Latest CDC findings reveal a drop in the maternal mortality rate in the US, yet disparities persist.
The United States saw a significant decrease in its maternal mortality rate from 2021 to 2022, dropping from 32.9 deaths per 100,000 live births to 22.3 deaths, as revealed in a report published by the CDC's National Center for Health Statistics. In 2022, a total of 817 women died of maternal causes compared to 1,205 in 2021, 861 in 2020, 754 in 2019, and 658 in 2018.
Dr. Donna Hoyert, a statistician at NCHS and the author of the report, noted that the maternal mortality rate decreased significantly in 2022, and this decline was widespread. Although the report didn't examine why the rate dropped, Hoyert suggested that the decrease may be associated with Covid-19 infections declining in 2022.
Covid-19 was the third leading cause of all deaths in the US during the first two years of the pandemic, but deaths from it halved in 2022, making it the fourth leading cause. Dr. Angela Bianco, director of maternal-fetal medicine and professor in the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, noted that there was indeed an increase in both maternal and perinatal mortality related to the Covid pandemic. However, she cautioned that it's difficult to determine whether this was directly due to Covid or the broader societal impacts of the pandemic on access to care, vaccinations, and other factors.
The JAMA Network Open journal published a study last year showing that the rate of pregnant women dying from delivery-related causes in US hospitals fell more than 50% from 2008 to 2021. However, this decrease only considers in-hospital maternal deaths and not all forms of maternal mortality, many of which occur outside the hospital setting.
Obstetrician and gynecologist Dr. Yolanda Lawson, president of the National Medical Association, believes the US is making progress on maternal health but is cautious not to become complacent. She emphasized that policies regarding obstetrical care must continue to improve to maintain the downward trend in the maternal mortality rate.
Dr. Tosin Goje, director of Cleveland Clinic's Center for Infant and Maternal Health, expressed optimism but cautioned against complacency, noting that the maternal mortality rate has been rising since 2000. She called for increased efforts in areas where access to maternal health care is limited, such as certain American states that have yet to expand their Medicaid programs.
Despite the recent decline, the US still struggles with racial disparities in maternal health. The maternal death rate for Black women in 2022 was 49.5 deaths per 100,000 live births, nearly three times higher than that of White women (19 deaths per 100,000). Addressing these disparities will require a strategic focus not only on lowering the overall maternal mortality rate but also tackling the deeper root causes fueling these persistent gaps.
'Disparity lingers and persists'
While the US experienced a decline in its maternal mortality rate in 2022, the report revealed that the maternal death rate for Black women was still higher than for other groups. In 2022, the rate among Black women stood at 49.5 deaths per 100,000 live births compared to 19 deaths per 100,000 for White women, 16.9 per 100,000 for Hispanic women, and 13.2 per 100,000 for Asian women.
Lawson highlighted the continuing struggle with these disparities: "The disparity lingers and persists, as you can see from the data with Black women versus Caucasian women and others." She pointed out the critical role that inadequate access to maternal health care plays in contributing to these disparities.
"Access is important from a lot of perspectives," she explained. "In this country, we're dealing with maternal health care deserts. We have states that haven't expanded Medicaid despite seeing not only maternal and infant mortality but also disparities. We need to continue supporting states in putting in quality improvement projects and initiatives."
The rates of maternal deaths for Black women have consistently been higher compared to those for White, Hispanic, and Asian women as per the Centers for Disease Control and Prevention's (CDC) data.
The CDC's website notes that multiple factors come into play here, such as inadequate healthcare quality, existing underlying health conditions, structural racism, and implicit bias. Social determinants of health often deprive people from racial and ethnic minorities the chance to enjoy fair economic, physical, and emotional well-being.
A recent report from the National Center for Health Statistics (NCHS) revealed that maternal death rates rose in correlation with age. For women under the age of 25, there were 14.4 deaths for every 100,000 live births in 2022, while for those between 25 and 39, it was 21.1 per 100,000, and for those aged 40 and above, the figure escalated to 87.1 per 100,000.
"This trend has constantly remained," said Hoyert.
The NCHS report used the World Health Organization's stipulation to define a maternal death as the demise of a woman either during pregnancy or within 42 days of the termination of the pregnancy due to any related complication, except for mishaps.
The United States continues to hold one of the highest maternal mortality rates among high-income nations. And as Candice Bianco, an obstetrician who practices at Massachusetts General Hospital, points out, the severity of the issue has sparked a "national call to arms" for combatting the country's maternal mortality crisis.
"Given that our statistics have been fairly disappointing, there's been a national call to arms to resolve our maternal mortality predicament, which has been disproportionately impacting women of color," said Bianco.
This week, the US Department of Health and Human Services unveiled that they would channel $105 million into financing more than 100 community-based organizations throughout the nation, targeting improved maternal and infant health. Through the administration's Healthy Start Program, these organizations will help cater to the healthcare and societal needs of pregnant women and new mothers in underprivileged communities.
"Via these Healthy Start grants, we'll support community-based organizations that will work steadily to assist expecting and new moms in acquiring the health care and essential support—such as transportation to prenatal appointments and food aid—they require for healthy pregnancies and healthy babies." said Carole Johnson, the director of the Health Resources and Services Administration.
There are also individual precautions women can consider to reduce their risks of pregnancy complications. Bianco highlighted the importance of a woman's health before even considering a pregnancy.
"The best thing to do is to optimize your health prior to a pregnancy. That entails quitting smoking; if there's a substance abuse issue, seek help before it gets out of hand; losing weight if needed through diet changes and exercise," Bianco suggested.
She also emphasized the importance of mental health, revealing the interconnectivity between one's mental state and maternal outcomes. "Mental health is directly linked to maternal complications and mortality," Bianco added. "To ensure the best outcomes, women should prioritize their physical and mental well-being, build a solid support network, forge strong connections with their healthcare providers, and consider availing ancillary services like birthing doulas if needed, and give preference to hospitals that provide comprehensive care," she advised.
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The report published by the CDC's National Center for Health Statistics highlights that despite the decrease in the overall maternal mortality rate in the US, the disparity in mortality rates between Black and White women persists.
Lawson underscores the need to address this discrepancy, stating that "the disparity lingers and persists." She emphasizes the importance of expanding access to maternal health care in states that have yet to expand their Medicaid programs to help reduce these disparities.
Source: edition.cnn.com
