The Government Accountability Office (GAO) reported to congressional attendees in October 2022 the concerning trend in maternal health outcomes. The GAO found maternal health outcomes and disparities worsened during the global pandemic.
For birth workers, it is important we remain aware of current trends in birth. This includes both positive changes as well as negative trends and disparities. As doulas and birth workers, we cannot easily change systems. However, we can be aware of the systemic issues our clients may face and help prepare and equip them to navigate a difficult system.
Unfortunately, the US does not have the best maternal statistics for anyone when compared to equally developed nations (and even many developing nations). However, beyond just overall poor outcomes, we see significant disparities in our maternal health outcomes. Black women are significantly more likely to face poor outcomes for no acceptable reason.
Maternal Health Outcomes and Disparities Before The Pandemic
The overall success of a country can be measured in a variety of ways. One major way to assess a country’s success and wellness is by looking at maternal child health.
“Each year in the U.S., hundreds of women die from complications related to pregnancy or childbirth, known as a maternal death. According to the Centers for Disease Control and Prevention (CDC), the U.S. averaged about 700 maternal deaths out of 3.7 million live births per year in recent years—a rate that exceeds almost every other developed, high-income country. For example, in 2018, the maternal death rate in the U.S. (17.4 per 100,000 births) was more than two times greater than Canada (8.6) and the United Kingdom (6.5).”
As you can see, the US has more than double the maternal deaths when compared to Canada and the UK. This is a major concern as this shows many of our maternal deaths are in fact preventable.
In addition to the unnecessarily higher maternal death rates in the US, we see significant racial and ethnic disparities in maternal health. In 2018 and 2019, the rate of death among Black women was 2.5 times higher than white women.
Giving birth in the US as a black woman means being four times more likely to die when compared to white peers.
Maternal Health Outcomes and Disparities Worsened
Unfortunately, the data the GAO reviewed found that maternal health outcomes and disparities worsened during the global pandemic. What was also interestingly noted, prior to the pandemic, we saw an increase in maternal death between 2018 and 2019.
However, there were notable increases, in 2020 and 2021, especially when including covid-19 related deaths. The data showed:
- 658 maternal deaths in 2018
- 754 maternal deaths in 2019
- 759 maternal deaths not related to Covid-19 plus 102 related to Covid-19 for a total of 861 maternal deaths in 2020
- 777 maternal deaths not related to Covid-19 plus 401 related to Covid-19 for a total of 1,178 maternal deaths in 2021 *provisional data at the time of the study
As you can see, even without the Covid-19 deaths, we saw an increase. However, with Covid-19 related maternal deaths, the rate of increase nearly doubled. For a well-developed nation, these statistics are completely inappropriate.
Increase in Racial Disparities
Even more concerning, the notable increase in racial and ethnic disparities. Given that these disparities already existed, and we saw disparities with Covid-19 as well, it is not surprising. Yet it is still a major concern.
“CDC data also show racial and ethnic disparities in the rate of maternal deaths per 100,000 live births per year. For example:
- The maternal death rate for Black or African American (not Hispanic or Latina) women was 44.0 per 100,000 live births in 2019, then increased to 55.3 in 2020, and 68.9 in 2021. In contrast, White (not Hispanic or Latina) women had death rates of 17.9, 19.1, and 26.1, respectively.
- The maternal death rate for Hispanic or Latina women was lower (12.6) compared with White (not Hispanic or Latina) women (17.9) in 2019 but increased significantly during the pandemic in 2020 (18.2) and 2021 (27.5).
We see a concerning increase in overall disparities in Black women compared to their white peers. And while Hispanic and Latina women overall rate is not significantly higher than their white peers, there was a significant increase in their rate of death from just 12.6 in 2019 to 27.5. Both of these statistics reflect disparities we saw in Covid-19 outcomes.
Why Aren’t Maternal Health Outcomes and Disparities Widely Covered?
Ask any Black maternity care provider or birth worker, and they can give you all the details about disparities. Look up data from the CDC, ACOG, etc., and you will see the numbers.
Ask public health officials about the disparities among Black and Hispanic or Latin populations during Covid-19 in general, and they will provide the information.
However, in the media? We simply are not seeing information about these numbers. Despite the fact that disparities have doubled, we are not seeing information in the news.
An Important Quote
The International Doula Institute asked Saleemah McNeil MS, MFT, founder of Oshun Family Center about the increase in disparities and lack of media coverage. She very honestly answered:
“Black maternal health and the increase in the mortality rates have not been a mainstream conversation because it does not directly impact the dominant population. In a health system that has not notoriously treated Black bodies with respect, the increased deaths that impact the birth community are buried beyond our reach in the media. This article discusses the unfortunate demise of a postpartum mom who’s untimely death gained national attention.
“However, on November 1st, 2022, a Black Mother and speech therapist in Philadelphia died almost 6 days after giving birth at Pennsylvania Hospital but there is not one article that I could find speaking about her passing at all. We like to think we are so far removed from the impact of a racist health system and that social determinants of health lend to the increase, but we must include isolation, cardiovascular disease, mental health concerns and racism not RACE. Accountability is a challenging concept, and we have to work much harder and become more open to the process of change for the collective advancement of Black birthing people.”
Simply put, the lack of coverage fits the trends we’ve seen for years. Black birth workers, our allies in birth work, we know the numbers. We share and educate. However, outside our work, we rarely make it to mainstream media coverage.
What Can Birth Workers Do?
As we see, these increases seem directly related to the global pandemic. We can encourage and educate our clients about mitigating overall risks. Yes, we seem to be moving towards endemic and life as “normal” again. However, for pregnant people, it seems vital to continue mitigating the risk of contracting Covid-19.
It is also important for birth workers to be aware of overall, ongoing disparities in maternal health. At the International Doula Institute, we feel it is our responsibility as birth workers to be involved in change. For this reason, we offer a comprehensive Diversity, Equity, and Inclusion For Birth Workers course.
We need to be aware of the disparities as well as how we can best support our clients as they navigate inequity. We can be part of awareness and systemic change.
Author: Maria Silver Pyanov, CPD, CCE
Maria Silver Pyanov, CPD, CCE has been serving prenatal and postpartum families since 2007.