According to a Center for Disease Control (CDC) report, the number of women who died during pregnancy or shortly after birth significantly increased during the first year of the coronavirus pandemic. The report is based on data from the National Vital Statistics System.
The World Health Organization (WHO) defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
The maternal mortality rate is the number of maternal deaths per 100,000 live births. In 2020, the maternal mortality rate was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. Specifically for Black women, the maternal mortality rate in 2020 was 55.3 deaths per 100,000 live births.
Black Americans make up roughly 12.4% of the population, yet Black women are three times as likely to die during pregnancy or shortly after birth than their White counterparts.
A February New York Times article suggests that the rise in the maternal mortality rate is directly related to the global pandemic. Pregnancy can put women at risk for intensive care if infected with the coronavirus and vaccines were not available for most of 2020.
Black Americans have suffered disproportionately during the pandemic, with higher death rates and hospitalizations when compared to white Americans. Despite this, racial disparities in maternal mortality predate the pandemic. It’s a complex issue with multiple causes.
Connecting state abortion laws to maternal mortality
Georgia State University researchers reviewed health records from the 1960s and 1970s and found that the state-level legalization of abortions produced a 30-40% decline in non-white maternal mortality in a recent paper. The impact of legal abortions in reducing minority maternal mortality rates through declines in abortion-related deaths indicates how crucial access to safe and legal abortions were crucial.
“The larger effects for racial and ethnic minorities could be due to economic disadvantages,” Michael Pesko, associate professor in Georgia State’s economics department and health economist said. “These groups may have had less financial ability to travel to states or other countries allowing abortions. Alternatively, a number of states allowed abortions in cases where the mother’s health was at risk prior to Roe v. Wade, and non-white women may have had less regular access with the healthcare system to identify problematic pregnancies and receive consent for abortions from physicians.”
Within the past couple of years, several states across the country have tried to pass laws that would ban abortions at six weeks gestation or earlier. An example in Georgia would be House Bill 481 in 2019.
These laws are often controversial and spark debates across the political spectrum, often focused on deaths that could be a result of having unsafe abortions. A recent study published by Demography analyzes how a federal abortion ban could impact maternal health. The study only considers deaths from being pregnant or giving birth, estimates of deaths due to unsafe abortions would be in addition to the results. The researcher did not include deaths from unsafe abortions in the study since it is statistically riskier to carry a pregnancy to term than get an abortion and also because of the option of self-managed abortions via medication.
The study found that a total abortion ban could increase pregnancy-related deaths by increasing exposure to the risks of carrying a pregnancy to term because wanted abortions are denied.
In the first year in which all abortions in the United States are denied, the estimated annual number of pregnancy-related deaths would increase from 675 to 724 (7% increase), and in subsequent years to 815 (21% increase).
Black people would experience the greatest increase in pregnancy-related deaths, with a 12% increase in the first year and a 33% increase in subsequent years.
How America compares globally
Most maternal deaths are preventable, yet the maternal mortality rate in the United States continues to increase. America has the highest maternal mortality rate when compared to other developed countries.
A 2020 report suggests that the U.S’s overrepresentation of Obstetrician-gynecologists (OB-GYNs) in maternal care could be one of the reasons for the country’s high maternal mortality rate. In other countries, midwives outnumber OB-GYNs and primary care plays a central role in the health system.
The report states that although a large share of maternal deaths occur post-birth, the U.S. is the only country that does not guarantee access to provider home visits or paid parental leave in the postpartum period. The WHO recommends midwives as an evidence-based approach to reducing maternal mortality.
At the local level
The Black Women’s Health Imperative (BWHI) was founded in Atlanta in 1983. To this day, it is still the only national nonprofit created by Black women to protect and advance the wellness of Black women and girls.
According to Senior Program Director Shana Davis, “Black women are disproportionately impacted by risk factors related to pregnancy, such as hypertension or gestational diabetes, but these factors are made worse by the compounded stress of racial discrimination, lower quality health care, climate change, and COVID-19.”
Davis believes that there is plenty of research that proves racism and disparities in America’s healthcare system and that more action needs to be taken.
The BWHI is collaborating with the All of Us Research Program to help create more equity in health research. Through the program, they hope to increase representation in medical data to ensure that treatments are created that work for those from diverse backgrounds, and that the understanding of health better reflects the diverse population the medical industry serves.
In her experience working closely with Black maternal health, Davis believes that there are several solutions available to decrease the number of Black women who die during pregnancy or shortly after the birth of their child such as increased access to quality health insurance, diversifying the medical field to include doulas and midwives, and policies for parental leave.
Davis also has an idea that could hold medical professionals accountable for implicit bias and racism.
“List discrimination or racism as a cause for wrongful death and outline clear consequences for hospitals and health systems,” Davis said. “The development of programs identifying and treating social disparities and other conditions that increase maternal mortality risks are needed for hypertension, diabetes, and obesity.”
There’s not much that the average person can do to tackle maternal mortality on their own. However, to Davis, voting for candidates who support maternal health and educating oneself on maternal health and becoming an advocate are a couple of ways that an individual can reduce maternal mortality.