Racial disparities in maternal health have widened since the 1980s, federal report says

Maternal mortality in the U.S. has worsened over the past three decades due in large part to mounting disparities in access to quality perinatal care among women of color, according to a report the U.S. Commission on Civil Rights issued Wednesday.

The maternal mortality rate rose from 6.6 deaths for every 100,000 live births in 1987 to 20.1 deaths by 2019, for a total of 754 that year, according to the report. The U.S. maternal death rate ranks among the highest of any high-income nation.

Pregnancy-related deaths among Black women have been the largest driver for the consistently high mortality rate for at least the past 20 years. Black women in the U.S. are three to four times more likely to die from pregnancy-related complications than white women and had the fastest escalation in deaths between 2007 and 2014. If the mortality data excluded Black and Native American women, the U.S. rate would be comparable to that of other wealthy nations.

"These dramatic disparities in rates of survivorship point to the stark reality that in our nation the experience of pregnant individuals is not equal," Civil Rights Commissioner Debo Adegbile said during a news conference Wednesday.

Maternal death rates among Black women in some areas of the country are up to 12 times higher than white women, and are comparable to the maternal mortality rates found in some developing countries, the report says.

"Maternal mortality is recognized as a key indicator of overall health of a nation and the data and analysis in our report reflect an intolerable racial disparity and a trend line that requires focused federal attention to address," Adegbile said.The findings seem to indicate the wide racial disparity in maternal health outcomes is connected to differences in access to medical care and the quality of the services women of color receive before, during and after they deliver.

An estimated 60% of pregnancy-related deaths are preventable, with most—36%—occurring during the week of delivery. A previous study found Black women had similar rates of pregnancy-related complications, including preeclampsia, seizures, placenta abruption and postpartum hemorrhage as white women, but were two to three times more likely to die from those conditions.

While socioeconomic factors are normally seen as strong determinants of a person's health, data has shown maternal mortality rates remain high among Black women regardless of their level of income or education. The report suggests women of color are more likely to experience barriers that prevent them from receiving quality maternal healthcare compared to white women. Such barriers can include being less likely to have insurance coverage, being at higher risk for chronic health conditions and being less likely to receive disease prevention and management care.

Women receiving no prenatal care are three to four times more likely to have a pregnancy-related death than women who receive prenatal care, according to the report.

Addressing the disparity in maternal health outcomes mortality has become a key issue among a number of lawmakers in recent years. Some support came with the passage of the COVID-19 relief bill in March, which included a provision that gave states the option to extend Medicaid coverage for postpartum care from 60 days to up to one year.

Further actions are currently being considered. On Wednesday, the House Energy and Commerce Committee advanced several provisions aiming to address maternal health disparities as part of the Democratic majority's $3.5 trillion domestic policy bill.

These parts of the legislation would provide $275 million toward diversifying the perinatal health workforce and an additional $175 million in funding for local entities to address social determinants of maternal health like housing, nutrition and environmental conditions.