A new CDC report on 2020 maternal mortality rates has unsurprising but disturbing findings: Maternal deaths increased compared to the previous year, and the increases were larger among Black and Hispanic women than White women.
Using the World Health Organization definition, CDC considers maternal deaths to be those that occur during pregnancy or in the 42 days after giving birth. In 2019, the U.S. maternal mortality rate was 20.1 deaths per 100,000 live births, and in 2020 it rose to 23.8. But that increase wasn’t evenly distributed: Non-Hispanic White women saw a 7% increase in maternal deaths (from 17.9 to 19.1), while the rates jumped 26% for non-Hispanic Black women (from 44.0 to 55.3) and 44% for Hispanic women (from 12.6 to 18.2).
The shameful disparity in maternal health between U.S. Black and White women is longstanding and rooted in a combination of factors, including broad societal forces like structural racism and the bias of individual providers who dismiss reports of symptoms from Black pregnant and birthing people. And although racism and other forms of bias also harm Hispanic people, until this year they hadn’t translated to faster-growing rates of maternal mortality when compared to White people.
What changed in 2020 was, of course, the COVID-19 pandemic, which disrupted medical care while creating new stressors. The fact that those disruptions and stressors translated into more of an increase in maternal mortality in Black and Hispanic people compared to White people is another demonstration of our country’s inadequate attention to equity in the pandemic response. Because of structural racism, Black and Hispanic people are more likely than White people to work “essential” jobs that require in-person attendance, which increases their risk of COVID exposure, and Black households are more likely to face pandemic-related hardships. Universal paid sick leave and stronger financial supports could have helped reduce the pandemic’s inequitable toll, but federal assistance has been limited in both scope and duration.
Efforts to reduce racial inequities in maternal mortality were underway long before the pandemic, and the latest numbers show that more work is essential. Nearly every state now has a maternal mortality review committee that reviews maternal deaths and makes recommendations to prevent future deaths. Committees have offered a range of recommendations, from improving access to care to “improving policies related to patient management, communication and coordination between providers, and language translation.”
Another set of recommendations comes from the National Birth Equity Collaborative, which wrote to Vice President Kamala Harris on the 2021 Maternal Health Day of Action at the White House to recommend steps the executive branch should take to advance U.S. maternal health. First on the list is establishing a White House Office of Sexual Reproductive Health and Wellbeing that would coordinate sexual and reproductive health wellbeing efforts and “address barriers to full reproductive autonomy, such as access to health care, including contraception, maternal and infant health, quality, affordable child care and comprehensive paid family leave.” Recommendations for individual agencies include the Department of Education reducing barriers for “Black, Indigenous and other people of color to enter, stay in and graduate from programs that train people to join the maternity care support workforce and for a thorough examination of medical and nursing school and training program curriculum to promote anti-racist models of care” and the Department of Housing and Urban Development to establish a Housing for Moms Task Force to ensure funding for “safe, stable, adequate, quality housing for pregnant and postpartum people.”
Members of Congress also must address this crisis. Along with other members of the Black Maternal Health Caucus, U.S. Rep. Lauren Underwood introduced the Black Maternal Health Momnibus Act, which includes 12 individual bills addressing different aspects of maternal health. The first of the bills would make “critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation and nutrition.” And a provision of the Build Back Better Act that would extend pregnancy Medicaid for a full year after childbirth (instead of the 60 days required under current law) in all states should be passed through another route if BBB isn’t happening.
Families across the country are suffering the loss of parents, spouses and siblings to maternal mortality. While the COVID-associated increase in maternal deaths is unsurprising, it’s also unacceptable. Let’s make the changes to laws, policies and practices to make sure everyone who’s looking forward to giving birth can live to see their babies grow up.
Liz Borkowski is a contributor to the public health blog The Pump Handle. She is managing editor of Women’s Health Issues, the peer-reviewed journal of the Jacobs Institute of Women’s Health, and a researcher in the Department of Health Policy and Management at the Milken Institute School of Public Health at George Washington University.