Study Finds Maternal Death Rate Rose in Last 20 Years

Hospital waiting area. (Public Domain)

A new state-by-state study shows that the rate of mothers dying during pregnancy or in the first year after giving birth has more than doubled over the last two decades nationwide.

The maternal mortality rate has gotten worse in every state, including in Wisconsin, according to the study, conducted by researchers at Mass General Brigham hospital in Boston and the University of Washington and published Monday in the Journal of the American Medical Association (JAMA).

The study compared maternal death rates in each state and among five racial or ethnic groups in the decade 2010-19 and in the previous decade, 1999-2009. It found sharp  disparities in both the rates of maternal deaths and in the increase in those rates over the two-decade period.

Data from the report shows Wisconsin is one of the 10 states with the lowest rate of maternal mortality overall — while at the same time showing much higher maternal death rates for Black women and for American Indian and Alaska Native women.

According to the Wisconsin Department of Health Services (DHS), in 2006-10 the maternal death rate for Black women in the state was five times that of white women — far outpacing the national disparity in that period.

The new report shows that Black maternal deaths continued to be worse in Wisconsin in 2010-19 than for other groups. It also found that Wisconsin was one of five states with the highest increases in maternal deaths for American Indian and Alaska Natives — jumping 162% in 2010-19 in the state compared with 1999-2009, an increase of more than two-and-a-half times.

The findings mirror some nationwide data in the study, which found “marked inequities facing the American Indian and Alaska Native population,” according to the report.

In the last three or four years of the 2010-19 decade, the year-to-year maternal death rates leveled off for Black, Hispanic and white populations, the report states, while continuing to increase among American Indian and Alaska Native mothers.

“The profound disparity observed suggests that a national approach to reducing inequities among American Indian and Alaska Native populations may be required,” the report states.

Nevertheless, all groups have shown a dramatic increase in maternal death over the two decades.

“On average, we’re seeing increases across the board,” said Dr. Greg Roth, a contributor to the study. “The patterns of where those increases are largest differ by race and ethnic group. And that was one of the goals of our study was to show those patterns.”

High maternal death rates are “a major public health problem in the United States,” said Roth, a cardiologist and population health researcher at the University of Washington Institute for Health Metrics and Evaluation, in an interview with the Wisconsin Examiner.

The study did not attempt to drill into why maternal death rates increased overall or for individual groups. Generally, researchers already know that the U.S. stands out from other countries — both in the overall maternal death rate and in its causes.

In other countries, the deaths of pregnant women or new mothers are commonly due to infections or bleeding, for example. “But in the United States, in contrast to that, severe high blood pressure associated with pregnancy and blood clots are common causes of maternal deaths,” Roth said. “And those are the same kinds of mechanisms and risks that cause heart attacks and strokes.”

He called maternal death rates “a signal, a canary in the coal mine, that women are living in a community where there are increased risks, that social determinants of the health in that community may be driving bad maternal outcomes, but also [contributing to] other diseases as well.”

Roth said research has shown that a contributing factor to maternal death are the gaps in care at the time of childbirth and the shift of responsibility for a mother’s care from before birth to afterward.

“Obstetrics has to be delivered in the prenatal period, with appropriate screening and treatment if needed,” he said. “But then after a woman gives birth, there needs to be a collaborative handoff with primary care, mental health care and community-based care, so that post-natal period, when women also experience [health] risks, isn’t ignored.”

For Wisconsin, the study data showed that in 2019, the state recorded just over 20.1 maternal deaths per 100,000 live births. By comparison, the state with the lowest rate of maternal death that year was Massachusetts (14.7 deaths per 100,000 live births), and the state with the highest rate was Mississippi, with 62.2 deaths per 100,000 live births.

While the death rates varied by racial and ethnic group in Wisconsin, they rose for every group over the two-decade period.

Wisconsin maternal deaths in the 2010-2019 period were highest among Black mothers, who experienced 40.4 deaths per 100,000 live births. Maternal death rates for that decade for other groups in Wisconsin were:

• American Indian and Alaskan Native mothers, 32.5.
• White mothers, 24.2.
• Hispanic mothers, 18.5.
•  Asian, Native Hawaiian or other Pacific Islander mothers, 18.4.

The increase in rates from 1999-2009 to 2010-2019 in Wisconsin were:

• American Indian and Alaskan Native, 162.1%
• Hispanic, 101.1%
• Asian, Native Hawaiian or other Pacific Islander, 82.2%
• White, 69.2%
• Black, 33.8%.

According to the report, state-level trends in maternal mortality haven’t been well understood because of differences among states in population size, terminology and other factors. The new report draws on data from the National Vital Statistics System, including live birth data and death certificate data.

The new study used mathematical modeling and collected two decades worth of data “to understand what populations were highest risk and where, and to do that over a much longer time period,” Roth said.

The report calls for additional research “to better understand what factors are contributing to increasing maternal mortality.” It observed that systemic racism has been found to be a factor in social conditions that affect people’s health, and suggests that research should also explore how that relates to persistent inequities in maternal mortality in the U.S. and “how interventions to dismantle these structural barriers might improve outcomes.”

National study finds maternal deaths got worse in the last two decades was originally published by the Wisconsin Examiner.