An American Crisis — The Alarming Rates of Maternal Mortality

According to data open_in_new from the Center for Disease Control and Prevention (CDC), the U.S. has the highest maternal mortality rate among developed countries and it continues to rise. The CDC and the World Health Organization defines maternal mortality rate as "the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy". In 2020, the maternal mortality rate in the U.S. was reported as 23.8 deaths per 100,000 live births which is almost 3 times higher than France (8.7), the industrialized country with the next highest rate. Furthermore, the CDC data show significant and concerning disparities by race and ethnicity with black women open_in_new and American Indian/Alaska Native women open_in_new bearing the brunt of this crisis at 2 to 3 times the pregnancy-related deaths as white and Hispanic women.

According to a 2019 Weekly MMWR Report open_in_new, there are multiple factors that have been implicated in these racial/ethnic disparities related to maternal deaths including the following:

• Chronic diseases that are less well controlled (i.e., hypertension)
• Access to consistent, quality care during preconception, pregnancy, and postpartum periods
• Gaps in healthcare coverage and preventive care including social services
• Lack of transportation for medical visits and inadequate housing
• Obstetric services received in hospitals with lower quality care
• Implicit racial bias and structural racism

Given the current state of pregnancy related deaths in the US, it will be critical for healthcare providers, government and community organizations, hospitals and clinics, and others to raise awareness and implement proven strategies to address this public health crisis.

Suggestions for Healthcare Providers from CDC open_in_new:

• Ask probing, open-ended questions to gain a better insight into the factors affecting health in your patients' lives
• Educate your patients and their families regarding maternal warning signs open_in_new and the importance of seeking medical attention anytime something does not feel right
• Help patients manage co-morbidities and other health conditions that may arise during pregnancy such as diabetes, depression, or hypertension
• Identify and address any unconscious bias in yourself and your practice
• Provide respect to all patients and address all concerns that a patient may express

In addition to the suggestions from CDC, healthcare providers can also consider the following actions:

• Advocate to improve access to quality prenatal and postpartum care in the communities you serve
• Consider partnering with and/or leveraging the services of a doula which have been showed to improve the outcomes of "socially disadvantaged" women (Gruber et al. J. Perinatal Educ. 2013. Winter; 22 (1): 49-58 open_in_new)

Additional Articles and Resources

• Together to Reduce Black Maternal Mortality, April 6, 2022, CDC open_in_new
• Severe Maternal Morbidity in the United States, CDC, Sept 6, 2019 open_in_new
• Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016, CDC, Sept 6, 2019 open_in_new
• Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013 Winter;22(1):49-58. doi: 10.1891/1058-1243.22.1.49. PMID: 24381478; PMCID: PMC3647727 open_in_new
• CDC Hear Her Campaign open_in_new
• March of Dimes 2022 Report on Maternity Care Deserts Across the United States open_in_new