The rate of women dying in childbirth surged by 40%. These deaths are preventable.

Nada Hassanein and Nathaniel Shuda, The Columbus Dispatch
·6 min read
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Maternal death rates surged by nearly 40% during the second year of the pandemic, widening disparities as Black women again faced alarmingly high, disproportionate rates, a new federal analysis shows.

In 2021, there were about 33 maternal deaths per 100,000 live births — a 38% increase from the year before, according to the report released recently from the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Experts say COVID-19 likely contributed to the increases but that the sobering rates continue to reveal deep flaws in health systems, such as structural racism, implicit bias and communities losing access to care.

“A roughly 40% increase in preventable deaths compared to a year prior is stunning news,” Dr. Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists, said in a statement to USA TODAY.

The rates “send a resounding message” that maternal health and evidence-based efforts to eliminate racial inequities must remain at the forefront of public health priorities, Hoskins said.

'Staggering': More than 80% of US maternal deaths are preventable

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Most maternal deaths — which happen during pregnancy, labor or within 42 days of birth, per the CDC — are preventable. The United States' maternal death rate continues to be higher than other wealthy, developed countries, and the new data shows a roughly 60% increase in overall rates in 2021 from 2019, the year before the start of the pandemic.

Ohio experienced nearly 24 maternal deaths for every 100,000 live births in 2018, the most recent data available, according to the state. That amounted to a 38% increase from 2008-2016.

While the CDC bases its data only on vital statistics, such as birth and death certificates, the Ohio Pregnancy-Associated Mortality Review also uses medical and social service records to provide more detailed data it can then use to recommend prevention strategies and determine whether the death was directly related to pregnancy or merely associated with it, according to the Ohio Department of Health.

'Inequities are increasing'

In total, 1,205 women died of maternal causes in 2021, an increase from 861 in 2020 and 754 in 2019.

Maternal death rates among all racial groups saw statistically significant increases, according to the analysis:

  • Black women again saw the highest rates at almost 70 deaths per 100,000 births, up from about 55 in 2020.

  • White women’s rates also saw concerning increase, jumping from 19 to 26.6 deaths per 100,000 in 2021.

  • Hispanic women’s rates surged from about 18 to 28 deaths per 100,000. Prior to the the pandemic, Hispanic women had lower rates than white women.

While Black women gave birth less in 2021 compared to 2020, they died at higher rates.

According to a 2019 analysis of pregnancy-associated deaths in Ohio from 2008 to 2016, Black women died at a rate more than two and a half times that of white women.

“It’s alarming that this disparity continues,” said Dr. Kamilah Dixon, clinical assistant professor of obstetrics and gynecology and medical director of Moms2B at the Ohio State University Wexner Medical Center in Columbus. “It really begs us in health care — and, really, everyone — to pay attention to this.”

The new CDC analysis also found deaths among women 40 and older were almost seven times higher than those women younger than 25.

It also mirrors the findings of existing research by the Abigail Wexner Research Institute at Nationwide Children’s Hospital and CelebrateOne, a Columbus nonprofit created in 2014 to help pregnant women and new mothers have a healthy pregnancy and first year.

The study, published in 2022, identified seven themes that describe the experiences of women of color: Lack of knowledge, mental health, communication with providers, support systems, representation, social determinants of health and discrimination and stigma.

"There's power in the patient voice," Dixon said, noting Ohio State also is researching the issue. "For so long, the voice of Black birthing people have been discluded from this."

COVID-19 and maternal mortality

Pregnant people are more vulnerable to COVID-19, and the virus can contribute to severe complications in pregnancy, according to the CDC.

“While we are still working to better understand the drivers of this increase, we know that pregnant or recently pregnant persons are more likely to get severely ill from COVID-19 compared to people who are not pregnant,” Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health, told USA TODAY.

A report from the U.S. Government Accountability Office last year found COVID-19 contributed to about a quarter of maternal deaths.

“The pandemic has brought in a pathophysiology that puts those women more at risk,” said Dr. Idalia Rosado-Torres, obstetrician and gynecologist at Chesapeake Regional Medical Center and site director of Ob-Hospitalist Group.

Preeclampsia risk, for example, increases when a patient has COVID-19, she explained.

More: COVID-19 contributed to a quarter of maternal deaths from 2020 to 2021

Barfield said other factors at play also include chronic conditions during pregnancy, access to quality care during and after pregnancy, and structural racism and implicit bias.

Reports have shown disparities persist even when accounting for education or income, reflecting potential bias in care. For example, Black women with college education still died at higher rates than white women with the same education level. Research has also found Black babies are more likely to survive when cared for by Black doctors.

Dixon said systems need to prioritize equity and implement evidence-based practices, such as patient safety strategies from the Ohio Better Birth Outcome collaborative.

"It's important that we're making sure that we recognize that these gaps happen regardless of socioeconomic status," she said. "It's about making sure people have providers that they trust and … making sure our workforce is reflective of the people that we serve."

Maternity care is disappearing

The continued increase in deaths underscores the nation's crisis of disappearing maternal health care.

Half of the nation’s rural counties have no obstetric care or OB-GYN practitioner, for example, and researchers found Black communities are more likely to lose their obstetric units.

About 2 million rural women of childbearing age live at least 25 miles away from a labor and delivery unit, a USA TODAY analysis found. Some urban communities are also losing their labor and delivery units.

"These maternity care deserts are very problematic because that means people have to travel farther to get care. People have to wait longer for appointment times," said maternal health scholar and professor Ndidiamaka Amutah-Onukagha, founding director of the Tufts University Center for Black Maternal Health and Reproductive Justice.

There's a "depleting of resources, of infrastructure, in Black and brown spaces where we are already seeing more increased likelihood or prevalence of chronic conditions," Amutah-Onukagha said.

The disappearing care, coupled with the pandemic, exacerbates the problem for people who are already at high risk, Rosado-Torres said.

The dearth is “isolating them from the care that they need,” she said.

Nada Hassanein is a national correspondent at USA TODAY covering environmental and health inequities. Reach her at nhassanein@usatoday.com or on Twitter @nhassanein_.

Nathaniel Shuda covers health and affordable housing for The Columbus Dispatch. Reach him at nshuda@dispatch.com or on Twitter @NathanielShuda.

This article originally appeared on The Columbus Dispatch: Why maternal mortality rate surged by 40% when deaths are preventable