In May 2021, House Oversight and Reform Committee joined the Black Maternal Health Caucus to request that the nonpartisan Government Accounting Office prepare three reports on America's Black maternal health crisis. Topics for the reports were 1) how the pandemic has exacerbated America's Black maternal health crisis and how government efforts to promote pandemic recovery are affecting maternal health outcomes, 2) the state of America's perinatal workforce including barriers to accessing care by midwives and other maternity care professionals, and 3) how America's Black maternal health crisis disproportionately harms people who are incarcerated. On October 19, 2022, the first of these reports were released (United States Government Accountability Office [U.S. GAO], 2022) based in part on provisional data from the National Center for Health Statistics' (NCHS) National Vital Statistics System at Centers for Disease Control and Prevention (CDC). The news was not good. Maternal deaths have continued to increase, most sharply in the last 2 years during the pandemic, and include higher rates for Black women and Hispanic women compared with non-Hispanic White women (U.S. GAO, 2022).
In 2021, there were 1,178 maternal deaths in the United States, representing a 37% increase from 2020 (861) and a 56% increase from 2019 (754) pre-COVID. The CDC estimated that 102 maternal deaths in 2020 and 401 maternal deaths in 2021 were related to COVID. The overall U.S. maternal mortality rate for 2021 was 32.2 deaths per 100,000 live births compared with a rate of 23.8 in 2020, 20.1 in 2019, and 17.4 in 2018 (Hoyert, 2021; U.S. GAO, 2022).
Maternal mortality data highlight disparities in health outcomes based on maternal race and ethnicity. Although race is the variable collected in the vital statistics reports, patients, maternity caregivers, and public health experts generally agree that systemic and long-standing societal and health care racism rather than race is the reason for these differences (Chambers et al., 2021; Chambers et al., 2022; U.S. GAO, 2022). The maternal death rate for non-Hispanic Black women was 44.0 per 100,000 live births in 2019, then increased to 55.3 in 2020, and 68.9 in 2021 (U.S. GAO, 2022). The maternal death rate for Hispanic women was 12.6 in 2019 but increased significantly during the pandemic to 18.2 in 2020 and 27.5 in 2021. Non-Hispanic White women had much lower rates of maternal death; 17.9 per 100,000 live births in 2019, 19.1 in 2020, and 26.1 in 2021 (U.S. GAO, 2022). The rates of preterm births and low birthweight babies were increased from 2022 to 2021 showing similar disparities between groups. Preterm birth rates from 2020 to 2021 for Hispanic women increased from 9.8% to 10.2%, non-Hispanic Black women from 14.4 to 14.8, and non-Hispanic White women from 9.1 to 9.5 (U.S. GAO, 2022).
These data show the significant negative effect of the COVID-19 pandemic on U.S. maternal health and major disparities in outcomes. Much work needs to be done to improve maternal health outcomes. As the health care professional who provides the vast majority of hands-on care to the childbearing population, nurses can make a major difference in promoting better and more equitable outcomes by listening to women and providing respectful maternity care.
Chambers B. D., Arega H. A., Arabia S. E., Taylor B., Barron R. G., Gates B., Scruggs-Leach L., Scott K. A., McLemore M. R. (2021). Black women's perspectives on structural racism across the reproductive lifespan: A conceptual framework for measurement development. Maternal and Child Health Journal
, 25(3), 402–413. https://doi.org/10.1007/s10995-020-03074-3
Chambers B. D., Taylor B., Nelson T., Harrison J., Bell A., O'Leary A., Arega H. A., Hashemi S., McKenzie-Sampson S., Scott K. A., Raine-Bennett T., Jackson A. V., Kuppermann M., McLemore M. R. (2022). Clinicians' perspectives on racism and Black women's maternal health. Women's Health Reports
, 3(1), 476–482. https://doi.org/10.1089/whr.2021.0148
House Committee on Oversight and Reform. (2021, May 21). Chairwoman Maloney, committee members, and Black Maternal Health Caucus leaders seek three GAO studies on America's Black maternal health crisis
(Press Release). https://oversight.house.gov/news/press-releases/chairwoman-maloney-committee-members-and-black-maternal-health-caucus-leaders
Hoyert D. L. (2021, April 1). Maternal mortality rates in the United States, 2019. NCHS Health E-Stats
, 1–5. https://doi.org/10.15620/cdc:103855
United States Government Accountability Office. (2022, October 19). Maternal health outcomes worsened and disparities persisted during the pandemic
(Report to Congressional Addressees). https://www.gao.gov/products/gao-23-105871