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The number of people dying in the United States from pregnancy-related causes has more than doubled in the past 20 years, according to a new study, published in JAMA, THE Journal of the American Medical Association.
And while the study found that death rates remain « unacceptably high among all racial and ethnic groups in the United States, » the worst performers were among Black women, Native Americans and Alaska Natives.
The study examines state-by-state data from 2009 to 2019. Co-author Dr. Allison Bryantan obstetrician at Massachusetts General Hospital in Boston, says maternal mortality rates in the United States continue to deteriorate.
“And that is exacerbated in populations that have historically been underserved or where structural racism affects them greatly,” she says.
Maternal mortality rates have consistently been the highest among black women, and these high rates have more than doubled in the past twenty years. For Native Americans and Alaska Natives, the rates tripled.
Dr. Gregory Roth, at the University of Washington, is also a co-author of the paper. He says efforts to halt pregnancy deaths haven’t just stalled in areas like the South, where rates have typically been high. « We’re showing that they’re getting worse in places that are thought to have better health, » he says.
Places like New York and New Jersey have seen an increase in deaths among Black and Latina mothers. Wyoming and Montana saw more Asian mothers die. And while maternal mortality is lower for white women, it’s also on the rise in some parts of the country.
« We see that for white women, maternal mortality is also increasing throughout the South, parts of New England, and all parts of the Midwest and Northern Mountain states, » she says.
The steady rise in maternal mortality in the United States stands in contrast to other high-income countries that have seen theirs much lower rates go down more and more.
“There’s this crystalline graph that’s been out there that’s very amazing,” Bryant says. With countries such as Holland, Austria and Japan in sharp decline. “And then there is the United States which is way above them and going in the opposite direction,” she says.
Most maternal deaths are deemed preventable by state review boards. Dr Catherine Spong, at the University of Texas Southwestern Medical Center, says pregnancy-related deaths can be caused by several different things. The biggest risk factors are conditions like cardiovascular disease, severe preeclampsia, maternal heart disease and bleeding, she says.
Continuing heart problems and mental health conditions can also contribute to the death of a new mother.
Researchers say doctors would be more likely to address these health conditions if more women had access to health care after the birth of their babies.
About half of births in the United States are paid for by Medicaid, and « most deaths occur in the immediate postpartum period, » Roth says. « If you don’t have easy access to health care during this time, you are at very high risk. »
For those who get health care through Medicaid, medical coverage lasts at least two months after the birth of a child. Starting in 2021, states have the option to extend that coverage for one year. So far, 36 states and Washington DC have done so. States like Alabama and Mississippi, which have seen some of the highest increases in maternal mortality, have not.