Contrary to the global trend, the maternal mortality rate is growing in the United States. And there are fears that the problem will worsen with restrictions on abortion implemented in several states after the Supreme Court ruled last year that the voluntary termination of pregnancy is not a constitutional right.
The main factors for the high number of deaths are the increase in chronic diseases, such as obesity and cardiovascular problems, and the advance in the average age of pregnant women, in the 30s, according to the most recent data and studies.
This scenario is compounded by the difficulty of accessing specialized health services – since 2018, the US has lost 301 hospital birth units. Today, there are a total of 2,158 in operation in the country, according to a survey released last month.
“Our research shows that maternal care is not a priority in our health system, and action needs to be taken to ensure that all mothers receive the care they need and deserve to have healthy pregnancies and strong babies,” says the doctor in a statement. Elizabeth Cherot, president of the March of Dimes, the nonprofit organization responsible for the work.
The maternal mortality rate corresponds to the proportion of deaths during pregnancy, childbirth and up to 42 days after birth per 100,000 live births. Deaths linked to pregnancy are considered; homicides, suicides and overdoses, for example, do not count.
In the USA, this number rose from 12 in 2000 to 21 in 2020, according to data from Unicef (UN Children’s Fund). Meanwhile, the global rate fell 32%. In Western Europe, it went from 9 to 6.
For comparison, in neighboring Canada, there were 11 deaths for every 100,000 births in 2020. In Brazil, that number was 72.
With the Covid pandemic, there was another increase in deaths in the US, and the rate soared to 33 in 2021, points out the Center for Disease Prevention and Control (CDC, in its acronym in English). Of the approximately 2,000 deaths recorded in the biennium, a quarter can be attributed to Covid. There is no data yet for 2022.
The national average hides a significant racial disparity.
“Implicit bias, where a person is not aware of their bias, is particularly problematic,” Monique Rainford, an obstetrician-gynecologist at Yale’s department of medicine and author of “Pregnant While Black,” told a university website.
“A provider may think he is doing the right thing for his pregnant patient, but his implicit bias against race affects the care he provides.”
Black women are the ones who proportionally die the most in the country: 68.9 deaths in every 100,000 births in 2021, according to the GAO (governmental agency for providing information). Among white women, this rate is 26.1. Among Latinas, 27.5.
According to Rainford, one factor is so-called “allostatic load” — the cumulative effects of stressors, including racism and poverty, on health. The aging caused by the accumulation of this load can mean a biological age of up to ten years higher for black women compared to white women, says the Yale doctor.
A study by the think tank Milken Institute focused on the so-called “Extremely Vulnerable America”, defined as the regions of the country with the worst economic and social indicators, shows that the maternal mortality rate is even higher in these regions.
In Arkansas, Alabama, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia, the death rate among black women is 85.9 and among white women it is 38.6.
Of those ten states, six have made abortion illegal (Arkansas, Alabama, Kentucky, Mississippi and Tennessee). Georgia, North Carolina and South Carolina have already expressed their intention to ban the procedure. In Virginia, abortion remains accessible but is not protected by state law.
Many so-called “mothering deserts” —counties without a hospital or birthing center that offers obstetric services or that have an obstetrician— are located in these regions. According to the March of Dimes, 36% of counties, home to 2.2 million women of reproductive age, fit this classification.
Two-thirds of them are in rural areas. In this case, pregnant women have to face long distances in search of medical care, which makes it difficult to prevent and treat complications both before and after childbirth.
Between 2018 and 2022, these deserts increased by 5%, as a result of the closure of specialized services in hospitals in the face of the falling number of births. Another factor should aggravate the problem: the resistance of newly formed physicians to do residency in states with the toughest legislation against abortion.
According to an analysis by the Association of American Medical Universities, there was a 10.5% drop between 2022 and 2023 in applications for residency in obstetrics and gynecology in states that have banned abortion. Considering all specialties, the drop was 3%. Where termination of pregnancy is permitted after 22 weeks of gestation, these percentages are -5.3% and -1.9%, respectively.
As the number of specialists falls, research suggests that birth rates may be rising where abortion has been banned. John Hopkins researchers’ analysis of Texas published in July estimated births would be about 10,000 higher than expected if the pre-prohibition trend had continued — a 3% increase.