Maternal Mortality in the United States Is Not Unsolvable, Just Neglected

Every time a woman dies due to pregnancy, childbirth, or related complications, it is a tragedy. Not only does a young woman die, but a newborn infant, and often other siblings, are left to grow up without a mother. Partners are left to grieve and raise their children alone. Communities lose a friend. Heartbreakingly, these tragedies are becoming all too common.

Public health researchers measure these deaths through maternal mortality. The World Health Organization defines maternal mortality as the annual number of deaths due to pregnancy, its management, or childbirth within 42 days of the birth or pregnancy termination. Maternal mortality ratios (MMR) refer to the number of maternal deaths per 100,000 live births. MMRs allow us to compare maternal mortality.

The MMR in the United States has been increasing since 1997 and is higher than comparable high-income countries. In 2020, our MMR was 23.8 maternal deaths per 100,000 births, compared to 1.2 in the Netherlands, 2.0 in Australia, and 8.4 in Canada. While our MMR already looks bleak in comparison to these countries, consider our MMR for Black women in 2020: 55.3 maternal deaths per 100,000 births. The rate of maternal death for Black women is double the country’s average rate and almost three times higher than that of White women. This trend isn’t new: Black women have been between three and four times more likely to die due to pregnancy and childbirth since the 1970s. Additionally, the previous data was from before the COVID-19 pandemic, which worsened maternal outcomes, including maternal mortality, and exacerbated racial disparities for Black women.

My home state of North Carolina is not immune to this problem. In 2021, the state’s MMR was 44 per 100,000 births, which is higher than the national rate and double the state’s 2019 rate. We have high racial disparities in birth outcomes and a high level of maternal vulnerability, especially in eastern counties. Our maternal vulnerability index, which looks at clinical risk factors and social, contextual, and environmental factors to understand a community’s likelihood of poor birth outcomes, is particularly elevated due to socioeconomic determinants and access to healthcare. Thirty-eight percent of counties are maternity care deserts or have low access, meaning that there are one or fewer hospitals or birth centers providing obstetric care and not enough obstetric providers for the population or a high proportion of women without health insurance.

As a current public health graduate student in the Department of Maternal, Child, and Family Health at the University of North Carolina at Chapel Hill, I often read about maternal morbidity and mortality. While this is becoming a more widely discussed issue, I still don’t see it frequently connected to the recent attacks on reproductive rights.

Access to reproductive and obstetric care has become more difficult since the overturning of Roe v. Wade. In North Carolina, access to abortion is very restrictive, with abortion being banned at and after twelve weeks and state Medicaid coverage of abortion being banned. Even before the overturning of Roe v. Wade, abortion-restriction states had higher maternal mortality rates, higher proportions of maternity care deserts, and higher proportions of pregnant people with late or no prenatal care. Due to an increased number of women who are being forced to be pregnant, an increased number of illegal abortions, and reduced access to healthcare, as well as the fact that childbirth is more dangerous for women than safe and legal abortion, abortion restrictions will result in higher maternal mortality rates. Using the MMR from 2020, there were 23.8 maternal deaths in the United States per 100,000 births compared to 0.41 abortion-related deaths per 100,000 births. Solely using this knowledge, researchers estimated that if no abortions occurred in the United States in 2020, the MMR would increase by 24 percent, with the greatest increases being for Black women.

Even so, maternal mortality doesn’t demonstrate the entire problem: for every woman who dies in pregnancy or childbirth, between 75 and 100 women experience a life-threatening complication. Some of the most common causes of these complications include hemorrhage, preeclampsia or eclampsia, sepsis, anesthesia or Cesarean delivery complications, and pre-existing conditions such as heart or kidney disease, diabetes, or autoimmune diseases. Severe maternal morbidity (SMM), referring to unexpected outcomes of childbirth that can cause long-term or short-term health consequences for the birthing person, captures these complications and has been increasing alongside maternal mortality. This can lead to consequences in addition to the health effects, including increased medical costs, longer hospitalizations, and separation between the birthing person and their newborn.

While far-reaching and complex, maternal mortality is not an unsolvable problem; it’s just neglected. Rather than restricting access to reproductive and obstetric healthcare, as many states are doing in the aftermath of Dobbs v. Jackson Women’s Health Organization, more policies need to be expanding healthcare coverage. Medicaid expansion, which has been adopted in North Carolina, increased preconception and postpartum insurance among low-income pregnant people, resulting in increased use of outpatient care and reduced hospitalizations within the first six months postpartum. This may lead to greater trends in reduced maternal morbidity and mortality. The Black Maternal Health Momnibus Act, introduced in the Senate, proposes a multitude of policies to target disparities in maternal morbidity and mortality by investing in the social determinants of health, extending WIC eligibility, funding community organizations working in this space, and improving data collection processes.

Use your power to vote and urge policymakers to support policies that can save women’s lives.