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More than four out of five maternal deaths in the United States are preventable. This is the sobering news from an analysis of federal maternal death data released Monday by the Centers for Disease Control and Prevention (CDC).
The analysis is based on figures from Maternal Mortality Review Committees (MMRCs) in 36 states that investigate circumstances around maternal deaths. Pregnancy-related deaths analyzed by the CDC include deaths during pregnancy, delivery and up to a year postpartum.
A Commonwealth Fund study in April also found that US women of reproductive age (18 to 49) have the highest rates of death from avoidable causes, including pregnancy related complications, far outpacing deaths of women in 10 other high-income countries.
The COVID-19 pandemic has served to exacerbate this already damning state of affairs. Based on National Center for Health Statistics (NCHS), a JAMA Network Open research letter published in June found an 18.4 percent increase in US maternal mortality between 2019 and 2020. The JAMA figures include deaths during pregnancy or within 42 days of pregnancy.
As women are 14 times more likely to die from giving birth than from a safe, legal abortion, the reactionary ruling of the US Supreme Court in June, tearing away the constitutional right to abortion by overturning the 1973 landmark Roe v. Wade decision, is certain to increase the already abysmal maternal death rate.
According to a CNN analysis of 2018 data from the CDC, maternal mortality rates are already 47 percent higher than the national average in those states certain or likely to ban abortion in the wake of the Dobbs v. Jackson Women’s Health Organization ruling.
The CDC studied 1,018 pregnancy-related deaths occurring in the US between 2017 and 2019 and found that a staggering 84 percent of these were due to preventable causes. Black and Indigenous women were significantly more likely than white women to suffer deaths in pregnancy and postpartum. Mental health conditions were the top underlying cause of death.
Of the 1,018 maternal deaths, about 22 percent took place during pregnancy and a quarter occurred on the day of delivery or within a week after delivery. Mental health conditions, including deaths by suicide or overdose, were the top underlying cause of death, followed by extreme bleeding, or hemorrhage, according to the report.
These causes were followed by infection, embolism, cardiomyopathy and high blood pressure-related disorders.
African American mothers were three times as likely as white mothers to die, with most likely due to cardiac and coronary problems. Both white mothers, who made up 14 percent of deaths, and Hispanic mothers, who made up 14 percent of deaths, most frequently died of mental health conditions.
Almost all—90 percent—of American Indian and Alaska Native maternal deaths were preventable, with most due to mental health conditions and hemorrhage. This is an indictment of care given under the Indian Health Service, the federal program tasked with providing medical services to this population.
The JAMA study exposes the dramatic impact of the COVID-19 pandemic on maternal mortality in the US. The NCHC reported a 16.8 percent increase in overall mortality in 2020, the first year of the pandemic, and an 18.4 percent increase in maternal mortality. The relative increase in maternal deaths was 44.5 percent among Hispanic women, 25.7 percent among non-Hispanic black women and 6.1 percent among non-Hispanic white women.
Maternal deaths studied by JAMA were separated into deaths before the pandemic (2018, 2019 and January-March 2020) and during the pandemic (April-December 2020). A total of 1,588 maternal deaths (18.8 per 100,000 live births) occurred before the pandemic versus 684 deaths (25.1 per 100,000 live deaths) during the pandemic, for a relative increase of 33.3 percent. Late maternal mortality—within 6 weeks of delivery—increased by 41 percent.
The increase in maternal deaths during the pandemic period studied, at 33.3 percent, was higher than the 22 percent overall excess death estimate associated with the pandemic, according to the JAMA study.
The Commonwealth Fund study on health and health care for women of reproductive age (18-39 years) shows that US maternal mortality rates correspond with higher overall avoidable death rates when compared to women in other high-income countries. US women are also less likely to have a regular doctor and more likely to report problems paying medical bills.
Using data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development, the brief compares measures of health care access and outcomes for women of reproductive age in the US and 10 other countries.
Among US women ages 18-49, only 26 percent rated overall performance of the US health care system as “good” or “very good.” This compares to 58 percent of women in Sweden and 84 percent in Switzerland.