Maternal mortality refers to the death of a woman during her pregnancy or up to a year after her pregnancy has terminated; this metric only includes causes related to the pregnancy, and does not include accidental causes. Some sources define maternal mortality as the death of a woman up to 42 days after the pregnancy has ended, instead of one year. In 1986, the CDC began tracking pregnancy-related deaths to gather information and determine what was causing these deaths by creating the Pregnancy-Related Mortality Surveillance System. According to a 2010–2011 report, although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest (12.7 deaths per 100,000 births) when compared to 49 other countries in the developed world.
As of 2023, the US had an estimated 18.6 deaths per 100,000 births. The CDC reported an increase in the maternal mortality ratio in the United States from 18.8 deaths per 100,000 births to 23.8 deaths per 100,000 births between 2000 and 2014, a 26.6% increase. The mortality rate of pregnant and recently pregnant women in the United States rose almost 30% between 2019 and 2020. According to the CDC, a study that included data from 36 states found that more than 80% of pregnancy-related deaths were preventable between 2017 and 2019.
Monitoring maternal mortality In 1986, the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) created the Pregnancy-Related Mortality Surveillance System to monitor maternal deaths during pregnancy and up to one year after giving birth. Prior to this, women were monitored up to six weeks postpartum.
In 2016 the CDC Foundation, the Centers for Disease Control and Prevention (CDC) and the Association of Maternal and Child Health Programs (AMCHP) undertook a collaborative initiative—"Building U.S. Capacity to Review and Prevent Maternal Deaths"— funded by Merck under the Merck for Mothers program. They are reviewing maternal mortality to enhance understanding of the increase in the maternal mortality ratio in the United States, and to identify preventative interventions. Through this initiative, they have created the Review to Action website which hosts their reports and resources. In their 2017 report, four states, Colorado, Delaware, Georgia, and Ohio, supported the development of the Maternal Mortality Review Data System (MMRDS) which was intended as a precursor to the Maternal Mortality Review Information Application (MMRIA). The three agencies have partnered with Colorado, Delaware, Georgia, Hawaii, Illinois, North Carolina, Ohio, South Carolina, and Utah to collect data for the Maternal Mortality Review Information Application (MMRIA); the nine states submitted their first reports in 2018.
After decades of inaction on the part of the U.S. Congress towards reducing the maternal mortality ratio, the United States Senate Committee on Appropriations voted on June 28, 2018, to request $50 million to prevent the pregnancy-related deaths of American women. The CDC would receive $12 million for research and data collection. They would also support individual states in counting and reviewing data on maternal deaths. The federal Maternal and Child Health Bureau would receive the remaining $38 million directed towards Healthy Start program and "life saving, evidence-based programs" at hospitals. MCHB's Healthy Start was mandated to reduce the infant mortality rate.
In 2019, Kamala Harris reintroduced the Maternal Care Access and Reducing Emergencies (CARE) Act which aimed to address the maternal mortality disparity faced by women of color by training providers on recognizing implicit racial bias and its impact on care. Harris stated:"We need to speak the uncomfortable truth that women—and especially Black women—are too often not listened to or taken seriously by the health care system, and therefore they are denied the dignity that they deserve. And we need to speak this truth because today, the United States is 1 of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. That risk is even higher for Black women, who are three to four times more likely than white women to die from pregnancy-related causes. These numbers are simply outrageous."
In the 1930s, the Maternal Mortality Review Committees (MMRCs) formed in New York City and Philadelphia in response to high maternal mortality rates. Philadelphia saw success with reducing the rates through data collected from their MMRC and over the next two decades MMRCs popped up throughout the country. MMRCs have grown and shrunk in popularity since, but the CDC now recommends MMRC data as the gold standard for understanding the causes of maternal mortality and planning intervention. The reasoning is that MMRCs are uniquely poised to identify opportunities for action despite difficulties in classifying deaths as pregnancy-related.
Measurement and data collection According to a 2016 article in Obstetrics and Gynecology by MacDorman et al., one factor affecting the US maternal death rate is the variability in the calculation of maternal deaths. The WHO deems maternal deaths to be those occurring within 42 days of the end of pregnancy, whereas the United States Pregnancy Mortality Surveillance System measures maternal deaths as those occurring within a year of the end of pregnancy. Some states allow multiple responses, such as whether the death occurred during pregnancy, within 42 days after pregnancy, or within a year of pregnancy, but some states, such as California, ask simply whether the death occurred within a year postpartum.
