Pregnancy Is Getting More Dangerous In The US, New Data Show, Especially For Black People

“Let’s face it. We lie in America by saying we really value mothers, motherhood, and women when we clearly don’t.”

Since 2018, maternal mortality rates in the US have been on the rise, particularly during the pandemic and especially among Black people, and now new data released this week reinforces the alarming and mostly preventable trend. 

In 2021, there were 1,205 deaths among pregnant people due to “maternal causes” reported to the CDC, compared with 861 deaths in 2020 and 754 in 2019 — an overall increase of nearly 60%

(Those numbers don't include murders, which are a leading cause of death in people who are pregnant. Those who are pregnant are 16% more likely to die by homicide than others the same age who are not.)

Maternal death rates — defined as the death of a person during or within 42 days of pregnancy due to causes related to the pregnancy — for all races increased with age, with women aged 40 and older experiencing mortality rates 6.8 times higher than women under age 25, according to the CDC. 

Black pregnant women, however, were found to have a maternal mortality rate 2.6 times higher than white pregnant women: a well-known statistic that is not at all shocking to the doctors who care for pregnant people. For Black women, the rate was 69.9 deaths per 100,000 live births compared with 26.6 per 100,000 in whites.

“I’m not surprised,” said Dr. Shieva Ghofrany, an OB-GYN in Stamford, Connecticut, and founder of Tribe Called V. “Black women don’t have equal access to care and they don't feel safe when they do have access, because they feel like they're in hospitals or practices that have either very clear or unconscious biases that affect them.”

When asked why such stark racial inequities among pregnant people continue to persist despite being well-known for years, Ghofrany said, “There’s so many mishaps in the system that are only going to lead to increased problems, and I don’t think this is going to be solved anytime soon.”

“The glaring reality is that health care in America is a very broken system,” said Ghofrany, who added that she doesn’t need data to understand how Black pregnant people are treated; she hears about it during discussions with patients.

In fact, the US has the worst maternal mortality rates among high-income countries; they’re more than double those of the second- and third-worst countries (France and Canada) and about 16 times those of New Zealand and Norway, according to the Commonwealth Fund. 

It’s possible, Ghofrany said, that the US reports maternal deaths more accurately (or inaccurately) and frequently than other similar countries, but that’s wishful thinking. There’s no denying that the US has a diverse population that includes more fat people, people who get pregnant at older ages, and those who use assisted reproductive techniques — all of which are associated with a higher risk of maternal death — but given that other developed countries share similar characteristics, that argument only accounts for so much, Ghofrany said.

A shortage of maternity care providers in the US, including both OB-GYNs and midwives, relative to the number of births may help explain the nation’s high maternal death rates too, research shows. What’s worse, Ghofrany said, is that many maternal care providers are choosing to stop performing deliveries because of how exhausting, unpredictable, and risky (in terms of high malpractice costs) the job has become — particularly given the pandemic has doctors in general feeling “more tired, more undervalued, and more attacked by the public.”

“Let’s face it. We lie in America by saying we really value mothers, motherhood, and women when we clearly don’t,” Ghofrany said. “We see this every day with reproductive rights. The amount of hypocrisy is outrageous.” 

There’s an immense amount of pressure on pregnant people in the US to work until delivery and then return shortly after. Not to mention, America is the only country that doesn’t guarantee access to paid parental leave or medical provider home visits, even though most pregnancy-related deaths occur after they give birth. 

Especially in the wake of Roe v. Wade’s downfall, which stripped people of their right to an abortion in many states last summer, more and more people have and will have unintended pregnancies that they are forced to carry to term — a reality that has always and will continue to have a greater impact on people of color. (Some states are trying to take it even further; South Carolina, for example, just introduced a bill that would allow the death penalty for people who get an abortion.)

“The states that have claimed to value life really need to start putting their money where their mouth is and advocate for and invest in the fully realized lives that are alive right now,” Ghofrany said, “the women and mothers who need their help.”

Black people in the US experience higher rates of unintended pregnancies and more restricted access to abortion than members of all other racial groups for a number of reasons, including barriers to quality health care, family planning services, and mental health counseling. All of these factors increase Black pregnant people’s risks of depression, high blood pressure (preeclampsia), heart problems, physical violence during pregnancy, and maternal death; they also affect their babies, increasing their chances of low birth weight, preterm birth, birth defects, and death. 

The pandemic certainly made its mark too. Fewer appointments, and check-ups done over telemedicine, may have allowed many pregnant people’s medical conditions like high blood pressure and depression to go unnoticed, Ghofrany said, increasing their risk for intrapartum or postpartum complications.

It’s likely that these factors also play at least some role in the increasing rates of sudden unexpected infant deaths (SUID) in the US. A CDC study published this week in the journal Pediatrics found that SUID rose in prevalence 15% from 2019 to 2020, becoming the third leading cause of infant death in the country; the rate for Black and American Indian or Alaskan Native infants was nearly three times that for white infants.

The SUID rate in Black infants increased the most, reaching levels higher than any time between 2017 and 2019. The researchers said pandemic-related losses of or changes in child care may be to blame due to “unaccustomed infant sleep positioning and other unsafe sleep practices.”  

In an attempt to bridge racial disparities in health care, Ghofrany said patients are often encouraged to seek their medical providers’ help and advice more often, “but that’s actually impossible nowadays,” particularly when it comes to mental health care. 

“We don’t have enough mental health providers for patients to see and many of them don’t take insurance because they don’t get reimbursed anything,” Ghofrany said. “Ultimately, patients are going to lose out, because now you’re asking your OB-GYN to also be in charge of mental health.”

Theoretically, pregnant people can take steps to reduce their risk of dying during their pregnancy journey, such as not gaining more than the recommended weight, quitting smoking and drinking alcohol, and addressing mental health issues before getting pregnant. However, this advice, Ghofrany said, is “fraught with privilege.” 

“It means you have to recognize these issues, know that these issues are not good, and have not only the psychological capability to make changes but also the financial means and the time in your life,” Ghofrany said. “Even privileged people don't have time off from work to have access to this.”

That’s why it’s of “paramount importance to find a doctor, nurse, or midwife that you really feel that you can collaborate with, and who hears, listens, and directs you in a way that’s authentic,” Ghofrany said. 

But even that seemingly simple piece of advice is actionable only with some amount of privilege, she said. Hospitals that predominantly treat Black people, for example, provide lower-quality care and have higher rates of maternal complications than other facilities, data show. Even so, Black people still prefer to be treated by people who look like and can relate to them, in the hopes of receiving better care.

“When we talk about how people can advocate for themselves, it’s assuming that they have options to choose from,” Ghofrany said. “There’s so much work that needs to be done on every single level.”

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