- Of the 1,018 deaths, 839 occurred up to a year after giving birth, with mental health issues being the main underlying cause, according to the analysis.
- Black mothers, who are three times more likely than white mothers to die, accounted for almost a third of deaths from 2017 to 2019.
- More than 90% of the deaths of Aboriginal mothers could have been prevented, most of them due to mental health problems and hemorrhages.
A staggering number of maternal deaths in the United States have been shown to be preventable, according to a federal analysis of maternal death data released Monday.
More than 80%, or about 4 in 5 maternal deaths over a two-year period, were due to preventable causes, according to the Centers for Disease Control and Prevention report.
The analysis of pregnancy-related deaths from 2017 to 2019, which occur disproportionately among women of color, including black and Indigenous people, is based on figures from maternal mortality review boards. These are multidisciplinary groups based in 36 states that investigate the circumstances surrounding maternal deaths.
Of the 1,018 deaths, 839 occurred up to a year after giving birth, with mental health issues – death by suicide or overdose – being the main underlying cause, followed by extreme bleeding or hemorrhage, according to the report. About 22% of deaths occurred during pregnancy, and a quarter on the day of delivery or within a week of delivery.
Nearly a quarter of the deaths were due to mental health problems, 14% to haemorrhage and 13% to heart problems. The others were caused by infection, embolism, cardiomyopathy and disorders related to high blood pressure.
Experts say the findings point to a critical need for rigorous postpartum and mental health care resources, as well as tailored strategies to address persistent racial disparities.
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Dr. Allison Bryant, a high-risk obstetrician, is senior medical director for health equity at Massachusetts General Hospital.
“It is significant. It’s amazing. It’s heartbreaking,” said Bryant, who chairs the Massachusetts review board. “It just means we have so much work to do.”
The analysis included a section on maternal deaths among Native Americans and Alaska Natives who are more than twice as likely as white mothers to die from pregnancy-related causes, but often underestimated in data on health due to misclassification.
Assistant Professor of Obstetrics and Gynecology at Upstate Medical University in Syracuse, New York, Dr. Brian Thompson of the Oneida Nation, is working with the National Indian Health Board to create the first national tribal review board
According to the analysis, more than 90% of deaths of Aboriginal mothers could have been prevented, most of them due to mental health problems and hemorrhages.
“You really have to examine and examine why this is the case if virtually all of them are preventable,” he said. “It’s incredibly painful.”
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Dr Andrea Jackson, chief of the division of obstetrics and gynecology at the University of California, San Francisco, said there are known toolkits for clinicians that offer evidence-based guides on prevention. and treatment of bleeding.
“No pregnant person should die from a hemorrhage. We have the tools in the United States and we know how to deal with it. It was really disheartening to see,” she said.
Black mothers, who are three times more likely than white mothers to die, accounted for nearly a third of deaths and were the most likely to die from heart and coronary problems.
“Among African Americans and Native Americans, we see this historic and unfortunate and consistent disparity in outcomes,” Jackson said.
Hispanic mothers, who accounted for 14% of deaths, died most often from mental health issues, as did white mothers who accounted for 46% of deaths.
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Charletta Ayers, an obstetrician and gynecologist and director of the OB-GYN division at Rutgers University Robert Wood Johnson Medical School, called the numbers “sobering.”
The findings also clearly show the need for stronger mental health resources for pregnant and postpartum women to keep them from falling “under the radar”, she said.
Echoing Ayers, Dr. Lethenia Baker, obstetrician-gynecologist at Wellstar Health in Georgia, said there can be a “long lag in diagnosis and treatment” of postpartum conditions. Baker said improvements in diagnosis, access to care and awareness must be structural.
“These are things that need to happen systemically,” she said. “It can’t just be a few practices here or there adopting best practices. It must be a systemic change.
Contact Nada Hassanein at firstname.lastname@example.org or on Twitter @nhassanein_.