Pregnancy-related deaths across the United States, already the highest among developed countries, increased as the COVID pandemic hit in 2020, with Black women suffering the highest mortality rates.
Maternal deaths in the United States were already increasing for several years before the pandemic. But the onset of COVID made things worse, new data show.
The Centers for Disease Control and Prevention last week reported that 861 women died during or soon after pregnancy in 2020, up from 754 deaths in 2019. The mortality rate rose from about 20 deaths per 100,000, to about 24.
The greatest increase in deaths was among Black women, for whom the mortality rate was 55 per 100,000, a sharp increase from the previous year — and three times the rate for white women. For Hispanic women, the death rate increased from about 13 to about 18 per 100,000.
The CDC report did not include state-specific data, but the same trends observed nationally — increasing overall death rates and wide racial disparities — are also happening in Massachusetts, according to earlier studies.
The data show the crisis is worsening despite years of attention and initiatives in Massachusetts and across the country to tackle racial disparities in maternal health and reduce serious complications during pregnancy and childbirth.
“Those are incredibly high numbers,” said Dr. Nawal Nour, chairwoman of obstetrics and gynecology at Brigham and Women’s Hospital.
“Maternal mortality has been front and center as an issue. There’s been all these efforts to address it, think about it, to ensure that we’re well aware of preventive measures — and yet, you look at the numbers, and they still are increasing.”
Maternal health experts said the data reflect the fact that people of color are at greater risk of pregnancy-related complications — and at greater risk of severe illness and death from COVID.
In rare cases, pregnant women have died from COVID, though the CDC report did not specify how many maternal deaths were related to COVID and how many from other causes.
Pregnancy-related deaths can occur from severe bleeding, infections, heart disease, and other issues. Most of these deaths occur during or after a birth. And most are preventable.
The start of the pandemic in 2020 disrupted medical care for pregnant women. In-person appointments shifted to telehealth, and ultrasounds were delayed. Some hospitals sent pregnant patients home with cuffs to remotely monitor their blood pressure.
But these disruptions in care meant that complications — such as the early stages of preeclampsia, a serious condition characterized by high blood pressure — might have been missed, said Dr. Julianne Lauring, a maternal and fetal medicine physician at UMass Memorial Medical Center.
“Routine prenatal care has a purpose,” she said. “We need to be doing it to help improve outcomes. When we tried to stop it, things seemed like they got worse, and these numbers are showing that.”
Even when pregnant patients were allowed to see their doctors in person, some were afraid to come in for fear of catching COVID. Others missed appointments because they didn’t have child care or lost their health insurance because they were laid off during the pandemic, Lauring said.
The trends are concerning even in Massachusetts, a state known for its medical care. From 2014 to 2017, the most recent years for which data are available, the percentage of babies born in the state to parents who received adequate prenatal care declined, and Black women were least likely to receive prenatal care, according to the Department of Public Health. Black women in Massachusetts had the highest death rate and were three times as likely as white women to suffer severe outcomes from labor and delivery.
Last year, lawmakers approved a law enacted by Governor Charlie Baker that created a commission to address racial inequities in maternal health and pregnancy-related deaths.
The worse outcomes for pregnant women of color stem from longstanding issues of structural racism and implicit bias, doctors said. For example, health care providers may be less likely to take seriously the concerns of a Black woman who describes pain or other symptoms.
“Black women may come from a background where there are a lot of socio-economic issues, and if we don’t look with a holistic lens, we miss out on the kind of care that they need and deserve,” added Nour, of Brigham and Women’s.
Also, women who speak a language other than English may receive poor care if an interpreter is not available to help them through an appointment, she said.
The United States lags behind other wealthy nations in the support offered to pregnant and postpartum women, according to a 2020 report from the Commonwealth Fund.
Other wealthy countries have universal access to health care, stronger social safety nets, parental leave policies, and health care systems that incorporate midwives instead of relying mostly on doctors for maternity care, said Tejumola Adegoke, an obstetrician-gynecologist and director of equity and inclusion at Boston Medical Center.
“We’ve had this data on deaths for decades, and the numbers have actually only gotten worse, not better,” she said. “Until we have those things, we are going to continue seeing these inequities.”