Maternal Mortality

By Vanessa Barnabei, MD, PhD

The United States has one of the best and most expensive health care systems in the world, yet the maternal mortality rate (MMR) is rising and significantly higher than that of other developed countries. Pregnancy-related death is defined as the death of a woman while pregnant or within a year from termination of pregnancy, occurring as a result of a pregnancy-related illness or as a result of an underlying illness exacerbated by pregnancy. Between 1987 and 2016, the MMR increased from 7.2 deaths to 16.9 deaths per 100,000 live births. Approximately half of the more than 700 maternal deaths in the U.S. each year are deemed preventable. What is more striking, although maybe not unexpected, is the racial disparity in maternal mortality, as well as severe maternal morbidity, with greater than three times the rate of death in non-Hispanic black and indigenous women compared to white women, regardless of income or education level. There is an association with government insurance, as well as poverty level. This points to differential access to quality prenatal care and high-performing hospitals; Hispanic and black women are more likely to deliver their babies in low-performing hospitals.

There is a concerted effort nationwide to address both the high rate of MMR, as well as the racial disparities. Even prior to pregnancy, it may be possible to impact a woman’s risk of serious morbidity and mortality associated with pregnancy. Improved access to family planning services (including abortion) and affordable contraception would decrease the likelihood of unplanned pregnancy, which in and of itself is a risk factor for maternal morbidity and mortality. The Affordable Care Act, passed in 2010, eliminated substantial insurance co-pays for contraception, decreasing the disparity in access to these options—although many groups have argued successfully against this provision. The Biden administration has plans to reverse some of these rollbacks, as well as end the Hyde Amendment, which prevents public funding for abortion services. President Biden has already reversed a ban on federal funds going to international aid groups that perform or inform about abortions. Women’s reproductive rights continue to be assaulted at the state and local levels as well, even though the majority of individuals in this country support access to affordable contraception and abortion.

The leading causes of pregnancy-related maternal death in New York state are embolism (blood clots), hemorrhage, infection and cardiomyopathy. Cardiovascular disorders, including hypertension, are increasing in women of childbearing age and are adversely impacting prenatal outcomes. In 2019, the New York State legislature approved funding for the establishment of a statewide maternal mortality review board (MMRB) in order to identify female deaths that were pregnancy-related, to conduct a comprehensive, detailed review of factors leading to these deaths, and to develop strategies and interventions to decrease the risk of future deaths. The MMRB, which includes experts from throughout the state, began meeting early in 2020, and has been reviewing all cases of maternal mortality that are possibly related to pregnancy.

Future strategies might include improved education about certain medical conditions, and the development of hospital policies to limit disparities in care. Working through the UB Community Health Equity Research Institute, for example, UB and Jacobs School faculty can investigate the specific causes of maternal morbidity and mortality, in order to develop solutions that address the impact of social determinants of health on MMR in our own community. We can also recognize our own biases and the impact these may have on the care of our most vulnerable neighbors.