The number of women in the United States who died during pregnancy or shortly after giving birth increased sharply during the first year of the coronavirus pandemic, according to a new study, an increase that health officials attribute partly to Covid and pandemic-related disruptions.
The new report, from the National Center for Health Statistics, found that the rate of maternal deaths rose 14 percent, to 861 in 2020 from 754 in 2019.
The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.
Black women in America experienced the most deaths: One-third of the pregnant women and new mothers who died in 2020 were Black, though Black Americans make up just over 13 percent of the population. Their mortality rate was nearly three times that of white women.
The mortality rate for Hispanic women, which has historically been lower than for white women, also increased significantly in 2020 and is now almost on par with the rate for white women. Death rates increased among all pregnant women older than 24, but particularly in those 40 and over, whose mortality rate was nearly eight times that of women younger than 25.
“Our maternal morbidity and mortality is the highest in the developed world, and the trend is continuing despite our awareness of it, despite our maternal-mortality review committees, despite attention in the press,” said Kara Zivin, a professor of psychiatry, obstetrics and gynecology at the University of Michigan who studies access to care during and after pregnancy. “Whatever we’re doing is clearly not enough to address either the overall rate or the disparities.”
Although the new report is sparse on details — no maternal mortality figures were provided for American Indian/Alaska Native women, who have higher pregnancy-related deaths than white, Hispanic and Asian/Pacific Islander women — experts said some of the deaths were most likely related to the coronavirus pandemic. Pregnancy puts women at risk for more severe disease if they are infected with the SARS-CoV-2 virus, which causes Covid, and vaccines were not available for them in 2020.
“We actually said when the lockdown started that we anticipated an increase in maternal deaths, both due to Covid and the responses to Covid,” said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, adding that she was not surprised by the increases.
In addition to the greater risks faced by pregnant women who have Covid, she said, “we hadn’t figured out how to deliver obstetric care safely in 2020.”
“Our health systems weren’t set up yet to manage telehealth,” she said, “and there were other barriers: Kids were home from school, and parents couldn’t get away for medical appointments.”
Many doctors had stopped seeing patients in person, hospitals were often crowded and patients avoided emergency rooms filled with Covid patients.
Pregnant women who develop Covid face a higher risk of requiring intensive care or mechanical ventilation. And despite the relative youth of pregnant women, they face a higher risk of dying, studies found. Health experts have been urging them to be vaccinated, but their vaccination rates have remained low.
Black Americans overall suffered disproportionately from the pandemic, with higher hospitalization and death rates than their white counterparts, but the racial disparities in maternal mortality predate and extend beyond Covid, and stem from structural health inequities that have complex root causes.
Stress, mental health problems and substance abuse increased during the pandemic and might also have contributed to worse outcomes, said Dr. Mary D’Alton, chair of the department of obstetrics and gynecology at Columbia University Irving Medical Center.
New programs that provide enhanced services for patients, such as doulas, who can support and advocate for patients, are positive advances, she said.
“We also have to educate our providers on listening to patients,” Dr. D’Alton said. “My dad was a primary care doctor and he used to say, ‘Mary, if you want to know what’s wrong with the patient, ask them and they’ll tell you. But first of all, you’ve got to listen to them.’”
“Pregnant women’s complaints are often dismissed, and that is probably much more significant for Black and brown women,” she added.
Generally speaking, the leading causes of pregnancy-related deaths are cardiovascular conditions, other medical conditions and infections. Research has found that cardiomyopathy, a disease of the heart muscle; blood clots to the lung; and hypertensive disorders of pregnancy contribute to a higher proportion of pregnancy-related deaths among Black women than among white women.
One of the new mothers who died in 2020, whose story was widely reported, was Dr. Chaniece Wallace, a Black physician who was the chief pediatric resident at the Indiana University School of Medicine in Indianapolis.
Dr. Wallace developed a pregnancy complication called pre-eclampsia and her baby girl was delivered early by cesarean section in October 2020. But Dr. Wallace went on to develop additional complications, and she died just days after giving birth.