Number of maternal deaths in the USA grew 140% in 20 years – 07/04/2023 – Health

The number of maternal deaths in the United States has worsened over the past two decades, from 505 deaths in 1999 to 1,210 in 2019, an increase of 139.6%.

The maternal mortality ratio or MMR (deaths per 100,000 live births) increased from 12.7 (range 10.5-15.1) to 32.2 (range 28.1-36.3) in the same period , growth of 153%.

The data were analyzed by the Institute of Metrics and Evaluation in Health (IHME), at the University of Washington, based on national data from the American CDC (Center for Disease Control and Prevention), and published this Monday (3) in the scientific journal Jama .

Despite this generalized increase, the MMR varies according to different states and racial groups, being more pronounced in black populations, American Indians and Alaska Natives, Hispanics and Asian descendants and Hawaiian natives. In these groups, mortality reaches 94.2 deaths per 100,000 live births in the states of the American Midwest.

The study is unique in that it considers the variations observed in both the MMR and estimated maternal deaths —considered up to one year after the end of pregnancy— by state and by ethnic-racial groups, thus allowing more reliable indicators to be obtained for those less populous states or regions. , such as the states in the north of the country and which still concentrate Native American territories.

The incidence of maternal deaths rose by 162% among American Indians and Alaska Natives living in Florida, Kansas, Illinois, Rhode Island and Wisconsin. Among the main causes of death in this group are hemorrhages resulting from childbirth, problems related to mental health and other health factors that contribute to the increased risk of death during pregnancy.

Although maternal mortality in the US is still considered extremely high for a wealthy country, rates were even higher among black populations. Black American women have the highest annual MMRs, going from 31.4 in 1999 to 67.6 in 2009.

In the white population, the largest increases in MMR were observed in the states of Indiana, Georgia, Tennessee, Louisiana and Missouri, with growth above 135% in the period studied.

According to the IHME, racial and ethnic disparities between American populations reveal how public policies to reduce maternal mortality have not been systematically applied in all American states.

The data analyzed includes the period up to 2019, before the Covid-19 pandemic. Around the world, maternal mortality took a hit during the three years of the health crisis, reaching alarming numbers globally.

According to the IHME Global Burden of Diseases, the MMR in rich countries in 2019 ranged from 4 to 44, while in the US it was around 20.1. In the American country, this number increased to 23.8 in 2020, the first year of the pandemic, and reached 32.9 in 2021, a number comparable to that of countries in Central Asia and Southeast Asia, according to the latest bulletin released by the WHO ( World Health Organization) in February this year.

In Brazil, the MMR was high during the pandemic in all ethnic-racial groups, according to preliminary data released by Vital Strategies, a global public health organization. Between 2018 and 2021.

In the white population, the MMR increased from 49.9 to 118.6 deaths per 100,000 live births. Among black women, it went from 104 to 190.8, the highest among all groups, as well as in the USA. In the indigenous population, it went from 99 to 149; and, among mixed races, it went from 55.5 to 96.5.

The increase in maternal deaths in Brazil and in the rest of the world during the pandemic period can be explained, in part, by the greater risk that pregnant women had in the face of infection with the coronavirus and also by the delay in vaccinating the group considered a priority in some contexts. , like the Brazilian. In addition, the lack of public policies aimed at preventing maternal and baby health may also have contributed to this.

According to the IHME study, the disparities in the maternal mortality rate between the different ethnic groups show that in the 20-year period since the beginning of the data analysis, there has not been a significant improvement in health indicators in this population.

Furthermore, the fact that black women had the highest MMR each year studied indicates that health prevention efforts have not reduced the high risk of mortality in this population.

The study did not consider maternal deaths related to mental disorders, due to suicide or drug overdose. According to another analysis by CDC researchers, suicide is the leading cause of maternal death in Hispanic communities; this may have contributed to the fact that the observed increase in mortality in this group was the smallest compared to other ethnic groups in the same period.