Maternal mortality rates have doubled in the US over the last two decades – with deaths highest among black mothers, a new study suggests.
American Indian and Alaska Native women saw the greatest increase, the study in Journal of the American Medical Association (JAMA) said.
Southern states had the highest maternal death rates across all race and ethnicity groups, the study found.
Maternal mortality means a death during pregnancy or up to a year afterward.
In 1999, there were an estimated 12.7 deaths per 100,000 live births and in 2019 that figure rose to 32.2 deaths per 100,000 live births in 2019, according to the research, which did not study data from the pandemic years.
Unlike other studies, this one examined disparities within states instead of measuring rates at the national level, and it monitored five racial and ethnic groups.
Dr Allison Bryant, one of the study’s authors, said the findings were a call to action “to understand that some of it is about health care and access to health care, but a lot of it is about structural racism”.
She said some current policies and procedures “may keep people from being healthy”.
Black women had the highest median maternal death rate per 100,000 live births, which had tripled in some north-eastern states over 20 years, the research found.
“Often, states in the south are called out as having the worst maternal mortality rates in the nation, whereas California and Massachusetts have the best. But that doesn’t tell the whole story,” Dr Bryant said.
“It’s essential to look at the disparities between populations that exist even in the ‘best’ states.”
While southern states had the highest maternal mortality rates for any demographic, figures showed they were especially high for black women.
The study found Midwest and Great Plains states had the highest death rates for American Indian and Alaskan Native women.
Why US mothers are more likely to die in childbirth
Missouri Governor Mike Parson recently signed a budget bill that includes $4.4m (£3.47m) for a maternal mortality prevention plan.
Maternal mortality rates for black women have long been an issue across the socioeconomic spectrum.
US Olympic champion sprinter Tori Bowie died in May from childbirth complications at the age of 32, her agent said.
Common causes of death within a year of pregnancy include mental health conditions, excessive bleeding, cardiac conditions, pregnancy-related high blood pressure, infections and blood clots, according to the US Centers for Disease Control and Prevention.
The JAMA study had some limitations – the researchers did not always have access to the cause of maternal death information and the way maternal deaths are recorded on death certificates changed in the US during the course of this study.
Dr Bryant said that if they were to study the years after 2019, during Covid-19, there would be a “continued increase in the risk of maternal mortality across all populations”.
