A report from the Centers for Disease Control and Prevention (CDC) released in March 2023 found a large and statistically significant increase in U.S. maternal mortality in 2021. The rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births, significantly higher than that for White or Hispanic women. Overall, the maternal mortality rate (which is the number of maternal deaths per 100,000 live births) increased by 40% from 2020 to 2021. (See Figure 1 below) The report also found increases in maternal mortality across all age groups for 2021, with the largest increases among older women.
The report highlights longstanding disparities in maternal health for Black women in the United States, but also raises questions about factors that could have worsened these disparities during the pandemic. A Government Accountability Office (GAO) study based on a provisional version of the CDC data suggests that the pandemic likely exacerbated effects of social determinants of health in a number of areas.
- Women from racial and ethnic minority groups and other underserved communities have long faced barriers to maternal health care.
- In many areas, the pandemic reduced access to services such as public transportation and child care that may have worsened these barriers.
- A reliance on telehealth, or online medical appointments, created barriers for families who did not have reliable internet access.
- Women in low-income areas and Hispanic women (who were more likely to be essential workers)Cha faced higher rates of COVID-19 infection.
- Challenges stemming from inconsistent or frequently changing guidance around COVID-19.
Officials from the Department of Health and Human Services and other stakeholders interviewed by GAO researchers stated that racism is a key factor related to disparities in maternal mortality. This includes:
- Structural racism, or historical and current social factors in which people of color have unequal access to housing, education, employment, health care, and other needs.
- Discrimination or bias that leads to different treatment behaviors on the part of medical providers.
- Adverse physiological changes due to stress.
- Mistrust of health care systems and government guidance.
Even before the pandemic, the United States had higher rates of maternal mortality than any other developed, high-income country. Rates among Black women in the United States were around 2.5 times those of white women in 2018 and 2019. Importantly, the GAO study identifies these disparities as preventable.
Figure 1. U.S. maternal mortality rates, 2018-2021
