healthcare.”

There are also large differences in mortality rates depending on where the birthing person lives. A Birth by the Numbers analysis of 2018-2021 data shows that the highest maternal mortality rates are in Alabama, Arkansas, Mississippi and Tennessee, and they are at least twice as high as the states with the lowest rates in the country.

Alabama, Arkansas, Mississippi and Tennessee have enacted significant abortion restrictions since the Supreme Court’s Dobbs decision in June 2022, which overturned Roe v. Wade. Amutah-Onukagha, an epidemiologist in maternal and child health and co-author of a article on state abortion restrictions and maternal mortalityShe expects that the impact of these laws, which make it more difficult to end a pregnancy that threatens a mother’s life, will be reflected in the 2023 data.

“I definitely think they will contribute to a higher maternal mortality rate,” she said.

Over the years, there have been several efforts to prevent pregnancy-related deaths, including those from the CDC Hear her campaign to raise awareness of urgent warning signs in mothers and improve communication between pregnant people and their healthcare providers. There also is a CDC initiative to encourage states to share strategies to reduce pregnancy-related deaths.

Monique Rainford, an obstetrician and assistant professor at the Yale School of Medicine, noted that the effect of these programs has not yet been reflected in the maternal mortality rate.

“There is a financial commitment to make things better – you see government commitment and you see conversations,” Rainford said. “But we haven’t seen the results of those investments yet, and there are many initiatives that need investment and haven’t gotten it yet.”

This story is part of the ongoing reproductive healthcare coverage supported by a grant from the Commonwealth Fund.