Maternal Mortality in the United States

Thanks in part to a recent surge in research, better data collection methods, and media attention, maternal mortality is once again on the minds of researchers, policy makers, and providers.  Previously considered a problem only in the developing world, the U.S. is now the most dangerous high-income country in which to give birth. In honor of National Women’s Health Week, we created a Story Map to further explore maternal mortality in the U.S., including contributing factors, geographic distribution, and potential solutions.

Background

Though disparate definitions of maternal mortality exist, it is defined by the CDC as the death of a pregnant woman or a woman within one year of giving birth ”from any cause related to or aggravated by the pregnancy or its management.” While many countries have made great strides in reducing maternal mortality, the United States has seen major setbacks. According to the CDC, between 1987 and 2014, the maternal mortality rate increased from 7.2/100,000 live births to 18.0/100,000 live births, more than doubling. 

Image source: CDC Pregnancy Mortality Surveillance System

A Story Map

Researchers site many factors that contribute to these statistics. In a 2017 series entitled “Lost Mothers: Maternal Mortality in the U.S.,” Martin and Montagne explore several of these factors, including racial disparities in health and access to health care. In the article “Black Mothers Keep Dying After Giving Birth,” as noted in Panel 4, the authors state that black women die at nearly four times the rate of white women, and these disparities persist across all income and education levels.  Martin and Montagne cite systemic social inequalities, poor access to care, and unconscious provider bias as contributing factors. In National Geographic, Jones expands on this concept by attributing maternal mortality racial disparities, in part, to “weathering,” the concept that the constant stress placed on racial and ethnic minorities by racism and bias leads to poor health outcomes.

Researchers also blame health care inequality and unequal access to care, explored in Panel 5. The U.S. is the only highly-developed county in the world without some form of universal health coverage, leading to women delaying or forgoing care they cannot afford. Additionally, uninsured women are more likely to suffer from chronic conditions which can lead to pregnancy complications. In fact, “women who lack health insurance are four times more likely to die of a pregnancy-related complication compared to their insured counterparts,” states Barone in Berkeley Wellness.

As Panel 6, also shown below, shows the geographic variation in maternal mortality is strongly correlated with other indicators of health and well being. The southern U.S. has the highest rates, with a maximum in Georgia at 46.2 deaths/100,000 live births.

The map in Panel 7 (left) shows county-level data following the same distribution as state-level data; however, county data are only available using 100,000 population as the rate denominator. So, while the state of Georgia has the highest maternal mortality ratio at 46.2 deaths/100,000 live births, county-level data for Jefferson County, for example, are reported as 1.14 deaths/100,000 population. Also noteworthy in Panel 7 is the ability to view mortality trends. Again, using Jefferson County as an example, we see maternal mortality has increased between 1985-2014 from 0.62 to 1.14/100,000 population, up 84%.

Next Steps

So what’s being done about this crisis in our midst? Organizations and initiatives are stepping up to create change. The American Academy of Family Physicians has implemented awareness campaigns, legislative initiatives, provider training, and innovative partnerships. The Health Resources and Services Administration (HRSA) convened a maternal mortality summit last year and has pledged to increase action via implementing best practices, increasing access to care via the Health Center Program, supporting providers, and more.  In California, the California Maternal Quality Care Collaborative (CMQCC) is being credited with reducing state maternal mortality rates by 55% using data-driven quality improvement initiatives.

Learn more about this issue, its geographic distribution, and improvement efforts in Maternal Mortality in the United States, and let us know if you have questions or feedback.

Jessica McCann
User Engagement Specialist, HealthLandscape