The number of people in the U.S. dying from pregnancy-related causes has more than doubled in two decades, with black, Native Americans and Alaskan Native people at greatest risk, according to a new study in JAMA.
The US has the highest maternal mortality rate compared to other high-income countries, despite spending much more on health care, both per person and per share of gross domestic product. And while maternal mortality rates have long been high in the US, they’ve only gotten higher, while other high-income countries have seen a decline.
Still, it’s hard to dig into the U.S. maternal mortality data to understand the trend. States define maternal mortality differently, some have been slow to add a standard pregnancy-related question on death certificates, and some are delaying the release of their data.
In the new JAMA study, researchers sought to make up for those differences by modeling maternal mortality trends at the state level using national data, looking specifically at death rates by race and ethnicity for each year between 1999 and 2019. The study was led by Gregory Roth of the Institute for Health Metrics and Evaluation at the University of Washington.
Overall, the study’s findings are consistent with what we already know about maternal mortality in the US: It’s high and getting higher and especially high for black people in Southern states. But it also revealed growing inequalities in specific states and ethnic groups that had not been highlighted before.
Overall, the study noted that in 1999 there were an estimated 505 pregnancy-related deaths — defined as deaths related to pregnancy by medical coding that occur up to one year after termination of pregnancy. (Unintentional injuries, homicides and suicides were excluded). In 2019, the number of pregnancy-related deaths more than doubled to 1,210. The maternal mortality rate (deaths per 100,000 live births) went from 12.7 in 2009 to 32.2 in 2019.
Among black pregnant people, the national death rate went from 31.4 to 67.7 during that time. For each year studied, the black population had the highest state median for maternal mortality. Unsurprisingly, many of the states with the highest maternal mortality rates that rose during the study period were in the South, but not all. New Jersey and Arizona were among the top five states with the largest increases in black maternal mortality during the study period, along with Louisiana, Georgia and Texas.
The American Indian and Alaska Native population saw the largest increases in median death rates in the state. Florida, Kansas, Illinois, Rhode Island and Wisconsin all saw death rates in these populations increase by more than 162 percent during the study period. Asian maternal mortality rates, meanwhile, were high in Wyoming, Montana and Nevada, which are home to many Filipino populations.
Hispanic and white populations saw lower maternal mortality rates than the other groups, but still saw increases, especially in the South and Northeast. The authors note that mental health is a leading factor in maternal mortality in these two groups, and because suicide and overdose deaths were excluded from the study, it may have masked some estimates of maternal mortality in these groups.
Overall, the study paints a bleak picture of maternal health in the US. “Maternal mortality remains a source of increasing inequities in many US states and prevention efforts during this study period appear to have had limited impact in addressing this health crisis,” the authors conclude.
In addition, the study period ended in 2019 before the CDC reported a pandemic-related spike in pregnancy-related deaths. Maternal morbidity and mortality are also expected to increase following the Supreme Court’s decision to overturn the constitutional right to abortion. Bans and restrictions now going into effect in about half of the US states will restrict access to abortion and pregnancy care.
Editor’s Note: This post has been updated to correct the dates of the study.