Maternal Mortality Rose Significantly in 2021, CDC Says

Maternal mortality in the U.S. significantly increased in 2021 compared with the previous year, the CDC reported Thursday.

A total of 1,205 women died of maternal causes in 2021, compared with 861 in 2020 and 754 in 2019, according to the report from Donna Hoyert, PhD, of the CDC’s National Center for Health Statistics.

The maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019.

“Maternal death is defined by the World Health Organization as ‘the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes,'” Hoyert noted.

Death rates varied by racial/ethnic groups, with the maternal mortality rate for non-Hispanic Black patients at 69.9 per 100,000 live births, which was 2.6 times the death rate for non-Hispanic white women (26.6 per 100,000). However, “the increases from 2020 to 2021 for all race and Hispanic-origin groups were significant,” Hoyert wrote.

Rates also grew higher as maternal age rose. For women under 25, the rate was 20.4 deaths per 100,000 live births, compared with 31.3 for women ages 25-39 and 138.5 for those ages 40 and over. The rate for women ages 40 and over was 6.8 times higher than the rate for those under age 25. As with differences by race and ethnicity, the differences in the rates between age groups were statistically significant, as were the increases in the rates between 2020 and 2021 for each age group.

The data in the report “send a resounding message that maternal health and evidence‐based efforts to eliminate racial health inequities need to be, and remain, a top public health priority,” said Iffath Abbasi Hoskins, MD, president of the American College of Obstetricians and Gynecologists (ACOG), in a statement. Although provisional data released last year by the Government Accountability Office showed a spike in maternal death rates due in large part to the COVID-19 pandemic, “confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning news,” she said.

However, although “the COVID‐19 pandemic had a dramatic and tragic effect on maternal death rates … we cannot let that fact obscure that there was — and still is — already a maternal mortality crisis to compound,” Hoskins continued. “Just as concerning are worsening racial health inequities and the fact that pregnant and postpartum Black people continue to make up a disproportionate number of maternal deaths at growing and alarming rates. This trend must be stopped.”

The American Academy of Family Physicians (AAFP) also expressed concern about the report. “It is alarming that the CDC’s new report shows that maternal mortality rates continued to rise in the U.S. in 2021, with persistent racial disparities in maternal health outcomes,” AAFP President Tochi Iroku-Malize, MD, MPH, said in a statement. “These data reinforce the urgent need for achieving birth equity and addressing health disparities among Black, Indigenous and other pregnant people of color.”

Iroku-Malize added that the academy supported a provision in last year’s omnibus budget bill that made permanent the state option to extend postpartum Medicaid coverage for a full year, and has advocated to require all states to extend postpartum Medicaid coverage. “We have also applauded the administration’s commitment to improving healthcare access and quality throughout the perinatal period, including by encouraging continuous quality improvement efforts in hospital labor and delivery units and keeping rural emergency departments open,” she said. “Nonetheless, the CDC’s latest report confirms that additional action is needed to stem the rise in maternal deaths and mitigate maternal health disparities.”

The maternal mortality increases will likely be impacted by another factor: the Supreme Court’s overturning of Roe v. Wade, wrote Jen Villavicencio, MD, MPP, ACOG’s lead for equity transformation, in an email to MedPage Today.

In the wake of that decision, “we’ve seen abortion bans and restrictions take effect in various states across the country and, as a result, we can expect to see the U.S. maternal mortality crisis exacerbated,” she added. “It is a horrifying prospect that many more individuals could die because they will be forced to remain pregnant against their will or needlessly suffer untreated pregnancy complications as clinicians and institutions grapple with what constitutes a lawful medical exception.”

“To be clear, the worsening U.S. maternal mortality rate cannot be addressed without addressing how each American can access safe abortion care if and when they need it,” Villavicencio noted. “The overturning of the longstanding protections for abortion access will serve only to set us back in the fight against rising maternal mortality.”