Pregnancy-related deaths were already increasing in the United States. Then COVID came along and made things worse.
The largest increase in deaths was among black women, who had a death rate of 55 per 100,000, a sharp increase from the previous year – and three times that of white women. For Hispanic women, the death rate increased from about 13 to about 18 per 100,000.
The CDC report didn’t include state-specific data, but the same trends observed nationally — rising all-cause mortality rates and wide racial disparities — also occur in Massachusetts, according to previous studies.
The data shows the crisis is worsening despite years of attention and initiatives in Massachusetts and across the country to address racial disparities in maternal health and reduce serious complications during pregnancy and childbirth.
“These are incredibly high numbers,” said Dr. Nawal Nour, Chair of Obstetrics and Gynecology at Brigham and Women’s Hospital.
“Maternal mortality was a key issue. There’s been all this effort to address it, to think about it, to make sure we’re aware of the preventive measures – and yet when you look at the numbers, they’re still going up.”
Maternal health experts said the data reflects the fact that people of color are at higher risk of pregnancy-related complications – and at higher risk of serious illness and death from COVID.
In rare cases, pregnant women have died from COVID, although the CDC report doesn’t say how many maternal deaths are related to COVID and how many are due to other causes.
Pregnancy-related deaths can occur from heavy bleeding, infection, heart disease, and other problems. Most of these deaths occur during or after childbirth. And most are preventable.
The onset of the 2020 pandemic disrupted medical care for pregnant women. In-person appointments have been shifted to telemedicine and ultrasound scans have been delayed. Some hospitals have sent pregnant patients home with cuffs to monitor their blood pressure remotely.
But those interruptions in care meant complications — such as the early stages of preeclampsia, a serious condition characterized by high blood pressure — may have been missed, said Dr. Julianne Lauring, Physician of Maternal and Fetal Medicine at UMass Memorial Medical Center.
“Routine prenatal care has a purpose,” she said. “We have to do it to improve the results. As we tried to stop it things seemed to get worse and these numbers show that.”
Even when pregnant patients were allowed to see their doctors in person, some were afraid to come for fear of catching COVID. Others missed appointments because they didn’t have childcare or lost their health insurance because they were laid off during the pandemic, Lauring said.
The trends are worrying even in Massachusetts, a state known for its medical care. From 2014 to 2017, the most recent years for which data are available, the percentage of babies born in the state to parents who received adequate prenatal care decreased, and black women were the least likely to receive prenatal care, according to the Department of Health. Black women in Massachusetts had the highest mortality rate and were three times as likely as white women to experience severe complications from labor and delivery.
Last year, lawmakers passed legislation enacted by Gov. Charlie Baker that created a commission to address racial inequalities in maternal health and pregnancy-related deaths.
The poorer outcomes for pregnant women of color stem from long-standing issues with structural racism and implicit bias, doctors said. For example, healthcare providers are less likely to take seriously a Black woman’s concerns when she describes pain or other symptoms.
“Black women may come from environments where there are many socioeconomic issues, and if we don’t look at it with a holistic lens, we’re missing out on the kind of care they need and deserve,” added Nour Brigham and Women.
Also, women who speak a language other than English may be poorly cared for if an interpreter isn’t available to help them with an appointment, she said.
According to a 2020 Commonwealth Fund report, the United States lags behind other wealthy nations in providing support for pregnant women and women after childbirth.
Other affluent countries have universal access to health care, stronger social safety nets, parental leave policies and health care systems that involve midwives rather than relying primarily on physicians for maternity care, said Tejumola Adegoke, OB/GYN and director of equity and inclusion at Boston Medical Center.
“We’ve had this data on deaths for decades, and the numbers have actually only gotten worse, not better,” she said. “Until we have these things, we will continue to see these inequalities.”