The United States has the highest maternal mortality rate in the developed world, with some 700 women dying from pregnancy-related complications every year. But a new report published by the Centers for Disease Control and Prevention suggests the majority of lives lost—approximately three out of five, or 60 percent—could have been saved if the mothers had access to better medical care.
According to U.S. News and World Report’s Gaby Galvin, 3,410 pregnancy-related deaths were recorded in the U.S. between 2011 and 2015, reaching an overall rate of 17.2 deaths per 100,000 live births. Of the 2,990 deaths for which timing was known, 31 percent took place during pregnancy, while 36 percent occurred during or in the week after delivery. Thirty-three percent happened between one week to one year postpartum.
Heart disease and stroke—cardiac issues known to disproportionately affect African American women, reports Roni Caryn Rabin for The New York Times—contributed to more than one-third of these fatalities. CBS News’ Ashley Welch reports that leading causes of death during delivery were obstetric emergencies such as hemorrhaging and amniotic fluid embolism. In the week following childbirth, high blood pressure, severe bleeding and infection were the most deadly health issues. Following this immediate postpartum period, cardiomyopathy, or weakened heart muscle, was the most significant risk factor.
Crucially, the analysis reveals a significant racial disparity in deaths linked to pregnancy. Rabin reports that African American, Native American and Alaska Native women are around three times more likely to die from pregnancy-related issues than white women, in large part due to racial bias endemic in the health care system.
“The reason for this higher prevalence is still being explored and one emergent theory is the effect of weathering or early aging of the body due to chronic stress related to structural racism or systemic racism and its impact on health,” Emily Petersen, co-author of the study and medical officer in the C.D.C.’s Division of Reproductive Health, tells the Washington Post’s Lindsey Bever. “There’s also a growing body of research on the role of structural racism and implicit bias in health care and its impact on patient care and outcomes.”
Overall, U.S. News and World Report’s Galvin writes, pregnancy-related death rates among African American women reached 42.8 per 100,000 live births between 2011 to 2015, as opposed to 32.5 per 100,000 for American Indian or Alaska Native women, 14 for Asians and Pacific Islanders, 13 for white women, and 11.4 for Hispanic women. (Comparatively, CBS News’ Welch notes, Sweden, one of the countries with the lowest maternal mortality rates, experiences just 4 deaths per 100,000 live births.)
Race isn’t the only risk factor: Unmarried mothers are more likely to die of pregnancy-related issues than married women, while women who have only graduated high school experience higher death rates than both those who completed less and more schooling. As Rabin of The New York Times reports, mothers aged 40 and over have a pregnancy-related death rate of 76.5 per 100,000 live births.
The C.D.C. report outlines nearly 40 strategies for lowering the U.S.’ unprecedented maternal mortality rate. According to USA Today’s Alison Young, a key recommendation is helping patients manage underlying chronic health problems exacerbated by pregnancy. By educating expectant mothers on early indicators of potentially deadly complications—a swollen leg could signal a blood clot, for example, while a fever may warn of infection—health care providers can encourage them to seek care before it’s too late.
Other recommendations include standardizing the ways in which health care providers respond to obstetric emergencies, ensuring doctors only perform C-sections if medically necessary, and calling on states and communities to provide better access to housing and transportation.
“Preventing pregnancy-related deaths needs actions by states and communities where pregnant and postpartum women live, as well as the health care providers, facilities and systems that serve them,” Anne Schuchat, principal deputy director of the C.D.C., told reporters earlier this week. “There are big-picture, systems-level changes that could help ensure all pregnant women receive high-quality care during pregnancy, at delivery and up to a year afterward.”