The Uneven Burden of Maternal Mortality in the U.S.

Reproductive health and maternal health encompasses: American Civil Liberties Union, Why We Use Inclusive Language to Talk About Abortion, June 2022

What does maternal mortality mean in the US?

What does maternal mortality mean in the US: The Commonwealth Fund, Maternal Mortality in the United States: A Primer, December 2020

• Pregnancy-associated mortality

• Pregnancy-related mortality

• Maternal mortality ratio

Pregnancy-related mortality in the United States: Centers for Disease Control and Prevention (CDC), Reproductive Health: Pregnancy Mortality Surveillance System, April 2022

• NOTE: The graph above shows trends in pregnancy-related mortality ratios between 1987 and 2017 (the latest available year of data)

Highest maternal mortality: The Commonwealth Fund, Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries, November 2020

Maternal mortality increasing: National Public Radio (NPR), U.S. Has The Worst Rate Of Maternal Deaths In The Developed World, May 2017

When do pregnancy-related deaths occur: The Commonwealth Fund, Maternal Mortality in the United States: A Primer, December 2020

• 31% - Maternal deaths during pregnancy
• 17% - Maternal deaths around time of delivery
• 52% - Postpartum maternal deaths (up to 1 year)

Childbirth is the leading reason for hospitalization of women in the US: Kozhimannil KB, Shippee TP, Adegoke O, Vemig BA. Trends in hospital-based childbirth care: the role of health insurance. Am J Manag Care. 2013;19(4):e125-e132. April 2013

2 out of 3 deaths are preventable: Centers for Disease Control and Prevention (CDC), Pregnancy-Related Deaths in the United States, February 2022

Racial and ethnic disparities continue in maternal mortality

Maternal mortality rate for Black women was about 3x the rate for White women: Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022

Maternal mortality by race: Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022

• NOTE: Data are from the National Vital Statistics System mortality file. Consistent with previous reports, the number of maternal deaths does not include all deaths occurring to pregnant or recently pregnant women, but only those deaths with the underlying cause of death assigned to International Statistical Classification of Diseases

• NOTE: Maternal mortality rates are per 100,000 live births based on data from the National Vital Statistics System natality file.

Factors contributing to racial maternal mortality disparities: Centers for Disease Control and Prevention (CDC), Health Equity: Working Together to Reduce Black Maternal Mortality, April 2022

Leading causes of maternal death for Black women: MacDorman MF, Thoma M, Declercq E, and Howell EA. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016-2017. American Journal of Public Health DOI: 10.2105/AJPH.2021.306375 (2021)

What happens when access to maternal health care is restricted?

Impacting on reproductive health outcomes: Hawkins, Summer Sherburne et al. “Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study.” American journal of preventive medicine vol. 58, February 2020

How to reduce maternal mortality and morbidity in the US?

Invest in social determinants of health

Invest in social determinants of health & address structural racism: Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019

Increase access to alternative perinatal workforce

Benefits of receiving midwifery care: American Pregnancy Association, Midwives, 2021

• Increased satisfaction
• Increases chance at positive breastfeeding

Benefits of receiving midwifery care: Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, et al. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. 2018

• Fewer adverse neonatal outcomes
• Reduced racial disparities in maternity care access
• Less obstetric interventions
• Cost-effectiveness

Diversify the perinatal workforce

Birthing population and workforce: The Commonwealth Fund, Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health

• NOTE: Original data come from here

Invest in alternative maternal care options

Invest in tele-health: Amritha Bhat et al., “Longitudinal Remote Coaching for Implementation of Perinatal Collaborative Care: A Mixed-Methods Analysis,” Psychiatric Services 71, no. 5, 2020

Invest in black community-based organizations: Julian Z, Robles D, Whetstone S, Perritt JB, Jackson AV, Hardeman RR, Scott KA. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Semin Perinatol. June 2020

Improve point of care locations for maternal health

Implementing hospital-wide safety bundles: Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019

Integrating multidisciplinary care for women: Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019

Regionalizing maternal levels of care: Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019

Support parents and families before and after birth

Providing patient education on early warning signs for pregnancy complications: Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019

Increase access and coverage to postpartum care: American College of Obstetricians and Gynecologists, Extend Postpartum Medicaid Coverage, 2022

Improve paid maternal leave: National Partnership for Women & Families, Paid Leave Is Essential for Healthy Moms and Babies, May 2021