(CN) — Over the last two decades, the rate of maternal mortality for hospital deliveries dropped significantly across the U.S. even as delivery-related complications increased, according to a study published Thursday in the Journal of the American Medical Association.
The U.S. has the highest maternal mortality rate among developed countries, with the ratio increasing from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths in 2017. For every mother who dies giving birth, 20 to 30 more suffer from morbidities impacting their short- and long-term health.
The U.S. Department of Human Health and Services funded the study and credit the decline in deaths to “national strategies focused on improving maternal quality of care provided during delivery-related hospitalizations.”
“We are committed to improving health outcomes before, during, and after pregnancy,” said Dr. Rachel Levine, the agency’s assistant secretary for health in a statement. “These results underscore the need to better manage women’s health, including identifying the most significant risk factors and supporting access to improved care.”
The paper analyzes data reported by the Premier PINC AI Healthcare Database from January 2008 to December 2021 detailing 11.6 million hospital deliveries. Over that period, maternal mortalities per 100,000 discharges dropped from 10.6 to 4.6.
At the same time, severe maternal morbidity complications, or SMMs, that put a mother’s health at risk increased from 147 per 10,000 to 179 over the course of the study.
Researchers also identified more preexisting comorbidities in patients in 2021 compared to 2008, including higher rates of sickle cell disease, gestational hypertension, severe preeclampsia and others. The study therefore attributes the uptick in SMMs to increases in preexisting health conditions as well as to more older patients giving birth as more women chose to delay motherhood.
Of the 11.6 million deliveries analyzed, the mean patient age was 28. Half of the patients identified as white, while 15% were Hispanic and 14% Black.
Women ages 35 to 44 were at greater risk of death than patients between the ages of 25 to 34, as were patients who identified as Black, Asian or American Indian.
“We're talking about deaths, among for the most part, a population of young women, and much of that is preventable,” emphasized Usha R. Ranji, associate director of Women’s Health Policy at KFF, a nonpartisan health policy think tank.
“While we have seen these declines in the hospital mortality rates, there is still a pretty wide gulf between people of different racial and ethnic groups,” Ranji told Courthouse News in a phone interview. “Understanding that mortality is really complex and is driven by so many different factors, the amount of societal racism, structural racism that is in our society plays into so much of this and pervades the health care system as well.”
Structural racism drives racial inequities in health care access, coverage and financing, all of which contribute to variations in quality of care, Ranji said.
In addition to age and race, the study also found having a cesarean delivery increased the risk of death by 10 times and that patients diagnosed with Covid-19 were 13 times more likely to die during hospital childbirth than patients who were not infected with the virus.
While the HSS study tracked a decrease in maternal mortality for hospitalized childbirths, the CDC-sponsored Pregnancy Mortality and Surveillance System reported increases in maternal deaths over a similar period, factoring in pregnancy-related and postpartum deaths.
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