Maternal mortality in the United States continues on a dramatic increase. A first-of-its-kind state-by-state analysis of five racial and ethnic groups recently showed sharp increases for all groups studied. The most dramatic increases were among American Native and Alaskan Native people. Maternal mortality continues to be a public health problem that disproportionately affects non-white groups and little has been done to address the issue.
While the average state-level rates started to level off around 2015 (pre-COVID) for Black women, the maternal mortality rates for them continue to be the highest of any group. The study published by the American Medical Association highlights how factors like structural and interpersonal racism play into the disparities. It notes how substantial prevention and awareness efforts around maternal mortality may have had an impact on some populations, but not all.
Maternal mortality rates and disparities varied widely. The South had high maternal mortality across all race and ethnicity groups, but especially for Black women. Some states in the Northeast had the highest maternal mortality rates for Black women which tripled over the time of the study. In the Midwest and the Great Plains states, maternal mortality rates for American Native and Alaskan Native women were the highest.
“Maternal mortality is a crisis in the United States. These rates have been increasing over the past several decades and were exacerbated by the pandemic,” said co-first author Allison Bryant, MD, MPH, senior medical director for health equity at Mass General Brigham. “Our study sheds light on the wide disparities within maternal mortality rates – the specter of maternal death differentially burdens some ethnic and racial populations.”
While maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Natives and Alaska Natives and Black individuals are at increased risk, particularly in several states where these inequities have not been previously highlighted. The study highlighted the increases by ethnic groups and by states.
American Natives and Alaska Natives in Florida, Kansas, Illinois, Rhode Island, and Wisconsin saw an astounding increase in each state at more than 162%. White people in Indiana, Georgia, Tennessee, Louisiana, and Missouri also saw an alarming increase in each state at more than 135%. Hispanics/Latinos in Indiana, Minnesota, Georgia, Tennessee, and Illinois saw a staggering increase of more than 105% increase in each state, and Black women saw yet another frightening increase of 93% in Louisiana, New Jersey, Georgia, Arkansas, and Texas. And lastly, Asian Pacific Islanders saw an increase of 83% in Kansas, Illinois, Missouri, and Georgia.
“The median state Maternal Mortality Ratio (MMRs) for the Black population remains the highest in the U.S.,” reads the conclusion of the study. “Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups with the greatest potential to improve maternal mortality.”
While each group showed sharp increases in various states, noting the consistent disparities in how Black women are impacted should serve as a stark warning. The American healthcare system is undoubtedly biased and in many cases, flat-out racist. The problem isn’t always the “system” as it is the doctors and nurses who diagnose and provide care if they choose to do so or not based on their personal beliefs. Until those biases are addressed, not much will change.
“Maternal mortality persists as a source of worsening disparities in many US states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis,” reads the closing of the study.
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