In their article, the authors described how data collection on maternal mortality rates became an "international embarrassment". In 2003 the national U.S. standard death certificate added a "tick box" question regarding the pregnancy status of the deceased. Many states delayed adopting the new death certificate standards. This "muddied" data and obstructed analysis of trends in maternal mortality rates. It also meant that for many years, the United States could not report a national maternal mortality rate to the OECD or other repositories that collect data internationally.
In response to the MacDorman study, revealing the "inability, or unwillingness, of states and the federal government to track maternal deaths", ProPublica and NPR found that in 2016 alone, between 700 and 900 women died from pregnancy- and childbirth-related causes. In "Lost Mothers" they published stories of some of women who died, ranging from 16 to 43 years of age.
Healthy People is a federal organization that is managed by the Office of Disease Prevention and Health Promotion (ODPHP) at the U.S. Department of Health and Human Services (HHS). In 2010, the US maternal mortality ratio was 12.7 (deaths per 100,000 live births). This was three times as high as the Healthy People 2010 goal, a national target set by the US government.
According to a 2009 article in Anthropology News, studies conducted by but not limited to Amnesty International, the United Nations, and federal programs such as the CDC, maternal mortality has not decreased since 1999 and may have been rising.Morton, Christine H. "Where Are the Ethnographies of US Hospital Birth?" Anthropology News 50.3 (2009): 10-11. Web.
By November 2017, Baltimore, Philadelphia, and New York City had established committees to "review deaths and severe complications related to pregnancy and childbirth" in their cities to prevent maternal mortality. New York's panel, the Maternal Mortality and Morbidity Review Committee (M3RC), included doctors, nurses, "doulas, midwives and social workers". New York City will be collaborating with the State of New York, the first such collaboration in the US. In July 2018, New York City's de Blasio's administration announced that it would be allocating $12.8 million for the first three years of its five-year plan to "reduce maternal deaths and life-threatening complications of childbirth among women of color".
Causes Medical causes Maternal death can be traced to maternal health, which includes wellness throughout the entire pregnancy and access to basic care.
The World Health Organization and the CDC's National Vital Statistics System (NVSS) define maternal death as that which occurs within the first 42 days after birth.
Since 1986, the Center for Disease Control conducts a Pregnancy Mortality Surveillance Service (PMSS) to study the medical causes of maternal death. This tool defines pregnancy-related death as death during or within one year of completion of a woman's pregnancy by any cause attributed to the pregnancy to capture all deaths which might be pregnancy-related.
Race, location, and financial status all contribute to how maternal mortality affects women across the country. Non-Hispanic blacks account for 41.7% of maternal deaths in the United States. Additionally to race, According to a study published in (Jones et al.,2022), a woman's social determinants of health can affect both her health and her ability to conceive. Black women are more likely than other races to experience life-threatening complications, such as hemorrhage and even worse maternal outcomes. The research investigates the link between maternal morbidity and social determinants of health. The study's author also mentioned a few risk factors for adverse pregnancy outcomes that were related to the social determinants of these women's lives. These include the mother's age, any existing health conditions, and so on (Jones et al., 2022).
Maternal Mortality Review Committees (MMRCs), state and local committees that review pregnancy related deaths, found that the leading causes of maternal mortality from 36 participating states 2017–2019 are:
Mental health conditions including deaths of suicide, overdose/poisoning related to substance use disorder, and other deaths determined by the MMRC to be related to a mental health condition, including substance use disorder. (23%) Excessive bleeding (hemorrhage): Excluding aneurysms or cerebrovascular accident (14%) Cardiac and coronary conditions (relating to the heart) (13%) Infection (9%): including deaths of coronary artery disease, pulmonary hypertension, acquired and congenital valvular heart disease, vascular aneurysm, hypertensive cardiovascular disease, Marfan Syndrome, conduction defects, vascular malformations, and other cardiovascular disease; and excludes cardiomyopathy and hypertensive disorders of pregnancy. Thrombotic embolism (a type of blood clot) (9%) Cardiomyopathy (a disease of the heart muscle) (9%) Hypertensive disorders of pregnancy (relating to high blood pressure) (7%)
Social factors Social determinants of health also contribute to the maternal mortality rate. Some of these factors include access to healthcare, education, age, race, and income.
Access to healthcare Women in the US usually meet with their physicians just once after delivery, six weeks after giving birth. Due to this long gap during the postpartum period, many health problems remain unchecked, which can result in maternal death. Just as women, especially women of color, have difficulty with access to prenatal care, the same is true for accessibility to postpartum care. Postpartum depression can also lead to untimely deaths for both mother and child.