The United States, the wealthiest nation in the world, has a really bad record on maternal mortality. And it only worsened during the coronavirus pandemic.
The National Center for Health Statistics found that 861 women died during pregnancy or shortly thereafter in 2020 versus the 754 comparable deaths in 2019, the New York Times reported, noting:
“The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.
“Black women in America experienced the most deaths: One-third of the pregnant women and new mothers who died in 2020 were black, though Black Americans make up just over 13% of the population. Their mortality rate was nearly three times that of white women. The mortality rate for Hispanic women, which has historically been lower than for white women, also increased significantly in 2020 and is now almost on par with the rate for white women. Death rates increased among all pregnant women older than 24, but particularly in those 40 and over, whose mortality rate was nearly eight times that of women younger than 25.”
Kara Zivin, a professor of psychiatry, obstetrics, and gynecology at the University of Michigan who studies access to care during and after pregnancy, told the newspaper this about the dismal data:
“Our maternal morbidity and mortality is the highest in the developed world, and the trend is continuing despite our awareness of it, despite our maternal-mortality review committees, despite attention in the press. Whatever we’re doing is clearly not enough to address either the overall rate or the disparities.”
The coronavirus, of course, ripped up communities of color, causing disproportionate illness and deaths. But the pandemic also disrupted medical care — and especially prenatal services, notably in communities of color and for the poor. This worsened the maternal health crisis in unsurprising fashion, experts said:
“Stress, mental health problems and substance abuse increased during the pandemic and might also have contributed to worse outcomes, said Dr. Mary D’Alton, chair of the department of obstetrics and gynecology at Columbia University Irving Medical Center. New programs that provide enhanced services for patients, such as doulas, who can support and advocate for patients, are positive advances, she said. ‘We also have to educate our providers on listening to patients,’ Dr. D’Alton said. ‘My dad was a primary care doctor and he used to say, “Mary, if you want to know what’s wrong with the patient, ask them and they’ll tell you. But first of all, you’ve got to listen to them.” Pregnant women’s complaints are often dismissed, and that is probably much more significant for Black and brown women,’ she added.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on expectant women, babies, and children by abuse, neglect, and injury, especially by health workers and caregiving facilities. The record is clear that women suffer excessive mistreatment in the medical system and it become shocking to see with pregnancies, especially with women of color.
Before the pandemic, patient advocates had spoken out, rightly, about the terrible inequity of maternal care received by women of color, black women especially. It has imperiled even prominent patients like Beyonce and tennis legend Serena Williams. It is unacceptable — and its harms, including deaths, are preventable. As health critics have pointed out, repeatedly, we know how to deal with the problem, why aren’t we?
The Los Angeles Times, in a recent investigation, found that Big Pharma and stubborn doctors haven’t helped expectant moms, especially black women, by relying on a prescription medication — the hormone Makena — to prevent early births. The drug has failed to demonstrate its effectiveness and the federal Food and Drug Administration has recommended it be yanked from the market. But the maker’s appeals and doctors persistent use of the drug means women keep getting it — and paying thousands of dollars for it.
Adam Urato, chief of maternal and fetal medicine at MetroWest Medical Center in Framingham, Mass., told the newspaper this about the medication and its continued prescribing:
“It’s crazy. This is a drug that has never been shown to have clinical benefit. There is no way this drug should still be on the market.”
We have much work to do to safeguard pregnant patients, especially black women, and to ensure that they and their newborns have a great shot at healthy, joyous lives.