The maternal mortality rate in the United States surpasses rates of all high-income countries in Europe and Asia; however, recent increases in maternal mortality do not apply uniformly. Instead, a new study led by Arline Geronimus of the University of Michigan has found significant differences in mortality rates among women of different ages, races, and educational backgrounds.
Dr. Geronimus and her co-authors from the University of Michigan, Harvard University, and the National Association to Advance Black Birth examined data from the U.S. Pregnancy Mortality Surveillance System to understand pregnancy-related mortality trends among different groups between 2000 and 2019. According to the authors, the maternal death rate in the U.S. was 7.2 deaths per 100,000 women in 1987. By 2019, the rate had more than doubled to 17.6 deaths per 100,000 women. Rates in other high-income countries declined over the same time period.
Although Black women are still more likely than White women to experience pregnancy-related mortality, the racial gap has narrowed in recent years. This is largely due to a 92 percent increase in pregnancy-related mortality among White women with no education. Black women without a high school diploma exhibited a much smaller proportional increase (9 percent) in maternal mortality over the study period. In contrast, pregnancy-related mortality levels among college-educated Black women declined by over one percent per year.
The authors found that the increase in maternal mortality is also associated with age. The number of mothers younger than 30 has steadily decreased since the early 2000s, while the number of mothers in their 30s and 40s has increased. Among the Black population, the mortality rate among women ages 35 to 39 is more than three times the rate for women ages 20 to 24.
“All U.S. mothers — including the most educated — may be jeopardized by the lack of institutionalized wrap-around postnatal support, parental leave, or childcare and family policies to keep pace with the growing and holistic needs of working families,” the authors write. “The institutionalization of widespread and deep family policies might also open the door for people who want children to consider earlier ages at childbirth than their 30s or for those who wish to postpone childbearing to later ages to expect societal support and responsive maternity care, including in the postpartum period and beyond.”
They continue, “U.S. history is replete with evidence of actions based on implicit or explicit racist predispositions that were enacted against Black women in medical settings. The decline in [maternal mortality] among Black mothers at higher levels of education implies that progress can be made through best clinical practice. Yet, racialized bias in the health care system is not the only structural driver affecting population health.”
Dr. Geronimus is a professor of health behavior and health equity at the University of Michigan School of Public Health. She holds a bachelor’s degree from Princeton University and a doctorate from the Harvard School of Public Health.