The rate of Americans dying while giving birth — or in the weeks afterward — increased by more than one-third in 2021 compared with a year earlier, with the burden of death disproportionately borne by communities of color, according to a report released Thursday by U.S. health officials.
The number of maternal deaths jumped to 1,205 in 2021, up from 861 the previous year, according to the report from the National Center for Health Statistics. This means the rate at which all people died of medical conditions caused or aggravated by pregnancy increased from 23.8 to 32.9 deaths per 100,000 live births.
This was the third consecutive year the nation's maternal mortality rate, long the highest among high-income nations, increased, a jump the report said was "significant" for all racial and ethnic groups.
In 2021, according to the report, Hispanic women's maternal mortality rate jumped about 54 percent, White women's increased 39 percent and Black women's 26 percent. That was the year the nation marked a gruesome milestone in the pandemic: By September 2021, 1 in every 500 Americans had succumbed to the disease caused by the coronavirus.
Although the new report does not mention the pandemic, maternal health experts said it was natural to assume the coronavirus fueled the rise in maternal deaths. Research has shown that pregnant people infected with the coronavirus have a seven times higher risk of dying compared with pregnant individuals who are not infected.
Camille Clare, an obstetrician who is chair of the department of obstetrics and gynecology at SUNY Downstate Health Sciences University in New York, said people infected with the coronavirus also had higher rates of complications, were more likely to be admitted to intensive care and saw an increase in neonatal issues, meaning more preterm births.
So, she said, "the covid-19 pandemic really had a dramatic effect on those maternal death rates on top of the crisis that was already present."
Still, the shroud of death woven from pregnancy and childbirth did not cover all communities equally. The mortality rate was highest for Black women in 2021: 69.9 deaths per 100,000 live births, which was 2.6 times the rate for White women.
The increase in deaths underscores what public health experts exploring the nation's higher rates of maternal and infant mortality - and why Black women and infants are more likely to experience complications and death - have come to understand, said Kanika Harris, director of maternal and child health at the Black Women's Health Imperative, which works to improve the health and wellness of Black women and girls.
"You can't solve this issue by focusing on the process of being pregnant and birth," Harris said. "It's not just that moment in time."
That's why it's a top predictor of a nation's health, she said, because maternal health is informed by an accumulation of life events that start long before pregnancy and that are centuries in the making. Experts and federal officials acknowledge that addressing maternal mortality means understanding the effects imposed on expectant mothers by racism, housing policy, policing, climate change, pollution - and the pandemic.
"We have probably not uncovered all of the ways that the pandemic has impacted maternal and infant health," said Rachel Hardeman, founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health.
Researchers have found that the unrelenting stress caused by racism - and the cortisol it produces - wears the body down, aging it prematurely and is a factor in maternal mortality rates. It remains to be seen how the repeated hormone spikes triggered by the social upheaval of the last few years have affected people, Hardeman said.
"We haven't been able to measure what that's done to the body, how that's aged the body, how that's impacted how healthy - or not - someone goes into pregnancy," she said.
The federal report focused on deaths clearly linked to pregnancy or childbirth - including conditions such as preeclampsia, hemorrhage or pulmonary embolism - or to the period immediately after giving birth, which is generally six weeks. It showed maternal mortality rates increased with age.
The mortality rate was highest for women older than 40: 138.5 deaths per 100,000 live births, which was 6.8 times higher than the rate for women younger than 25. The report showed both groups saw their maternal death rates increase in 2021.
Elizabeth Cherot, chief medical and health officer at the March of Dimes, said she finds this figure particularly concerning as more women conceive at an older age.
"You really have to think about your patient differently," Cherot, who is an obstetrician, said, adding that people tend to focus on the fetal abnormalities that can occur with pregnancy at an older age and not maternal ones.
Often, the chronic conditions that can affect pregnancy, such as hypertension and cardiovascular disease, tend to start later in life, said Edward Hills, a professor of obstetrics and gynecology at Meharry Medical College. Research has shown that Black people have much higher rates of hypertension, obesity, diabetes and strokes than White people do, and they develop those chronic conditions up to 10 years earlier.
“Lord have mercy, don’t let that person be a highly educated woman with an advanced degree who’s done all this stuff and put off pregnancy to when she’s in her late 30s because she’d been establishing herself,” said Hills, who has been an obstetrician for nearly six decades. “That subset of patients we have to really watch very closely.”