Black people at greater risk of death during pregnancy and childbirth

The number of people in the United States dying during pregnancy, at delivery, or soon after delivery has been on the rise for the past 30 years. But the maternal mortality rate in the U.S. improved significantly in 2022, according to a May 2024 report from the Centers for Disease Control and Prevention (CDC).

The latest CDC report shows that 817 people died of maternal causes— dying during pregnancy or within 42 days after delivery—compared to 1,205 in 2021. In 2020, there were 861 deaths due to maternal causes.

Overall, this means the U.S. maternal death rate for 2022 was 22.3 deaths per 100,000 live births, following a jump to 32.9 in 2021, which was a notable surge from 23.8 in 2020.

A March 2024 study suggests the U.S. maternal mortality rate may actually be much lower, or 10.4 deaths per 100,000 births. The study’s authors say that the number of maternal deaths is overestimated due to the addition of a pregnancy checkbox on the national death certificate in 2003.

The study published in the American Journal of Obstetrics and Gynecology asserts that reporting errors have resulted from the misclassification of indirect, accidental, or incidental deaths. The researchers estimate that the U.S. maternal death rate—while still too high—is closer to other wealthy nations. The CDC points out that changes in maternal death rates from year to year may be “possibly due to issues with the reporting of maternal deaths on death certificates.”

But the maternal death rate has been climbing for several years, from 658 in 2018 to 754 in 2019. Risks for life-threatening complications increase with age. In 2022, The maternal death rate for people ages 40 and older was six times higher than the rate for those younger than age 25. In 2022, the death rate for Black people was also 49.5 deaths per 100,000 live births—more than double the rates for white (19.0), Hispanic (16.9), and Asian (13.2) people.

So, even if maternal death rates are much lower than initially reported, Black people are still more than twice as likely to die than white people. And most U.S. maternal deaths—more than 84 percent—are preventable, according to the CDC, noting that in these cases there was at least some chance that the death could have been avoided by one or more reasonable change involving the patient, healthcare provider, community, facility, or other factor.

Persistent racial disparities

The CDC's latest report reveals dramatic racial disparities in the U.S. maternal death rate. The March 2024 study, which showed much lower maternal death rates, still found that Black people had higher rates of maternal death from several causes, with “striking disparities in deaths” due to ectopic pregnancy (a pregnancy that occurs outside the uterus), high blood pressure-related disorders, embolism (the blockage of an artery usually by a clot), cardiomyopathy (a disease that affects the heart muscle),and other diseases, such as heart and kidney disease.

Racial disparities in U.S. maternal mortality reflect many factors stemming from racism, including connected social determinants of health like income, social status, education, access to health care, housing, social support networks, health behaviors, and culture, according to research published in 2021 in Obstetrics and Gynecology.

Centuries of racism in the U.S. has deeply and pervasively affected communities of color, affecting where they live, learn, work, and play. This has led to social and economic inequities, which put them at higher risk for worse health outcomes than white people, the CDC explains. Across the U.S., racial and ethnic minority groups experience higher rates of illness and death resulting from a range of health conditions, including diabetes, high blood pressure, obesity, asthma, and heart disease, the agency adds.

“Black women’s risk of dying from cardiovascular disease (CVD) is 3.4 times higher than that of white women,” noted ACOG in its 2019 release. “This disparity is due, in part, to racial bias and overt racism that exists in the provision of health care and in health system processes. The greatest health disparities in the management of CVD for black women usually exist prior to pregnancy when risk factors are not identified.”

Black people also fared worse during the pandemic, with higher rates of COVID infection and deaths than white people.

Causes of U.S. maternal deaths

Overall, heart disease and stroke contribute to more than 33 percent of U.S. pregnancy-related deaths. Other leading causes include:

• Preeclampsia is a condition that causes high blood pressure and, in some serious cases, organ damage, during pregnancy or up to six weeks after delivery.
• Amniotic fluid embolism occurs during delivery when amniotic fluid enters the mother’s bloodstream. This can cause an allergic-like reaction, leading to cardiac arrest or excessive bleeding.
• Postpartum hemorrhage (PPH) can cause heavy bleeding and a significant drop in blood pressure in the days after giving birth.
• Blood clots usually strike after delivery and can lead to serious conditions such as stroke, deep vein thrombosis (clots in the veins of the legs or pelvis), or pulmonary embolism, which blocks blood flow to the lungs.
• Cardiomyopathy is a type of heart failure that may surface during the last month of pregnancy or within five months of giving birth.
• Sepsis can occur during or after pregnancy. It’s an out-of-control immune response to an infection such as pneumonia, influenza, a urinary tract infection, or other complication related to pregnancy.
• Being uninsured or underinsured, and lacking access to quality health care can also contribute to poor prenatal health.

How to protect yourself

Improved clinical care and patient education—as well as access to better housing and transportation, healthier foods, and weight management strategies—could all lower the risk of maternal mortality in the United States.

Many pregnant people may also fail to recognize certain warning signs that their lives may be in danger after giving birth. While new parents may be coached on how to identify signs of an infant emergency, they may not receive instruction on how to take care of themselves, such as how to distinguish between normal postpartum recovery and worrisome symptoms, like extreme pain.

Your healthcare provider (HCP) should talk to you about potential problems and their warning signs during pregnancy. In the meantime, you can be proactive by learning about potential issues as well. Here are some ways to safeguard your health:

Get early and regular prenatal and postpartum care. Regular checkups and care during your pregnancy is essential, increasing the likelihood of a healthy outcome. Routine tests during pregnancy may include blood work, which can identify issues such as anemia, infections, and gestational diabetes as well as screenings for heart problems. Your HCP may also evaluate you for signs of postpartum depression (PPD).

Amid rising rates of maternal deaths due to heart disease, in May 2019 the American College of Obstetricians and Gynecologists (ACOG) released comprehensive guidance, advising that all pregnant people be screened for heart disease during pregnancy and after birth. ACOG also recommends that pregnant people with high blood pressure be evaluated by their primary care physician or cardiologist 7 to 10 days after they deliver. Pregnant people with heart disease or other heart problems should also see their doctors no later than 14 days after giving birth.

Depending on your individual needs, your HCP will help you determine how often you need follow-up postpartum appointments.

If cost or access is an issue, every U.S. state has a pregnancy care plan to help you afford medical care during pregnancy. Call 1-800-311-BABY to learn how to reach out to your local Health Department.

Know your numbers. Learn your normal blood pressure levels both before and during pregnancy so you and your HCP can refer to them in an emergency.

Adhere to prenatal guidelines. Listen to your HCP and follow recommendations about exercise, eating habits, stress levels, and lifestyle changes.

Reach out to your HCP when you have questions. Make a list of any concerns you have and connect with your provider as often as necessary to have them addressed. If something feels off or you have pain that is severe or persistent at any point during or after pregnancy, reach out for help.

Keep moving. Pregnant and postpartum women should also aim for at least 150 minutes of moderate-intensity exercise each week, according to the U.S. Department of Health and Human Services (DHHS). Standing up and moving your body can also help prevent blood clots. Consult your healthcare provider about whether or how to adjust your physical activity during and after your pregnancy.