After years on the rise, the U.S. maternal mortality rate decreased in 2022, new government data show. But maternal health experts warn there’s no reason to celebrate: The dip is a course correction following the Covid-19 pandemic, and mothers in the United States continue to die at dramatically higher rates than mothers in other high-income countries.
The racial disparities continued as well, with Black mothers in the U.S. dying at more than two and a half times the rate of white mothers, according to the data released Thursday by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention.
“It’s just shameful for our country,” said Elizabeth Cherot, president and chief executive officer of the March of Dimes. “There’s too many moms dying, and it doesn’t have to be that way.”
In 2022 in the U.S., there were 22.3 maternal deaths for every 100,000 live births, down from 32.9 in 2021, according to the new CDC data. That data reflects 817 maternal deaths in 2022 and 1,205 in 2021.
The death rate for Black mothers was 49.5 for every 100,000 live births in 2022, down from 69.9 in 2021.
The maternal mortality rate in the U.S. went up continuously from 2018 to 2021, and since Covid-19 was particularly dangerous for pregnant people, there was an especially dramatic increase from 2020 to 2021. The dip in the 2022 rate puts the maternal mortality rate back around where it was in 2019, before the Covid-19 pandemic.
While the CDC has not yet announced maternal mortality rates for 2023, some researchers expect that it increased in states with abortion restrictions that followed the Supreme Court’s Dobbs ruling in mid-2022.
“This crisis is far from over for us,” Cherot said.
The U.S. maternal mortality rate is more than six times higher, for example, than the rates in Spain, Japan, Australia, or Germany, according to an analysis of 2021-2022 data by Birth by the Numbers, a group run by Eugene Declercq, a professor of community health sciences at Boston University School of Public Health.
The reasons behind the U.S.’s high maternal mortality rate are complex, but a CDC analysis of data from 2017 through 2019 indicates that more than 80% of pregnancy-related deaths in the U.S. are preventable. In that analysis, the three leading causes of death were mental health issues, such as suicides and drug overdose; excessive bleeding; and cardiac and coronary conditions.
Part of the reason for the high maternal mortality rate in the U.S. is that the rates of some of these health problems, such as drug overdoses, are particularly high in the United States. Another reason is poor health care for many pregnant people in the U.S. In 2022, about 1 in 7 babies were born to a mother receiving inadequate prenatal care, according to the March of Dimes.
While there’s some controversy about the way maternal deaths are calculated in the U.S., the March of Dimes and other experts say however the rate is measured, it’s still higher than it should be.
“No matter how you structure a comparison, the U.S. fares poorly in cross-national comparisons,” according to Birth by the Numbers, which has done an extensive analysis of the different reporting methods.
The situation in the U.S. is particularly bad for Black mothers, with a maternal mortality rate that’s 2.6 times higher than white women, according to the new CDC data. The CDC says several factors contribute to this stark racial disparity, including differences in health care quality and underlying chronic conditions, but also systemic racism and inherent bias.
“Structural racism does not show up in the birthing experience as one bad actor — it’s not a nurse or an OB who is just a racist person, but it’s the entire health care system that has policies, procedures that are enacted and enforced, really to exacerbate racism,” said Ndidiamaka Amutah-Onukagha, professor of Black maternal health and founder of the Center of Black Maternal Health and Reproductive Justice at Tufts University School of Medicine.
She added that doctors and nurses might feel like “I provide the same standard of care to all my patients, [that] we treat everybody the same here. But then you talk to patients, or you do observational data, or you look at their emergency room or discharge notes and you realize that there are huge variations in care in the way people are treated when they come into the health care system.”
There are also large differences in mortality rates depending on where the person giving birth lives. A Birth by the Numbers analysis of 2018-2021 data shows that the highest maternal mortality rates are in Alabama, Arkansas, Mississippi, and Tennessee, and they’re at least twice as high as states with the lowest rates in the country.
Alabama, Arkansas, Mississippi, and Tennessee have enacted significant abortion restrictions since the Supreme Court’s Dobbs decision in June 2022 that overturned Roe v. Wade. Amutah-Onukagha, a maternal and child health epidemiologist and co-author of an article looking at state abortion restrictions and maternal mortality, said she expects the impact of those laws, which make it more difficult to terminate a pregnancy that threatens a mother’s life, will be reflected in 2023 data.
“I definitely think they’re going to contribute to a higher maternal mortality rate,” she said.
Over the years, there have been several efforts to prevent pregnancy-related deaths, including the CDC’s Hear Her campaign to raise awareness of urgent maternal warning signs and improve communication between pregnant people and their health care providers. There’s also a CDC initiative to encourage states to share strategies for reducing pregnancy-related deaths.
Monique Rainford, an obstetrician and assistant professor at Yale School of Medicine, noted that the effect of these programs has yet to be reflected in the maternal mortality rate.
“There is a financial commitment to make things better — you see government commitment and you see conversations,” Rainford said. “But we have haven’t seen the results of those investments, and there are a lot of initiatives that need investment and haven’t gotten it yet.”
This story is part of ongoing coverage of reproductive health care supported by a grant from the Commonwealth Fund.