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The number of U.S. maternal deaths in 2020 jumped 14 percent from 2019, going from 754 to 861, according to a report from the National Center for Health Statistics (NCHS).
Although the report didn’t investigate the reason behind the increase, many experts believe that COVID-19 and interruptions in care due to stay-at-home orders during the pandemic is at least partly to blame.
“Yes, the pandemic likely contributed to the increase from 2019 to 2020 and beyond that,” said Donna Hoyert, PhD, a health scientist in the NCHS’s Division of Vital Statistics and the author of the report, in an interview with ABC news.
“As the pandemic plays out, we want to see how it affects overall mortality rates and our trend of comparable data over time,” she said.
Other studies have come out documenting continuing mortality from COVID-19 and excess mortality associated with that, Dr. Hoyert added.
A study published in July 2021 used insurance data to look at 489,471 hospital deliveries between March and September 2020 and found that women with COVID-19 were at increased risk of several conditions, including death.
2 Out of 3 Maternal Deaths Are Preventable
A maternal death is defined by the World Health Organization as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
In the United States, a maternal death includes those related to pregnancy or its management. Deaths from accidental or incidental causes are not included.
Two-thirds of pregnancy-related deaths in the United States could be prevented, according to the Centers for Disease Control and Prevention (CDC).
Maternal Death Rates Were Significantly Higher for Black and Hispanic Women
All ages and all racial groups had increases in maternal mortality in 2020, though the overall rise was largely driven by Black and Hispanic women.
- Black women had the highest maternal mortality rate of the three racial or ethnic groups included in the report, with 55.3 deaths for every 100,000 live births, an increase of 26 percent over the previous year.
- White women had 19.1 deaths per 100,000 births, an increase of 7 percent compared with 2019.
- Hispanic women had a maternal death rate of 18.2 deaths per 100,000 births. Although Hispanic women continue to have the lowest mortality rate, the number of pregnancy-related deaths in this group jumped by 44 percent in 2020.
“This report is an accurate reflection of my experience, especially in regard to Black women,” says April Miller, MD, MPH, an assistant professor at the Wake Forest School of Medicine in Winston-Salem, North Carolina, who was not involved with the new report. “As a Black woman and an ob-gyn, I am alarmed at the increase of the mortality rate and even more alarmed at the huge disparity between Black women and non-Hispanic white women, which is 2.9 times higher in Black women,” says Dr. Miller.
Pregnancy-Related Deaths Are Higher in Older Women
The highest mortality rate among age groups was for women over the age of 40, with 107.9 per 100,000 births, about 7.8 times higher than the rate for women younger than 25.
The risks, including premature birth, gestational diabetes, and high blood pressure, increase for women who become pregnant after the age of 35, according to the Mayo Clinic.
The U.S. Continues to Lag Behind Other Developed Countries in Preventing Maternal Deaths
Even before the pandemic, the maternal mortality rate in United States was worse than in other developed countries. A 2020 report by the Commonwealth Fund found that the United States had the highest death rate for mothers compared with 10 other developed countries.
The authors found that the maternal death rate was 17 deaths per 100,000 live births in 2018, more than twice the rate of most other high-income countries; by contrast, the Netherlands, Norway, and New Zealand all have 3 or fewer maternal deaths per live births.
“Although the U.S. is a first world country, many people live in third world conditions,” says Miller. “For example, there are many food deserts — areas that have limited access to affordable and nutritious food — in the U.S.,” she says.
Poor Heart Health Is Likely a Factor in Maternal Death
“We have increased rates of obesity, diabetes mellitus, and chronic hypertension relative to these other countries, which can certainly have an impact on the greater incidence of maternal death,” said Shari Martin Lawson, MD, the division director of general obstetrics and gynecology and an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine in Baltimore, in an earlier interview with Everyday Health.
A study published this month in Circulation found that only about two in five U.S. women who gave birth in 2019 had good heart health prior to their pregnancy, with overweight and obesity being the primary risk factors, followed by high blood pressure and diabetes.
Poor heart health puts both mothers-to-be and their children at risk, with heart disease causing more than one in four pregnancy-related deaths (26.5 percent) according to the American Heart Association Heart Disease and Stroke Statistics 2022 Update.
Health Officials Aim to Increase Preventive Funding and Awareness of Maternal Death in the U.S.
Efforts to reduce the number of women who die of pregnancy- and delivery-related complications are underway.
In 2021, the Biden administration instituted Black Maternal Health Week, which will be recognized April 11–17 each year. The White House has pledged to reduce the “unacceptably high maternal mortality and morbidity rates and to [tackle] health disparities that are rooted in systemic racism,” according to a statement.
That includes increased funding to train healthcare workers to recognize bias and ensure the protection of civil rights in healthcare.
The HEAR HER campaign is focused on educating women about urgent maternal warning signs during and after pregnancy and seeks to improve communication between women and their healthcare providers.
“Many people have limited health literacy, and they do not know what questions to ask their healthcare providers,” says Miller.
Signs and Symptoms to Watch for During Pregnancy and a Year After Delivery
Here are some warning signs of potentially life-threatening situations, according to the CDC.
- Headache that won’t go away or gets worse over time
- Dizziness or fainting
- Changes in vision
- A fever of 100.4 or higher
- Extreme swelling of the hands or face
- Thoughts about harming yourself or your baby
- Trouble breathing
- Chest pain or racing heart
- Severe nausea and vomiting
- Severe belly pain that doesn’t go away
- Baby’s movement stops or slows during pregnancy
- Vaginal bleeding or fluid leaking during pregnancy
- Heavy vaginal bleeding or discharge after pregnancy
- Severe swelling, redness, or pain in your leg or arm
- Overwhelming tiredness
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