According to the March of Dimes, in 2019, the United States was one of the most dangerous developed nations in which to give birth.
A Rising Trend
While rates of pregnancy-related deaths have been falling globally for the last 25 years, the rate has more than doubled in the United States. In addition to a rising number of deaths, Americans are experiencing an increase in severe health complications as a result of pregnancy and childbirth. For birthing persons of color, the statistics are even more concerning and demand a change in how we approach maternal health as a nation.
A pregnancy-related death is defined as the death of a birthing person during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
Severe maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a birthing person’s health, such as blood transfusions, hysterectomy, ventilation, or temporary tracheostomy.
In the United States, nearly 700 birthing persons die as a result of pregnancy or pregnancy-related complications each year.
Between 1987 and 2014, deaths during pregnancy and up to a year after delivery more than doubled, rising from 7.2 per 100,000 live births to 18.0 per 100,000 live births.
A recent CDC study of maternal deaths across 13 states concluded that 2 out of 3 deaths were preventable.
For the period of 2011 to 2015:
- 31% of deaths occurred during pregnancy
- 36% of deaths occurred at delivery or in the week after
- 33% of deaths occurred 1 week to 1 year postpartum
Unfortunately, many discussions of the maternal health crisis exclude the fact that birthing persons of color are disproportionately affected. African American birthing persons are twice as likely to experience severe maternal morbidity than non-Hispanic white birthing persons. Although other birthing persons of color have elevated risks—notably Native American, Alaska Native (AIAN), and some Latina birthing persons—the disparities between African American and non-Hispanic white birthing persons is stark.
More Research Needed
There is little information about how birthing persons of color are affected differently by the timing in onset and manifestation of SMM. A recent study published in the Journal of Racial and Ethnic Health Disparities found that Black birthing persons experienced the highest proportion of SMM during the antepartum period. From the study’s authors:
“addressing racial disparities in maternal morbidity and mortality requires national policies and initiatives tailored to black women that address the specific types and timings of life-threatening obstetric complications.”
AIM CCI’s Approach
One of AIM CCI’s primary goals is continually addressing social determinants of health (SDOH) and advancing equity through our non-hospital focused safety bundles. We strive for a health care system that is truly equitable, where racial identity holds no influence on maternal health outcomes.
- March of Dimes 2019 Report Card
- CDC – Maternal Deaths
- CDC – Reproductive Health
- Taylor, J., Novoa, C., Hamm, K., and Phadke, S. (May 2, 2019). Eliminating Racial Disparities in Maternal and Infant Health: A Comprehensive Policy Blueprint. Center for American Progress. https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparitiesmaternal-infant-mortality/
- Liese KL1, Mogos M2, Abboud S2, Decocker K2, Koch AR3, Geller SE4 (2019) Racial and Ethnic Disparities in Severe Maternal Morbidity in the United States. J Racial Ethn Health Disparities. 2019 Mar 15. doi:10.1007/s40615-019-00577-w. [Epub ahead of print]
- Equity in the Center. Awake to Work to Work: Building a Race Equity Culture.
- Petersen, Emily E et al. “Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017.” MMWR. Morbidity and mortality weekly report vol. 68,18 423-429. 10 May. 2019, doi:10.15585/mmwr.mm6818e1