Weekly post: Maternal Mortality
What the data tells us about the state of maternal mortality in America
In addition to the Charts of the Week roundup, this newsletter features a weekly deep dive data storytelling post on a specific topic from a member of the community. This edition of the weekly post comes from our Data Journalist Intern, Emily Irion, a graduate student at UCSD’s School of Global Policy & Strategy. You can follow her on OpenAxis and Twitter. As always, each visualization has a backlink to share or remix the chart and explore the dataset with tools for collaboration and crowdsourcing insights. Join the conversation!
Reproductive rights have become a hot topic of discussion in America ever since the Roe v. Wade draft opinion leaked from the Supreme Court of the United States (SCOTUS) earlier this month. Experts estimate that one impact from a potential reversal of Roe v. Wade is an increase in maternal mortality rates. A Tulane study found that states with more restrictive abortion policies have a 7% increase in total maternal deaths compared to states with less restrictive abortion policies.
U.S. Maternal Mortality Rate (MMR)
The United States already has the worst maternal mortality rate among developed countries. According to the CDC, on average 700 people die from childbirth each year, and 2 out of the 3 deaths are preventable. In 2020, this number increased to 861 known deaths.
Race Disparities
For Black women, the risks are even higher. Black women are three times more likely to die from a pregnancy-related cause than White women. According to a new report from the National Center for Health Statistics, the beginning of the COVID-19 pandemic saw an increase in maternal deaths by 14%, and one third of those deaths were Black women.
Additionally, and not included in the above chart or in the recent CDC data breakdown, Indigenous women are two times more likely than white women to die from a pregnancy-related cause (2017 CDC data). According to the CDC, factors contributing to these staggering disparities are “variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias.”
Maternal Care Workforce
There are a few key differences between maternity care in the U.S. and other countries that might explain why the U.S. is so devastatingly behind. One being the fact that the U.S. does not have a federal parental paid leave policy. Another factor found by the Commonwealth Fund is "the shortage of maternity care providers in the U.S., and the lower supply of midwives in comparison to other high-income countries.”
The most recent study from the Commonwealth Fund also found that U.S. women of reproductive age are more likely to skip or delay needed care because of costs, more likely to have problems paying medical bills, and have the highest mental health care needs in comparison to other women of reproductive age in other developed countries.
Out-of-pocket expenses for childbirth can exceed $10,000 for new parents who have health insurance, a new study reports. Even families with private health insurance paid an average of $3,000 for maternal and newborn hospitalizations, according to researchers from the University of Michigan.
Even though experts and policy makers are aware of this public health crisis, the maternal mortality rate in the U.S. is on the rise.
Research shows three possible factors contributing to this increase over time:
Women waiting longer to have children which increases their risk;
Improvements to data collection and identification; and
Changes in age-specific maternal mortality.
For example, in 2003, the CDC recommended putting a pregnancy checkbox on death certificates to better identify deaths due to a pregnancy-related cause. As of 2018, all 50 states implemented these checkboxes. The CDC estimates that the United State’s MMR “increases between 1999 and 2017 are largely due to the implementation of the checkboxes.” However, the impact of the checkboxes is not isolated to the United States. According to the World Health Organization, 30 other countries have also implemented this checkbox albeit with varying language.
There have been many research-backed policy suggestions in recent years, as well as improved medical protocols to better the preparedness of hospitals in combating maternal mortality rates. And recently, the Maternal Health Quality Improvement Act passed Congress which the American College of Obstetricians and Gynecologists (ACOG) claims will help to eliminate racial inequities in maternal health. The bill provides “funding for training programs to address implicit bias and racism in reproductive health care, implementation of improved medical practices, and aims to improve access to obstetric care in rural areas.” As noted by the ACOG, these developments are not enough.
The majority of the data provided above was derived from the CDC and their National Center for Health Statistics, who in 2020 released the first national data on maternal mortality in the United States since 2007. Without accurate and timely data, this crisis will continue costing lives.
Overall, there are more questions than answers for why the U.S. has the highest maternal mortality rate of any high-income countries. If anything is clear from this data, it is that the U.S. can and should be doing more to improve comprehensive reproductive health care to eradicate preventable deaths from pregnancy related causes.
Great summary of a very important issue.