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Maternal Mortality in the U.S.: What’s Being Done?

February 5, 2024
Maternal Mortality in the U.S.: What’s Being Done?

The U.S. has a maternal mortality problem. According to the latest data available from the CDC, 1,205 women died from maternal causes in 2021, making the maternal mortality rate 32.9 deaths for every 100,000 live births. Not only does this rate severely lag behind the rates of other high-income countries, but it also represents a 40 percent increase from the previous year. The large spike in maternal deaths is largely attributed to causes related to the COVID-19 pandemic, but it continues a rising trend of deaths present even before the pandemic.

In response to America’s maternal mortality crisis, the Harvard T.H. Chan School of Public Health invited a panel of experts, moderated by WBUR health reporter Priyanka McCluskey, to discuss the landscape of maternal health in the U.S. and offer insights into solutions that address the high rates of maternal deaths and rethink care for pregnant people—at the community, healthcare, and policy levels.

The panelists began the discussion by first diving into the factors contributing to the staggeringly high maternal mortality rates in the U.S. Panelist Jessica Cohen, associate professor at the Harvard Chan School, pointed to the “declining and highly inequitable” access to maternity care. Rising out-of-pocket costs and lengthy travel distances present significant barriers for people seeking maternity and post-partum care. For example, a low-income birthing person might face long travel times on public transit to reach the only hospital that accepts Medicaid for births.

The panelists also discussed how even when care is available and accessible, structural racism and unconscious bias built into our health systems play a significant role in maternal health outcomes. Racism and bias can result in provision of care that vastly differs based on who you are, what you look like, or what language you speak. According to the same 2021 data from the CDC, Black women in the United States are more than 2.5 times as likely to die from maternal causes compared to white women. Other research has also shown that there is also an elevated maternal mortality rate for pregnant people who are disabled and those who are on Medicaid.

“We have a system that is built to be structurally racist. It’s built to be inequitable, and we have to deal with some of those structures before we’re going to see outcomes change,” said panelist Amber Weiseth, Director of the Delivery Decisions Initiative at Ariadne Labs, a joint center at the Brigham and Women’s Hospital and the Harvard Chan School. “So it’s not just that we may not have access or not have all the right systems, but it’s that people are […] not listening to patients in the way they should.”

In the face of such challenges, what can governments, health care systems, and health care providers do to reduce maternal mortality?

One solution being implemented is an initiative called TeamBirth. Weiseth, who leads the TeamBirth project, explained that a major root cause of preventable death in U.S. hospitals is due to a breakdown in communication. TeamBirth tries to address this issue by moving care team discussions from the hallway to the bedside, allowing decisions to be made with the patient’s input and involvement. Decisions are then written on a whiteboard in the patient’s room to provide transparency, accountability, and a physical reminder of care plans and patient preferences. Preliminary data suggests that this approach not only improves communication but also increases feelings of trust and patient autonomy, especially among Black and Indigenous patients.

Amanda Williams, Clinical Innovation Advisor for the California Maternal Quality Care Collaborative, agreed that concrete procedures that increase transparency and communication could help improve the birthing experience. She reiterated that addressing poor maternal outcomes for Black and Indigenous patients in the U.S. will require intentional dismantling of systemic racism and bias. “It takes formal structures—it takes intention to overcome those biases that are just part of being and living in America,” said Williams. Williams also advocated for increasing racial, ethnic, and language diversity in care teams, as well as integrating more midwives and doulas, who often provide more patient-centered and culturally-sensitive support, into the health care system.

Hafsatou Diop, Assistant Commissioner for Health Equity at the Massachusetts Department of Public Health discussed the various state-level initiatives to improve maternal health in Massachusetts. As part of the Advancing Health Equity in Massachusetts initiative, which aims to eliminate racial and geographic disparities in health outcomes, the state has invested in collecting data and designing policies to advance maternal and perinatal health. The state has also been working with clinical providers to sponsor trainings and implement patient safety bundles—collections of clinical best practices—in domains related to maternal health, such as hemorrhage, hypertension, and health equity. Finally, MassHealth, the state Medicaid program, as of December 2023 now covers doula services, with the hope that private insurers will follow.

Altogether, there are many people working at all levels to reduce America’s high maternal mortality rates. Concrete actions to improve access to maternal health services and increase health equity represent a solid step in the right direction. However, the panelists expressed that there is still much work to do. To learn more about the landscape of maternal mortality in America, check out our resource pack on Maternal Mortality in the U.S. or explore the selected resources below.

 

Selected Resources