Alarming rise in rate of Black and poor women dying during delivery in Pa. hospitals: study

The rate of pregnant Black and poor women who died while in Pennsylvania hospitals for delivery is on an alarming rise, according to a new study by a state health care agency.

Findings from the Pennsylvania Health Care Cost Containment Council show a spike in the death of expectant mothers hospitalized in Pennsylvania between 2016 and 2022. The most common causes of death cited in these cases involved acute renal failure and abnormal blood clotting and bleeding.

The findings show that the rate of severe maternal morbidity increased 40% in that time period, with the highest rates of morbidity tracked among Black women.

The increased rate of morbidity was also seen among Black women 40-55 years of age; women insured by Medicaid; and women who live in zip codes with poverty rates over 25%.

“When our research team identifies a data trend such as this, we know we need to make our stakeholders aware,” said Dr. Jane Keck, director of health policy research at the council. “We know this reporting provides valuable insights. We hope it can help improve future outcomes too,” she added.

The findings from the council align with national statistics that show broad health-related racial disparities. Studies show that Black women nationwide are three to four times as likely to die of pregnancy-related complications as white women. The statistics are nearly as dire for Native American women, who are more than twice as likely to die from those complications.

Dr. Sharee Livingston, chair of the ob-gyn department at UPMC Lititz, said the PCH4 report reflects a trend in recent data: the COVID-19 pandemic, among other things, has widened the gap in health disparities, particularly in communities of color.

“This research brief examines severe maternal morbidity (SMM) among patients hospitalized in Pennsylvania and should make readers stop in their tracks,” she said. “Everyone is impacted when a mom dies or her health is seriously affected, from her baby to her family to her community. Everyone must say, ‘We must identify and find solutions to the maternal health crisis.’”

The maternal health data also show that chronic conditions matter, Livingston added.

“Patients entering pregnancies with chronic conditions can increase their pregnancy risks,” she said. “We must improve access to preventive health care so that patients enter pregnancy healthier.”

Medical experts have for decades tracked these troubling disparities and attributed them to socio-economic factors such as housing, public safety, and lack of access to healthy food and water. Medical factors — lack of health insurance, a higher incidence of obesity, diabetes, hypertension and other chronic conditions — also play a role.

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The conversation increasingly in recent years has focused on the role that racism and implicit bias affect the birthing outcomes of Black women.

The four-year survey by the Pennsylvania Health Care Cost Containment Council found consistently high rates of death for Black, non-Hispanic patients. At the same time, morbidity rates were consistently lowest for white patients. The increase in sudden maternal morbidity during the study period was largest for Black patients: a 51% increase in 2021.

The study found consistently higher rates of death among patients covered by Medicaid compared to patients with commercial insurance.

The council is an independent state agency tasked primarily with addressing rapidly growing health care costs.

“Diversifying the perinatal workforce, utilizing supportive systems like doula care, and prioritizing health equity for communities of color and vulnerable populations are essential to decreasing maternal morbidity and mortality,” Livingston said.

Editor’s note: This report has been updated to add comments from Dr. Livingston.

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