The maternal mortality rate in the US more than doubled between 1999 and 2019. The rates were the highest among Native American, including Alaska Natives, and Black populations.
Among high-income countries, the US has one the of highest rates of maternal mortality, defined as death during or within a year after pregnancy. Mental health conditions, which may lead to suicide or drug abuse, are the most common cause, followed by excessive bleeding and cardiovascular issues.
“We know that the maternal mortality rate in the United States has been on the rise for a long time,” says Allison Bryant at Mass General Brigham in Boston, Massachusetts. What has been missing is how these numbers differ between racial and ethnic groups in each state, she says.
Bryant and her colleagues analysed data from the National Vital Statistics System, which tracks births and deaths across the country, between 1999 and 2019.
For the entire US population, the team found that the maternal mortality rate rose from 12.7 deaths per 100,000 live births in 1999 to 32.2 deaths per 100,000 live births in 2019.
Native American populations, including Alaska Natives, saw the biggest uptick, with a more than three-fold increase in the maternal mortality rate from 19.0 per 100,000 live births to 69.3. Among white people, the maternal mortality rate also tripled, from 9.2 to 27.9 per 100,000 live births.
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For the Black population, it rose from 31.4 to 67.6 per 100,000 live births. In both the Hispanic and Asian or Pacific Islander groups, it reached 20.8 per 100,000 live births in 2019, approximately twice the rates in 1999.
For most groups, maternal mortality was highest in southern states, apart from Native Americans, which had higher rates in the West, which includes Alaska.
Though the team didn’t look at the specific causes of death, Bryant says a range of factors are probably behind the rise. This includes people falling pregnant at a later age, which may lead to complications, as well as inadequate access to healthcare and systemic racism faced by many racial and ethnic groups.
“By zooming in to specific high-risk populations, we’re able to show where the problem is and where attention needs to be paid to address it,” says team member Greg Roth at the University of Washington.
Journal reference
JAMA DOI: 10.1001/jama.2023.9043
