Black and Native women had highest risk of maternal death in past 2 decades: Study

Maternal mortality rates doubled for every race and ethnicity in the past two decades, according to a new modeling study.

Researchers estimated maternal mortality rates — which includes the death of women occurring up to one year after the end of pregnancy per 100,000 live births — from 1999 to 2019.

The current study estimated that Black women experienced more than double the rate of maternal death compared to their white counterparts, and almost triple the rate compared to Hispanics.

American Indian and Alaska Native women were also at some of the highest risk and experienced the greatest increase over the 20-year study.

“Maternal mortality persists as a source of worsening disparities in many U.S. states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis,” the authors wrote in the new analysis.

The findings largely support those seen from other data, that pregnancy-related death rates are increasing in the United States, with the highest burden on Black women. In 2021, the maternal mortality rate in the U.S. was 32.9 deaths per 100,000 live births, according to a Centers for Disease Control and Prevention report. However, the rate for Black women was 69.9 deaths per 100,000 live births.

The majority of pregnancy-related deaths take place between a week and a year after delivery, CDC data shows. Most pregnancy-related deaths are preventable, according to the CDC.

Experts aren’t entirely sure why maternal mortality rates have risen so dramatically.

“That is the million-dollar question…why in a country that spends so much money on health care, do we still see these devastating outcomes, particularly when we compare our outcomes to similarly wealthy nations?” Dr. Elizabeth Langen, associate clinical professor of obstetrics and gynecology at the University of Michigan, told ABC News.

A myriad of issues could contribute to the alarming rates, including underlying health conditions people have going into pregnancy.

“It's a form of structural racism. But when we look specifically at why this happened, there are multiple layers to it,” Dr. Jessica Shepherd, chief medical officer at Verywell Health, told ABC News.

“If you just look at health outcomes in America, you know that most chronic diseases are seen in African American communities and so when you have some of these diseases, namely hypertension, diabetes and obesity, that are present before pregnancy, those are also going to be, what we would say comorbidities, that are going to impact the maternal mortality rate,” she added.

There also isn’t enough structural support given to people during and after pregnancy.

“We are often struggling with helping people have appropriate time off work for health care, appropriate considerations for pregnancy, so that people can either see their doctor or take breaks when needed,” Langen said.

Providers and hospital systems as a whole may also need to adapt in order to enforce a change. The "Hear Her" campaign launched by the CDC aims to increase awareness of pregnancy-related complications for patients and to encourage people who are pregnant to advocate for themselves in health care settings. It’s important for providers to take concerns seriously, especially from Black women.

“We have implicit bias that's going to impact a patient to provider interaction,” Shepherd said.

“And that is going to cause maybe mistrust or people missing appointments or not going to their appointments or maybe even the messaging and what's going on with management,” she adds.

Expectant mothers may benefit from maintaining a healthy diet and weight, being physically active, quitting substance use and preventing injuries, according to the CDC. Staying in contact with a health care provider may also reduce the risk of complications.

“I think optimizing your personal health, if you have the privilege to be able to do that, is a great first step. If pregnant people start a pregnancy healthy, that certainly gives them the best chance for having a healthy pregnancy outcome,“ Langen said.