Maternal Morbidity and Mortality: Are They Really Up? And What’s the Role of Measurement Changes, Real-World Factors, and Racism?
“U.S. maternal deaths keep rising.” “Maternal deaths in the U.S. more than doubled over two decades.” Startling headlines like these warn of a growing maternal health crisis in the United States. Indeed, the data show a steady doubling of the maternal mortality rate over much of the 2000s, leading into an even larger spike during the COVID-19 pandemic.
It turns out, though, that basically all of this reported increase in maternal mortality up to 2017 is the result of new data measurement and reporting practices that were gradually adopted by states over the time period of this increase, not an actual rise in mortality. While maternal mortality does appear to have momentarily increased during the early years of the COVID-19 pandemic, there actually is little evidence of an alarming rise in maternal mortality, as suggested by some of the news coverage. We discuss this in more detail later. It's important to note that these measurement improvements were made to correct for the systematic undercounting of maternal deaths. Although maternal deaths likely didn't increase significantly in the 2010s, we now know that maternal mortality rates are higher than previously thought. In Massachusetts, we’ve also seen reported rates of serious complications in pregnancy and childbirth, known in public health circles as maternal morbidity, increase in recent years. The Massachusetts severe maternal morbidity rate—the rate of labor and delivery complications that result in significant short-or long-term health consequences—nearly doubled between 2011 and 2020, jumping from 52.3 to 100.4 per 10,000i deliveries.
As with reports of increases in maternal mortality, it’s likely that some portion of the increase in SMM is attributable to measurement changes and possibly to an increasing awareness among health-care providers of conditions that make up SMM, leading to increased identification and reporting of associated conditions. However, it appears that measurement changes don’t explain the full increase in SMM, unlike with maternal morbidity.
In this brief, we’ll dig into the measurement changes driving higher levels of reported maternal deaths, as well as the role that COVID-19 played. We explore the likely real-world factors driving some of the reported increases in severe maternal morbidity. And we investigate why racial disparities are so large, regardless of measurement approach. We expect there are other contributing factors behind each of these, but we’ve done our best to summarize what we’ve found in the data and other research.