Redefining the Enduring Challenge of Maternal Mortality in the United States.
A recent study reveals a concerning deterioration in maternal mortality rates in the United States over the past few decades, with a notable impact on Native and Black women.
According to recent research, attempts to enhance maternal health in the United States have proven largely ineffective, as the maternal mortality rate has more than doubled in the past two decades, revealing significant disparities across different racial and ethnic groups.
Newly published in JAMA, a groundbreaking state-by-state analysis of maternal deaths reveals alarming trends. Between 1999 and 2019, the mortality rate among individuals aged 10 to 54 who were pregnant or had recently given birth rose from 12.7 deaths per 100,000 live births to 32.2 deaths per 100,000. The total number of maternal deaths increased from 505 to 1,210 during this period. Disturbingly, the study indicates a rise in maternal mortality rates across almost all states and among all racial and ethnic groups between the decades of 1999-2009 and 2010-2019.
Among the five included racial and ethnic groups, American Indian and Alaska Native females, as well as Black females, exhibited the highest maternal mortality rates in 2019. These groups also experienced the largest absolute increases in mortality rates since 1999. For American Indians and Alaska Natives, the national maternal mortality rate more than tripled over the two decades, soaring from 19 deaths per 100,000 live births to 69.3 deaths per 100,000. Similarly, maternal mortality among Black women more than doubled, escalating from 31.4 to 67.6 deaths per 100,000.
Among white women, the maternal mortality rate also witnessed a threefold increase, surging from 9.2 to 27.9 deaths per 100,000. Comparable patterns emerged when examining median maternal mortality rates across different states.
According to the study, maternal mortality rates in the United States remain unacceptably high for all racial and ethnic groups. However, American Indian and Alaska Native individuals, as well as Black individuals, face a higher risk, particularly in states where these disparities have not been previously emphasized.
The research reveals significant percentage increases in maternal mortality rates for the American Indian and Alaska Native population in Florida, Kansas, Illinois, Rhode Island, and Wisconsin, with all states surpassing a 162% increase. Similarly, for the Black population, Louisiana, New Jersey, Georgia, Arkansas, and Texas experienced rate increases greater than 93%.
The study’s authors highlight that these findings highlight a lack of progress in reducing maternal deaths in the United States, where maternal mortality rates have consistently been worse compared to other affluent nations. Despite efforts aimed at prevention, the study suggests that the impact on addressing this health crisis has been limited, contributing to worsening disparities in many states.
Dr. Abdulla al-Khan, co-director of the Fetal Care Center at Hackensack University Medical Center in New Jersey, emphasizes the importance of addressing underlying factors that contribute to disparities in order to reduce maternal mortality rates. These factors include limited access to healthcare and the influence of bias in the diagnosis and treatment of Black patients.
According to al-Khan, there should be zero tolerance for disparities within the healthcare profession. At Hackensack University Medical Center, efforts have been made to implement best practices in maternal care for all patients. They also utilize software that alerts clinicians to potential health issues, such as elevated blood pressure, in expectant mothers before they become severe. Notably, the hospital reported no maternal deaths in 2022.
Within the broader Hackensack Meridian Health network, there has reportedly been a decrease in cesarean section deliveries, a procedure associated with additional risks such as blood clots and blood loss. Previous research focused on low-risk pregnancies has shown that Black and Hispanic women are more likely to undergo C-sections compared to white women.
Al-Khan expresses concern about the diminishing humanism and individualized care in medicine, stressing the importance of paying attention to the specific details that patients share.
To eliminate maternal health disparities, al-Khan emphasizes the need to provide equitable services and resources to all mothers. This may involve engaging with mothers before and after their hospital delivery. Kathryn Kaintz, a nurse manager at Rush University Medical Center in Chicago, is involved in overseeing the Family Connects Chicago program. This program includes follow-up home visits by nurses to mothers approximately four weeks after their hospital delivery.
Implemented in March 2020, Kaintz explains that the program conducts around 900 home visits each year. These visits involve medical checkups, counseling, and providing referrals to local social support services. Kaintz highlights that the program plays a crucial role in reinforcing the education provided to new mothers at the hospital regarding the importance of recognizing health symptoms that may indicate a serious condition.
Kaintz suggests that providing parents with education during their hospital stay may not always be effective, comparing it to trying to teach someone immediately after running a marathon. She explains that the Family Connects program intervenes at a later time when parents have had the opportunity to settle down, allowing for the reinforcement of important education.
Dr. Gregory Roth, an associate professor at the University of Washington and co-author of the maternal mortality study, emphasizes that addressing America’s maternal mortality issues will require comprehensive and far-reaching solutions.
Roth highlights that maternal deaths associated with pregnancy are a pervasive issue throughout the entire country. He emphasizes that this problem is not confined to a specific region.
Roth suggests that the methods utilized in the new analysis can be employed to establish a comprehensive database, enabling each state to track annual maternal mortality outcomes among different racial and ethnic groups. He points out that such a database could assist policymakers in making informed decisions to improve the health of underserved populations.
Roth asserts that a significant portion of the responsibility for healthcare in the United States lies with the states. He emphasizes that no woman should lose her life during pregnancy, and although surveillance efforts have expanded, consistent reporting across all states has not been achieved. Therefore, the aim was to create a standardized and equitable system for reporting maternal mortality data.
