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The Washington PostDemocracy Dies in Darkness

Pregnancy-related deaths shot up during pandemic’s first year

Black women died at nearly three times the rate of White women in 2020, a government report found

Cots and cribs are arranged in an alternate care site for hospital overflow amid the covid-19 pandemic at the Mountain America Expo Center in Sandy, Utah, on April 6, 2020. (Rick Bowmer/AP)
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Pregnant women and new mothers died at a higher rate in 2020, an increase that mostly afflicted women of color, according to a report released Wednesday by U.S. health officials.

For all women, the number of maternal deaths rose 14 percent during the first year of the coronavirus pandemic, to 861, according to the report from the National Center for Health Statistics (NCHS). The maternal mortality rate in 2020 was 23.8 deaths per 100,000 live births.

When breaking down the data, however, the increase “for non-Hispanic White women was not significant.” Instead, it was women of color who died at significantly higher rates from pregnancy or childbirth in 2020.

The mortality rate was highest for non-Hispanic Black women: 55.3 deaths per 100,000 live births, which was 2.9 times the rate for non-Hispanic White women. The mortality rate jumped 26 percent in 2020 for Black women.

Hispanic women had a rate of 18.2 per 100,000 live births, which was below the overall U.S. rate, but a 44 percent spike from 2019.

For decades, researchers have documented the higher maternal and infant mortality rates in the United States compared with other industrialized countries — and how Black women and infants are particularly likely to experience complications and death.

Although the new report does not mention the coronavirus pandemic, experts said it was natural to assume the pandemic’s strain on hospitals and health-care providers, plus the lack of a vaccine at the time, may have heightened the barriers minority women already faced in accessing health care.

Clare C. Brown, a researcher on health disparities at the University of Arkansas for Medical Sciences and senior fellow at the Institute for Medicaid Innovation, said more policymakers and media began to focus on the startlingly high maternal death rates for Black women in 2018, when a previous NCHS report found they were 2.5 times more likely than White women to die during pregnancy or childbirth.

She said it was “incredibly unfortunate” that the racial divide grew wider in 2020 despite that burst of attention.

“These disparities have existed for decades and are apparently worsening, but I think we have to be careful not to pin that on the pandemic,” Brown said. “There are structural components leading to that, and we have to address those.”

“To be clear, the rates of maternal mortality in this country had doubled over the past 25 or 30 years, whereas in every other industrialized country, the rates had been decreasing,” said Stacey D. Stewart, president and chief executive of the nonprofit March of Dimes. “It’s natural to assume the pandemic could only make it worse, especially in 2020, before there was a vaccine.”

A large study published in April 2019 by the Journal of the American Medical Association analyzed the impact of state expansion of Medicaid under the Affordable Care Act on infant mortality. Brown and her co-authors concluded that expanding Medicaid did not reduce those death rates overall — but did narrow the differences between White and Black infant mortality. The study examined 15.6 million births from 2011 to 2016.

Researchers have found that stress, and the cortisol it produces, is a factor in maternal mortality rates and that some minorities are more likely to have unaddressed chronic conditions such as diabetes, hypertension or obesity.

Brown emphasized that although the pandemic may well have played a role in worsening health outcomes, the NCHS report focuses specifically on deaths clearly linked to pregnancy or childbirth, such as preeclampsia, hemorrhage, placenta previa, or pulmonary embolism, or to the period immediately after giving birth, which is generally six weeks.

Stewart said another issue was that about 54 percent of U.S. counties offer no maternity care whatsoever, or very limited care for women giving birth. March of Dimes, which focuses on health outcomes for mothers and babies, has called for a “Momnibus” package of bills in Congress to provide about $1 billion in funding to expand Medicaid for childbirth coverage and allow wider access to midwives and doulas.

“There are policy changes that can address these things,” Stewart said. “What it takes is the will of Congress and the will of state officials to take actions.”