Pregnancy and childbirth carry some risks, as any medical condition or event would, but most women who give birth have successful outcomes, healthy babies, and no life-threatening issues. Still, among industrialized countries, the United States has the most maternal deaths, with 26.4 deaths per 100,000 live births. How can this rate be so high in a country that has access to clean water, sanitation, food, healthcare, and education?
Globally, maternal death rates are going down. However, the trend is the opposite in the US. Between 1990 and 2015, maternal deaths decreased worldwide by between 30% and 45% depending on which estimates are used. During that same period, in the United States, the rate increased by 60%. Part of the issue could be reporting factors since it wasn’t until 2017 that every state began including pregnancy and childbirth information on death certificates. Another trend has been observed in the United States, however, and it’s related to race.
Studies show that black women in the United States have a higher chance of dying from a pregnancy-related complication. Depending on which data is used, the risk for women of color is three to four times higher than white women. As for complications, black women have nearly two times the rate of severe maternal morbidity (SMM) than white women. The cause of the increased risk is likely related to several factors.
Access to health care and insurance is lower in the South. In the state of Georgia, for instance, the maternal death rate is one of the highest n the US. For black women in the state, the rate of maternal mortality is 39 deaths for every 100,000 live births. That is four times higher than the rate of maternal death for white mothers in Georgia. Poverty is also a factor in most health conditions and pregnancy and childbirth is no exception. Pre-existing medical issues are part of the problem as well. On the whole, women are going into pregnancy at later ages and with higher rates of health conditions that can increase the risk of maternal death. Statistically, black women are already at a higher risk for diabetes, obesity and cardiovascular disease and that just piles on to the higher risk of less access to care, insurance and healthcare facilities.
It’s not all about education, access or the lack of available care. A five-year analysis of severe maternal morbidity in New York City found that a college-educated black woman giving birth in any local hospital (which are some of the best in the world) has a higher likelihood of serious complications than a white woman who never finished high school. In a survey study “Listening to Mothers: Pregnancy and Childbirth” 10% of black mothers reported they “often” or “always” felt they were treated poorly in the hospital or by pregnancy care providers, compared to 3% of white women.
While the problem is complex and has no one-size-fits-all solution, the numbers are clear that maternal health issues are on the rise among women of color and steps to reduce the rate of death and complications need to be researched. The video below includes more information on the problem, take a look.