Health Letter, May 2023
By Azza AbuDagga, M.H.A., Ph.D.
If you’re not outraged,
you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
Although the U.S. spends 18% of its gross domestic product on health, it has been lagging behind other high-income countries in terms of many key health indicators for many years. One of these indicators is the maternal mortality rate: death of women from any cause related to or aggravated by pregnancy or its management (except accidental or incidental causes) during pregnancy, childbirth or within 42 days of the end of a pregnancy.
In 2020, the United States was one of only eight countries and territories in the world (along with Belize, Cyprus, Dominican Republic, Greece, Mauritius, Puerto Rico and Venezuela) that had significant increases in its maternal mortality rate since 2000. In 2020, the U.S. maternal mortality rate was 23.8 per 100,000 live births, per Centers for Disease Control and Prevention (CDC) estimates. In contrast, the corresponding rate for other advanced countries, such as Norway, Poland and the Netherlands, ranged from only two to four deaths per 100,000 in 2020, per estimates by the World Health Organization and others.
In 2021, the U.S. maternal mortality rate reached 32.9 deaths per 100,000 live births, according to a brief report that the CDC released in March 2023. This outrageous spiking rate mirrors the corresponding U.S. rate in 1964 (33.3 deaths per 100,000 live births), indicating serious regression of U.S. performance with respect to maternal mortality.
The 2023 CDC report found that the increase in maternal mortality rate from 2020 to 2021 was statistically significant for all Hispanic-origin and ethnic groups. Nonetheless, non-Hispanic Black (hereafter, Black) women fared worse than their non-Hispanic White (hereafter, White) counterparts on this indicator. Specifically, there were 26.6 deaths per 100,000 live births pertaining to White women and 69.9 deaths per 100,000 live births pertaining to Black women in 2021.
The 2023 CDC report comes on the heels of a troubling 2022 CDC report with data from 36 states showing that 53% of U.S. pregnancy-related deaths — deaths during pregnancy or within a year of pregnancy end from any cause related to or aggravated by pregnancy — from 2017 to 2019 occurred within seven days to one year of pregnancy end. This later report also found that 84% of U.S. pregnancy-related deaths with a known cause were preventable: There was at least some chance of averting these deaths by one or more reasonable changes to factors pertaining to the patient, community, treating health care professional, health care facility or health care system.
The top six causes of pregnancy-related deaths in this report were mental health conditions (including suicide and overdose or poisoning related to substance-abuse disorder), hemorrhage, cardiac and coronary conditions, infection, blood-clot–related conditions and cardiomyopathy (a heart muscle disorder).
The recent CDC findings are unacceptable; they should serve as a wake-up call for U.S. policy and public health officials at the federal, state and local levels to renew their commitment to protect and support all pregnant women during and after pregnancy. This commitment should entail implementing more effective strategies to provide equitable access to health care services and mitigate related barriers for all affected women, especially those who are Black, poor or disadvantaged in any way.
Living in the United States should not be a persistent risk factor of preventable death among women due to pregnancy-related problems!