coulda shoulda

More than 80% of maternal deaths in the US are preventable

Better mental health care and monitoring after birth could reduce deaths significantly
More than 80% of maternal deaths in the US are preventable
Photo: Kevin Lamarque (Reuters)
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The tragedy of maternal mortality in the US is no longer secret, but it’s not improving, either. Official rates have continued to rise, from 17.4 out of every 100,000 live births in 2018 to 23.8 in 2020. Covid increased 2020 deaths, as did better surveillance and data for both years, stemming from more awareness around the issue.

But a damning new report published this week by the US Centers for Disease Control and Prevention (CDC) shows beyond doubt that the fundamental causes of such high rates of maternal mortality (several times those of comparable countries) are systemic.

The report reviewed 1,018 pregnancy-related deaths in 36 states, finding that more than 80% of them were from preventable causes.

What is a preventable death?

According to the CDC, “a death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors.”

Only about half the deaths occurred during pregnancy or within a day of childbirth, showing a need for better surveillance after mothers have left the hospital, and in the weeks and months following delivery (which can be especially delicate from a mental health perspective). For most women, including those who have had c-sections, the first postpartum appointment is scheduled six weeks after delivery.

Mental health intervention, for instance, could have avoided some deaths by suicide, while better monitoring of cardiovascular risk and health in mothers, even after they had left the hospital, might have reduced the risk of cardiac conditions.

Maternal death causes vary depending on race and ethnicity

The review looked at the causes of death, which varied significantly across ethnicities and race, as did mortality rates. More than 55 Black women die of pregnancy-related cause for every 100,000 live births, a risk three times as high as that of white women, whose mortality is less than 18 per 100,000. Along the same lines, in the sample studied in the report, Black women accounted for 31% of deaths, while representing only 13% of the population, while white women were underrepresented.

For white women, the top cause of death was by far mental health issues, accounting for nearly 35% of deaths, followed by hemorrhage (12%), cardiac and coronary conditions (11%), and infection (11%). Hispanic women’s maternal death causes mirrored white women’s, while Asian mothers died most of hemorrhage, cardiac conditions, and amniotic fluid embolism.

Black mothers died most of cardiac and coronary conditions (16%), followed by cardiomyopathy (14%), and embolisms (12%), while mental health death accounted for only 7% of reviewed deaths.

If you or someone you know is in crisis, in the US you can call the National Suicide Prevention Lifeline, 24/7, for confidential support at 1-800-273-8255. For hotlines in other countries, click here.