A new U.S. government paper documenting an increase in maternal mortality from 2018 to 2022 does not hedge in its conclusion, calling the issue “an urgent public health priority.” That it was published amid massive job and funding cuts at federal health agencies charged with reducing these deaths has not escaped notice.
A week ago, much of the department tasked with monitoring and improving maternal and child health at the Centers for Disease Control and Prevention was placed on leave, while some researchers who study maternal mortality have had their funding rescinded.
“It’s a hard time for this to come out,” said Rose Molina, an OB-GYN at Harvard Medical School, who co-authored the study. “We cannot take our eyes off of maternal health right now, and if anything, we need to not just maintain focus, but actually increase investment in maternal health to bring down some of what we’re seeing — increases in pregnancy-related death rates, but also persistent inequities by racial and ethnic groups.”
The study’s lead authors, who work at the National Institutes of Health, were not available to comment on the study.
While previous studies have also shown an increase in maternal mortality in the U.S., the new paper, published Wednesday in JAMA Network Open, shed light on long-term maternal health because it analyzed deaths up to a year postpartum. By expanding the window studied, the researchers found that cardiovascular disease, cancer, and mental disorders were leading causes of late maternal deaths.
The paper analyzed data from a CDC database that is different from the Pregnancy Risk Assessment Monitoring System hit hard by cuts last week. Overall, maternal mortality increased from 25.3 deaths per 100,000 live births in 2018 to 32.6 deaths per 100,000 live births in 2022 — an age-adjusted increase of about 27%.
The bottom-line finding lines up with previous research, said Marie Thoma, a reproductive and perinatal epidemiologist at the University of Maryland, who has studied maternal mortality during the Covid-19 pandemic. But the new study provides more detail regarding state-level mortality and reaffirmed the prevalence of inequities by race. Rates of maternal mortality were 3.8 times higher in American Indian and Alaska Native women when compared to white women, and rates in Black women were 2.8 times higher.
She pointed to California as a reason to be optimistic. The state had the lowest rate of maternal mortality, and the authors of the study note that if the nationwide rates of maternal mortality were brought down to California’s level it would have saved 2,679 pregnancy-related deaths.
“There was a lot of momentum,” said Thoma. She pointed to a Biden administration blueprint for maternal health as an example of progress. But now, “there’s just so much uncertainty.”
Kisha Davis, a member of the board of directors at the American Academy of Family Physicians and chief health officer for Montgomery County, Md., said she has seen progress in mitigating racial disparities in the hospitals within her county.
“I saw some really great data from our hospitals, and was really encouraged from some of the interventions that they’re doing, and some of them are even starting to see a reversal in that disparity,” she said, naming initiatives to train clinicians about implicit racial bias, as well as training physicians outside the OB-GYN specialty to better support mothers.
However, some support for programs mitigating racial disparities has been cut, said Marian Jarlenski, a professor of health policy at the University of Pittsburgh. For example, funding for the Center to Advance Reproductive Justice and Behavioral Health among Black Pregnant/Postpartum Women and Birthing People at the Morehouse School of Medicine, a historically Black medical school, was cut in the past several weeks.
“Some of these NIH initiatives to improve maternal mortality were started and funded in the first Trump administration, and they’re still going on. However, NIH has cut off funding for some of these maternal health research centers around the country, so it’s very confusing,” Jarlenski said. “This study that we’re talking about today shows why this is not a political issue, and it’s really important that we all be focusing on how we can reduce maternal mortality and working together on it.”
