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HomeWorldMaternal Deaths Saw Alarming Spike During the Pandemic, Study Shows

Maternal Deaths Saw Alarming Spike During the Pandemic, Study Shows

New figures offer a grim picture of the state of maternal health in the U.S. during the COVID-19 pandemic, with the maternal mortality rate increasing by 38% from 2020 to 2021 as racial disparities in outcomes continued to widen.

A total of 1,205 women in 2021 reportedly died either during or within 42 days of the end of their pregnancy, according to the analysis, compared with 861 women in 2020 and 754 in 2019. Before COVID-19, the average number of women who died each year from complications related to pregnancy or delivery had remained around 700.

Findings of the report are based on data collected from the CDC’s National Vital Statistics System, which includes only maternal deaths linked to a pregnancy or its management and not deaths from accidental or incidental causes.

The rate of maternal deaths increased across all racial and ethnic groups in 2021, but has disproportionately affected women of color, particularly Black women, who had the highest mortality rate compared to Hispanic and non-Hispanic white women.

The maternal mortality rate among non-Hispanic Black women rose by 26% from 2020 to 2021, from 55.3 deaths per 100,000 live births to 69.9 deaths per 100,000. Among non-Hispanic white women, rates increased by 39% from 2020 to 2021, from 19.1 deaths per 100,000 to 26.6 deaths per 100,000.

Andria Cornell, associate director for Women’s and Infant Health at the Association of Maternal and Child Programs, says such racial disparities are rooted in a system based in structural racism that stakeholders have only just begun to acknowledge and address.

“There is an environment now where public health professionals, knowledgeable about this influence, can’t confront antiquated or harmful institutional practices and policies and propose changes they know will help because they are being hamstrung by the politicization of terms and different interpretations of events in history,” Cornell says. “We are overdue in confronting hard truths, and until we do, we as a nation will continue to nibble at the edges of this crisis.”

For the second straight year, Hispanic women had the largest increase in maternal mortality rates, rising 54%, from 18.2 deaths per 100,000 in 2020 to 28 deaths per 100,000 in 2021, according to the study.

The study found maternal mortality increased by age, with the rate among women 40 and older increasing by 28% in 2021 to 138.5 deaths per 100,000 live births. The rate among women ages 25 to 39 increased by 37% to 31.1 deaths per 100,000 in 2021, while the rate among women under age 25 had the largest increase of any age group studied in 2021, rising 48% to 20.4 deaths per 100,000 compared to 13.8 deaths per 100,000 in 2020.

Study researchers say COVID-19 likely accelerated the rise in maternal mortality in 2021. “Both the number and percentage of maternal death records mentioning COVID-19 among the causes of death were greater in 2021 than in 2020,” a CDC spokesperson said in an email response to questions.

Experts say the pandemic had an indirect role in disrupting health care services as hospitals and clinics temporarily canceled many routine services like prenatal and perinatal care visits, which likely put vulnerable women at a greater health risk.

“Prior to the pandemic there was a growing consensus in health care and public health that accountability for health needed to be in the hands of birthing people – driving respect and holistic care and support,” Cornell says. “Many of the gains that were being made were upended by the pandemic and hospital and health care institution policies that prioritized protection from COVID-19. We’re likely seeing these impacts, especially for birthing persons with chronic or more complex health conditions.”

Preliminary signs do, however, seem to indicate maternal mortality has fallen as the severity of the pandemic has eased. A provisional count of maternal mortality deaths for a 12-month period ending October 2022 shows there were 830 maternal deaths, according to CDC data. While slightly higher, that figure is still closer to the annual number of maternal deaths that occurred in the years leading up to the pandemic.

However, as the Biden administration prepares to end the public health emergency related to the pandemic on May 11, some of the coverage protections and flexibilities provided during the emergency for Medicaid beneficiaries could make it more difficult for women to access maternal health care services. After the declaration expires, states will go back to pre-pandemic Medicaid eligibility requirements, which could remove pregnant women from coverage. Medicaid is the single largest payer of pregnancy-related care services in the U.S., covering the cost of nearly half of all births.

“We need to think about who is not going to have access to insurance coverage, who is not going to have access to key supports that have been critical to helping people live their lives,” says Dr. Laurie Zephyrin, senior vice president for advancing health equity for the Commonwealth Fund, a private foundation that promotes high-performing health care in the U.S.

Efforts to reduce maternal mortality could be further complicated by the U.S. Supreme Court’s decision in June 2022 to overturn Roe v. Wade, the landmark case that established a right to abortion. A Commonwealth Fund report from last December found fewer maternity care providers and resources and higher rates of maternal and infant mortality in states that have imposed or planned to impose restrictions on abortion compared to states where there were fewer restrictions.

“Given where we are today in terms of deaths, looking at just the different outcomes currently, people are at risk and it’s pretty scary,” Zephyrin says.

Previous evidence has ranked the U.S. near the bottom compared to other wealthy countries in terms of maternal health outcomes. A 2022 Commonwealth Fund report found women of reproductive age in the U.S. were more likely to delay or cancel medical visits due to cost and to spend more out of pocket for their health care. They were also less likely to have regular doctor visits or a place of care than women in most other countries.

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