The 2020 maternal mortality rates were just released by the Centers for Disease Control’s National Center for Health Statistics. The new information indicates that the United States continues to move in the wrong direction, and has had an increase in both the number and rate of people dying in the childbearing year.  Black and brown families have rates that are significantly higher than their white peers.

According to the World Health Organization:

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” is considered a maternal death. The maternal mortality rate is expressed as the number of maternal deaths per 100,000 live births.

In 2020, 861 people died of maternal causes in the United States, compared with 754 in 2019 (3). The maternal mortality rate for 2020 was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019.

In the United States, the COVID pandemic was the country’s reality starting in March 2020, though the original US cases had been reported earlier that year.  While the increased maternal mortality rate is not all due to pregnant people being sick with COVID, the pandemic created many downstream disruptions in the health care system that impacted people’s access to timely and appropriate care and limited needed resources.

For Black women in 2020, the maternal mortality rate was 55.3 deaths per 100,000 live births.  This rate is 2.9 times the rate for non-Hispanic White women.  The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women were significant.   The rates also increased as the age of the pregnant parent increased.  The maternal mortality rate for pregnant/postpartum people aged 40 and over was 7.8 times higher than the rate for people under age 25.

The United States continues to hold the ranking of the worst maternal mortality rate of all the developed countries.

It is easiest to blame the pregnant people themselves for this increase in 2020, stating people missed perinatal care appointments possibly due to lack of childcare for other children, school closures, and fear of being in public with high COVID case counts.  Additional stress, mental health challenges and increased substance abuse concerns and rising obesity rates, along with people delaying giving birth until they are in their late thirties or older also are stated as contributing to the increase.

But, according to a report released by the Commonwealth Fund, whose mission is to “promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color,” Obstetricians are overrepresented in the USA’s maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers relative to births.  Many other countries have significantly more midwives available to support growing families and these midwives play a key role in primary care for reproductive-aged people.  

As stated above, deaths that occur in the first 42 days after birth are included in the maternal mortality rate.  52% of all maternal deaths occur after birth or in the postpartum period. It is important to note that the United States is the only country that does not routinely provide home visits by health care providers.  Paid parental leave in the postpartum period is also not mandated, forcing many people to return to work while still recovering from their pregnancy and birth experience.  This lack of paid leave is unique to the United States.

The solution

The Centers for Disease Control states that most maternal deaths are preventable. The lack of Black and brown health care providers (both physicians and midwives), institutional racism and a desert of maternity care available to serve rural communities all contribute to the rising maternal mortality rate.

Solutions are available that can help to prevent more parents from dying during the childbearing year. Childbirth educators and other perinatal professionals can make a difference.  Make quality childbirth classes, such as those offered by Lamaze Certified Childbirth Educators both in person and online, accessible to all pregnant people in a wide variety of communities, so that families understand the labor and birth process and develop self-advocacy skills that can help them to find their voice and be involved as equal partners in their health care decisions.  Encourage state governments to fund birth and postpartum doulas so income qualified families can receive support during the most vulnerable time periods.  Increase the number of health care providers of color.  Help families understand that midwifery care is an appropriate choice for healthy, low-risk pregnant people, and that they can choose where to give birth, including in a birth center or at home.  Advocate for out of hospital birth attended by a Certified Professional Midwife to be legal in all 50 states. Listen to Black and brown voices, when they state that something is not right.  Believe Black and brown pregnant birthing and postpartum people when they share what is happening to their bodies.

Every person matters

Every single person who lost their life as result of being pregnant, or giving birth leaves a broken family.  A child (or children) who will live without a parent, a partner who is left to parent alone without a loved one, a hole in an extended family structure that can never be patched.  We can do better and we must.

References

Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. DOI: https://dx.doi.org/10.15620/cdc:113967

Hoyert DL, Miniño AM. Maternal mortality in the United States: Changes in coding, publication, and data release, 2018. National Vital Statistics Reports; vol 69 no 2. Hyattsville, MD: National Center for Health Statistics. 2020.

Roosa Tikkanen et al., Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries (Commonwealth Fund, Nov. 2020). https://doi.org/10.26099/411v-9255

World Health Organization. International statistical classification of diseases and related health problems, 10th revision. 2008 ed. 2009.

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