A certified nurse midwife monitors a baby’s heart rate during a prenatal checkup at Blanchfield Army Community Hospital in Kentucky in this 2018. photo. A new report says maternal mortality rates rose steadily from 1999 to 2019, with Black and Indigenous mothers at highest risk. (Photo by Maria Christina Yager/U.S. Army)
WASHINGTON – Maternal death rates more than doubled over the past 20 years in the U.S., with Black and Indigenous women continuing to see mortality rates that far exceeded other groups – a pattern that was repeated in Arizona, according to a recent study.
Health experts said no single factor is to blame, but said that “systemic racism” leads to a convergence of causes that can lead to more deaths during and after pregnancy.
“We have to recognize that there is still very, very real systemic racism that is taking place within our health care systems,” said Dr. Jill Gibson, the medical director of Planned Parenthood Arizona.
“The maternal mortality rate in our state is really the intersection of so many different elements of our society that have led to the creation of a state and a system where it’s not safe to be pregnant and it’s not safe to birth, especially if you’re a person of color,” Gibson said.
The report in the July 3 issue of the Journal of the American Medical Association looked at maternal mortality ratios – the number of deaths per 100,000 live births – from 1999 to 2019, a period during which overall maternal deaths in the U.S. jumped from 505 to 1,210, a 140% increase.
The report, by researchers at the University of Washington and Massachusetts General Hospital, said that while maternal mortality “remains unacceptably high among all racial and ethnic groups in the U.S., American Indian and Alaska Native and Black individuals are at increased risk.”
“Among Black females, the maternal death risk was the highest for every year during that period we studied,” said Laura Flezar, lead researcher of the study. “The fact that these disparities are not improving and maternal deaths are worsening for every racial ethnic group is definitely concerning.”
That was true in Arizona where, along with Tennessee, the report said maternal deaths in 2019 “were lower in the White population relative to other states but higher in all other racial and ethnic groups relative to other states.”
Flezar said that overall “Arizona looks very middle of the pack” compared to the rest of the nation. But she said that “if you really break it down by racial and ethnic group, you can see that it’s notably high in Arizona.”
Besides looking at maternal mortality for the nation by year, the report gave 10-year averages for racial and ethnic groups by state, with a median rate from 1999-2009 and again from 2010-2019.
Every group in Arizona saw increases over those periods, with maternal mortality for Hispanics going from 11.3 per 100,000 live births to 19.7. They were followed by whites, who went from a rate of 12.5 to 23.9 and Asians who saw maternal mortality rates rise from 13.4 to 20.6.
Black deaths, meanwhile, rose from 26.5 per 100,000 live births to 44.1, while the Indigenous mortality rate rose from 16.2 to 40.3.
Lakisa Muhammad, the executive director of the Phoenix Birth Foundation, pointed to “systemic racism, medical neglect, medical bias.”
“We live in societies where things are harder” for Black and Indigenous women, Muhammad said. “Where systems level things are not set up for your success, and living that way from birth to childbearing ages, we now have to understand and address that that affects birth outcomes.”
She said that not only does systemic racism pose a danger to women through medical bias and neglect during pre- and postpartum care, but it also “speaks to lifelong wear and tear on the body.”
In addition to the quality of pre- and postpartum care, Gibson said housing and food security, and substance abuse factor into maternal health. And she and other health professionals worry that the situation could only get worse in the face of abortion restrictions that have been implemented by states in the past year.
“It’s in states where there is this attitude that … you know, people can’t have bodily autonomy, they can’t have the right to determine if they’re going to bear a child or not bear a child and we’re not even creating a safe environment for them to then be forced to stay pregnant,” Gibson said.
That was echoed by Dr. Gabrielle Goodrick of Camelback Family Planning, who said abortion bans throughout the country have led to “more complications of pregnancy not being handled in appropriate ways because of fear from the medical staff and the doctors that they are doing something illegal.”
“More unplanned pregnancies lead to more types of pregnancies, which lead to more ruptures, which lead to more deaths,” Goodrick said. “Unplanned pregnancies are not, you know, good because some people that can’t get access to abortion care will carry those pregnancies to term and they will have the complications that will affect them the most.”
Will Humble, the executive director for the Arizona Public Health Association, said there are different medical concerns that can cause maternal death before, during and after delivery.
Prenatal care screens for signs of high blood pressure, blood sugar levels and other potential complications. Humble said delivery can be dangerous due to the risk of shock and hemorrhaging. Postnatal care is about recovery and managing a safe and healthy environment at home.
“You have to look at all three of those things and do interventions in all three of them if you’re going to really achieve progress,” he said.
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Gibson said postpartum “support is probably one of the greatest areas that we can have an impact on mental health after delivery.
“The postpartum period is a period of significant isolation and vulnerability. Everything is new, it’s terrifying,” she said.
Gibson said Planned Parenthood Arizona plans to expand its doula program, which currently provides emotional and physical support to women during abortion services, to include “support and advocacy for patients throughout any of their health care visits.”
“Patients come to us and they trust us with a lot of their vulnerable information,” Gibson said. “It’s important that we hear what they’re saying and and basically counsel them and provide care for them that is what they need, and not necessarily what someone in the healthcare system thinks that they need.”
Muhammad, a doula herself, said that while listening to patients is important, placing the pressure on them to make medical decisions and know the signs of complications can lead to “victim blaming.”
“It is a lot to ask parents to educate themselves to prepare for the birth of a baby … but also to acquire all of this medical knowledge that they may need in order to advocate for themselves in the medical setting,” Muhammad said. “We must start to look at providers and ask them to take a closer look at how are they honoring the dignity and the humanity of their patients.”
Muhammad, who provides childbirth classes and doula services through A Mother’s Worth Birth Services, called Planned Parenthood’s doula program a step in the right direction, but said that “doulas are not medical care providers.” She said more needs to be done to hold providers accountable.
“We’re still not addressing the root cause of the maternal health care crisis and that is systemic racism, medical neglect, medical bias. And in order to address that we have to have strategies that hold care providers accountable,” she said.
-Cronkite News reporter Ariana Araiza contributed to this report from Phoenix.
