Rising maternal mortality ratio in the United States: the role of chronic diseases and race

• Main Author: Muir, Cordelia R.
• Other Authors: Trinkaus-Randall, Vickery E.
• Language: en_US
• Published: 2021
• Subjects: Public health
• Online Access: https://hdl.handle.net/2144/43462

Maternal mortality has long been a gauge for the health of a nation. It represents not only the health of women in that country but the health of the nation as a whole. The world experienced a steep decline in maternal mortality ratio (MMR) in the early 20th century, but since the 1990s the United States (U.S.) has had a troubling upwards trend in maternal deaths. Given its status as the only developed nation with a rising MMR and the amount of money spend per capita on healthcare, this trend in MMR has garnered increasing attention over the past few decades. Defining and identifying maternal morbidity and mortality has led to confusion and inaccuracy when tracking the rising MMR. Due to increasing claims of underreporting of maternal deaths, the National Center for Health Statistics (NCHS) recommending states add a pregnancy checkbox to the U.S. Standard Certificate of Death. However, implementation of this checkbox was slow and lead to further data inaccuracy. On account of these inconsistencies, the Center for Disease Control (CDC) did not release maternal morbidity or mortality from 2007-2020. The newly released data, unfortunately, shows no significant change in maternal mortality prevalence, with disparities between races persisting. Chronic disease is a significant indicator for maternal morbidity or maternal death. With the prevalence of conditions like obesity, diabetes, and hypertension on the rise in the general population, the role of these disease in adverse pregnancy outcomes must be vigorously studied and mitigated. Additionally, chronic disease are more prevalent in older populations and, with the average maternal age in the U.S. on the rise, providers must understand how to provide the best care for their changing patient demographics. Finally, the U.S. has come to face the growing cries for justice and equity in all things, including healthcare. The MMR is no different. There are significant disparities between women of certain ethic and racial minorities when it comes to likelihood of adverse maternal outcome. These disparities are a product of structural racism that is pervasive throughout healthcare in the U.S. With these factors in mind, researchers, providers, and policymakers must take swift and targeted action to combat the rising MMR, with racial and ethnic minorities as their priority. This work should be informed by the most recent data released by the CDC that shows the trends in rising MMR and racial disparities are persisting despite decades of increased research and attention. With improved tracking methods and a focus on race and chronic disease the U.S. has a chance of decreasing its MMR substantially for the first time in 3 decades.