A Growing Crisis: Racial Disparities in Maternal Mortality Rates

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://sudrecoverycenters.com/our-team/
Staff Research and Content Writer

Despite significant advancements in many areas of women’s health over the past several decades, maternal mortality remains a serious and concerning issue in the United States. Each year, over 700 women die during the perinatal period, which encompasses pregnancy, childbirth, and the postpartum period of 42 days following childbirth. Tragically, the CDC reports that more than 80% of maternal mortality-related deaths are preventable.

Most studies on maternal mortality only examine deaths from direct or indirect obstetrical causes; for example, hemorrhaging, preeclampsia, and infections. However, obstetrical causes are not the only causes of death in pre- and postpartum women. Research and statistics often exclude accidental and incidental (non-obstetric) causes of maternal mortality, leading to an underestimation of the problem. These non-obstetric causes may include homicides, transport accidents, and other forms of violence against women. Studying both obstetrical and non-obstetrical causes of death is crucial to understand better the burden of maternal mortality, in particular across racial groups.

A new study aimed to examine racial disparities in maternal mortality, using an expanded definition of mortality that captured all causes of death in the perinatal period. The study was designed to analyze trends in maternal mortality over time from the period between 2000-2019. Researchers were interested in understanding how maternal mortality rates have changed over the past 20 years and which racial groups

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What did this study do?

This study used data from birth and multiple cause mortality records from the National Center for Health Statistics from 2000-2019. Researchers used these data to calculate maternal mortality during pregnancy, childbirth, and the postnatal period. This study categorized race as White, Black, Asian/Pacific Islander, American Indian, Hispanic, or Other.

The researchers defined maternal mortality as “the death of a woman during pregnancy, childbirth, or the period within 42 days of pregnancy termination from all causes, including those aggravated by pregnancy (obstetrical causes) and accidental and incidental causes. This definition enabled them to collect mortality data from sources often excluded from other studies.

The study used logistic regression to estimate the effects of race on the risk of maternal mortality. It also examined temporal trends in maternal mortality across each racial group over the study period. This statistical analysis allowed the researchers to observe how the rates of maternal mortality changed over time for women in each racial group.

What were the main findings?

Over 21,000 women died between 2000-2019 during the perinatal period in the US. The researchers determined the maternal mortality rate to be 26.3 per 100,000 live births. The maternal mortality rate increased significantly between 2000-2019, with an average annual increase of 1.6 maternal deaths per 100,000 births. In 2000, the rate was just over 10 deaths per 100,000 births; by 2019, it had increased to nearly 40 deaths.

Two-thirds (65.5%) of maternal mortality deaths were due to obstetrical causes. The remaining third were from accidental or incidental causes, the top three being transport accidents, accidental poisoning, and assault. It is worth noting that these deaths would have been excluded from previously completed studies, wherein maternal mortality was defined only as occurring from obstetric causes.

Racial Disparities

This study’s findings underscore the urgent need to address racial disparities in maternal mortality. The study determined that Black women face the greatest maternal mortality risk, consistent with previous research. Black women averaged the highest maternal mortality rate at 51.4 deaths per 100,000 births, nearly twice the population rate.

Both Black and American Indian women are twice as likely to die in the perinatal period than White women. However, mortality rates among Hispanic and Asian women were significantly lower than for White women. American Indian women experienced the most significant temporal increase in mortality rates, with an average increase of 4.7 deaths per 100,000 live births per year. This was followed closely by the increase of 2.4 deaths per year among Black women.

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Why are maternal mortality rates rising?

In discussing the possible explanations for increasing maternal mortality, the researchers first highlight that, in 2003, states began adding a checkbox to death records to indicate if the deceased was pregnant at the time of death. This checkbox made it easier to collect maternal mortality data, potentially leading to a more accurate and comprehensive understanding of maternal mortality rates. However, it also likely contributed to the rise in the maternal mortality rate between 2000-2019, as more cases of maternal mortality were identified due to improved data collection.

Other factors that may have contributed to increased maternal mortality include:

Increased drug use in pregnancy
Increased homicides and violence against women
Complications from cesarean births
Decreased and inequitable access to abortions
Reduced funding for Planned Parenthood
Racism and the social determinants of health

Why are maternal mortality rates higher for Black women?

Black women face the highest risk of maternal mortality of all racial groups in the US.

The top three causes of maternal mortality among Black women are:

Eclampsia
Preeclampsia
Postpartum cardiomyopathy

All these conditions are five times more common in Black women than in White women.

There are many contributing factors to Black women’s increased risk of maternal mortality, but the underlying cause is racism. Structural racism manifests in unequal access to care for Black women, who have lower access to prenatal care, contraceptive care, and abortion services than White women. Hospitals in predominantly Black neighborhoods are also often under-resourced or underfunded, a legacy of racial segregation. Black women also face more financial barriers to accessing health care and are less likely to have insurance than White women.

As a result of structural racism and the social determinants of health, Black women have higher rates of preventable and chronic health conditions such as diabetes, hypertension, and cardiovascular disease, which increase the risk of pregnancy complications and maternal mortality. Historical trauma and minority stress likely also contribute to these health conditions.

Finally, Black women experience racial discrimination and racial bias in health settings. Healthcare providers often do not take Black women’s symptoms seriously due to conscious or unconscious biases, sometimes neglecting to provide life-saving care until it is too late.

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How can we address the unequal burden of maternal mortality in Black women?

Addressing the disproportionately high rate of maternal mortality in Black women requires addressing the systemic and structural racism that continues to permeate the US healthcare system. For example, education campaigns for clinicians focused on addressing racial disparities and historical trauma may help them to unpack their implicit biases and work to dismantle systemic racism in their institutions.

Black women also need to be supported to access comprehensive care, for example, to prevent and address risk factors leading to chronic conditions that increase their risk of mortality during pregnancy. Public health programs should work with Black women and communities to understand the barriers they face to accessing care, work to expand healthcare coverage, and create safe communities and healthcare centers.

Key Points

Maternal mortality has increased in the US over the past 20 years, both from obstetric causes and accidental and incidental causes.
Black women in the US face the highest rates of maternal mortality. Black and American Indian women are twice as likely to die in the perinatal period as White women.
Structural and systematic racism and lack of access to healthcare underlie the disproportionately high rates of maternal mortality among Black women.
Public health programs must work to address racism, expand access to care, and create safe communities and healthcare centers for Black women in order to prevent maternal mortality.

References

Huang, R., Spence, A., & Abenhaim, H. (2024). Racial disparities in national maternal mortality trends in the United States from 2000 to 2019: a population-based study on 80 million live births. Archives of Gynecology and Obstetrics, 309(4), 1315-1322.

Lister RL, Drake W, Scott BH, Graves C. Black Maternal Mortality-The Elephant in the Room. World J Gynecol Womens Health. 2019;3(1):10.33552/wjgwh.2019.03.000555. doi: 10.33552/wjgwh.2019.03.000555. Epub 2019 Nov 22. PMID: 32719828; PMCID: PMC7384760.

Centers for Disease Control and Prevention. (n.d.). Working together to reduce Black maternal mortality. Retrieved November 26, 2024, from https://www.cdc.gov/womens-health/features/maternal-mortality.html

Salcedo, A., & Warren, C. (2023). From birth to death: Black women face a higher maternal mortality rate. Associated Press. Retrieved November 26, 2024, from https://projects.apnews.com/features/2023/from-birth-to-death/black-women-maternal-mortality-rate.html