We finally have a more accurate estimate of a terrible problem in America’s health care system: For the first time in more than a decade, the government has released new data on the maternal mortality rate.
According to a report out Thursday from the Centers for Disease Control and Prevention’s National Vital Statistics System, the 2018 maternal mortality rate was 17.4 maternal deaths per 100,000 live births — meaning 658 women died in 2018. The figure includes deaths during pregnancy, at birth, or within 42 days of birth.
The rate once again put the US last among similarly wealthy countries, according to Eugene Declercq, a professor of community health sciences at Boston University School of Public Health. If you compare the CDC figure to other countries in the World Health Organization’s latest maternal mortality ranking, the US would rank 55th, just behind Russia (17 per 100,000) and just ahead of Ukraine (19 per 100,000). And “If you limit the comparison to those similarly wealthy countries,” such as Germany, “the US would rank 10th — out of 10 countries.”
“No matter how one analyzes the data, we still lag well behind other countries,” he added.
“Maternal mortality is a sentinel public health indicator, and is one of the few health measures included in the United Nations Sustainable Health Goals,” said Marian MacDorman, a research professor at Maryland Population Research Center who has been studying the maternal mortality rate. “The 11-year gap in the United States producing an official maternal mortality rate was a national embarrassment.”
America’s abysmal maternal death record — including the data gaps — began to draw national attention in 2016 when MacDorman, Declercq, and other researchers published a study suggesting an even higher proportion of women (23.8 for every 100,000 births) died from causes related to childbirth. That was an increase of more than 25 percent from 2000, and it meant that not only was America an outlier among its peers, but giving birth in the US was becoming more dangerous as maternal health was improving around the world.
The figures spurred state- and national-level discussion about how to make birth safer for mothers, particularly for African American moms, whose rate of maternal death is currently more than double that of white moms.
Why the US hasn’t published a national maternal mortality rate since 2007
Researchers have since reanalyzed the 2016 numbers, drawing attention to fundamental errors in how maternal deaths had been counted. And a big part of the problem is how states collect this data. In 2003, the government added a pregnancy checkbox to the US standard death certificate, asking whether the person who died was pregnant or had recently given birth. But states weren’t required to use the checkbox, and some were slow to adopt the change.
The result: Maternal death data was widely viewed as problematic, and there was no reliable way to compare what was happening across states. Because of the inconsistencies in states adopting the checkbox, the National Center for Health Statistics paused publication of maternal mortality trends — a freeze that’s lasted until this year.
The new data, published Thursday, is based on a new method of coding maternal deaths designed to limit past errors. This represents the first time every state has a comparable “pregnancy” checkbox on death certificates.
Among the findings, in 2018:
- 658 women died of maternal causes in the United States.
- The overall maternal mortality rate was 17.4 deaths per 100,000 live births.
- The maternal mortality rate gets higher with each older age group; women ages 40 and older die at a rate of 81.9 per 100,000 births, meaning they’re 7.7 times more likely to die compared to women under age 25.
- The maternal death rate for black women was more than double that of white women: 37.1 deaths per 100,000 live births compared to 14.7. It was also more than three times the rate for Hispanic women (11.8).
“It is hard to fix something you can’t see”
While this new, standardized approach is an improvement in accuracy, it doesn’t mean America’s maternal mortality data problem is solved. It’s possible, for example, that the rate now represents a conservative estimate of what’s really happening, said Neel Shah, an OB-GYN and assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.
The new rate excludes moms over 44, and it only looks at deaths within 42 days of giving birth. That means the later postpartum deaths aren’t captured — at a time when, according to the CDC, 24 percent of maternal deaths are happening six or more weeks after a woman gives birth.
Overall, though, the report represents progress. “It is hard to fix something you can’t see,” Shah said, adding that the trends uncovered should by now look familiar. “Even with more conservative estimates, the topline findings verify the concerns of the scientific and medical community. There are hundreds of preventable pregnancy-related deaths each year. The rate appears to be rising, and there are stark racial inequities in outcomes.”
While there have been efforts to address the maternal health problem — ranging from California’s attempt to standardize and improve maternal care protocols in hospitals to Illinois’s legislation extending pregnancy Medicaid to a year after birth — these are mostly happening at the state level, and many have stalled, as a Vox and ProPublica investigation found.
Maternal health reformers would like to see a more holistic approach to women’s health — one that ensures, for example, that women have access to health care before they become pregnant. “The only way we’ll reduce maternal mortality is by valuing women’s health for itself, whether or not a woman happens to be pregnant,” Declercq said. “That way, women will begin their pregnancies in a healthier state and be well supported after they’ve had their baby.”