According to the Centers for Disease Control (CDC), there were 1,205 maternal deaths in the U.S. in 2021 – a 40% increase from the previous year and ten times the estimated rates of other high income countries such as Australia, Japan, and Spain. “This high level of maternal mortality is unacceptable for a high income country,” says Ellen Smith, Palladium Senior Technical Advisor. “And while the startling increase in 2021 can be largely attributed to COVID-19, it reflects continued divestment in the populations driving this crisis.”

In addition, the maternal death rate among Black Americans was 2.6 times higher than the rate for white Americans, further highlighting continued health disparities and inequities in the U.S. “Black birthing people are three times more likely to die during and after childbirth than white birthing people,” explains Chinwoke Isiguzo, Palladium Senior Technical Advisor.

According to a separate CDC report, 80% of these deaths are preventable.
A myriad of social and structural barriers put Black women at a disadvantage – structural racism, a historical mistrust of the healthcare system, lack of universal screening and mental health services, lack of culturally and racially concordant care, and missed or delayed diagnoses.

A Sign of a Larger Problem

The CDC’s report is indicative of a concerning public health issue in the U.S., says Smith. “While the numbers from 2021 may not continue in the long run, I think we’ll continue to see effects of the pandemic into 2022 and beyond.” This is the third consecutive year that the maternal mortality rate increased for all racial and ethnic groups in the U.S, indicating a concerning trend.

Though the pandemic exacerbated some of the causes of disparities in maternal health, Smith explains that maternal mortality, as well as morbidity for both mothers and babies, have long term implications that should concern families, employers, and the government. “Families are affected for generations by the loss of a mother,” says Smith. The costs of poor pregnancy outcomes should also be concerning to those paying for healthcare or insurance, including government schemes and self-insured employers.

Self-insured employers bear these costs, not only increasing premiums for the rest of the organisation but ultimately affecting the bottom line. With such stark racial inequities, these disparate health outcomes are also a matter of equity for employers.

“The fact that the racial inequities are so persistent means that this is also directly relevant to employer’s diversity, equity, and inclusion efforts,” Smith says. “In public health, we know that there are huge disparities in maternal and infant health by race and ethnicity. But this often goes unnoticed by employers, whose health insurance covers approximately half of the births in the U.S. Employers are usually focused on insurance claims data, which do not have racial or ethnic breakdowns.”

Elevating Mortality Review Committees

For state and local governments, these mortality increases, and persistent disparities only increase the importance of maternal mortality review committees. These committees consist of multidisciplinary teams of healthcare and human service professionals who review the medical records and circumstances surrounding a maternal death to determine the underlying causes and contributing factors. They are critical for identifying and addressing the causes of maternal deaths with the goal of identifying opportunities for prevention.

“For these committees to be truly effective, it’s critical to ensure they include racially and ethnically diverse people as well,” Smith adds. “Lived experience really matters in understanding what went wrong in each case, and why we continue to see a completely unacceptable level of racial inequities.”

Moving Forward with Equity

Although the increase in maternal mortality in 2021 was due to complications from COVID-19, these same data also reflect how deep-seated racial inequities are, even in times of crisis.

There’s no one solution to addressing this issue, notes Smith, but it’s one that should concern citizens, government, and private sector alike. “From improving representation on maternal mortality committees, to addressing systemic racism in obstetric and medical care by integrating it into quality metrics, and addressing perinatal mental health via culturally concordant providers, the solutions are out there, we simply need to begin implementing them at scale.”

For more, read 'Black Women and Children are Dying in Birth in the U.S. - Can Employers Make a Difference?' or contact info@thepalladiumgroup.com.