Maternal mortality in the United States has more than doubled in the last few decades, with 32.9 maternal deaths per 100,000 live births in 2021, according to data from the U.S. Centers for Disease Control and Prevention (CDC).
More than half of maternal deaths occurs in the first year after giving birth, but this so-called “fourth trimester” is often overlooked. For the first time, researchers from Columbia University have conducted a large-scale and representative study of postpartum health in the U.S. to better understand the social and medical needs of mothers after birth.
“When people think about maternal mortality, they are usually thinking about pregnancy, labor and childbirth,” Jamie Daw, an assistant professor of health policy and management at Columbia and first author on the study, told Newsweek.
“However, more than half of pregnancy-related deaths actually occur in the year after birth. Yet, this postpartum year, or ‘fourth trimester,’ has been long overlooked and we don’t have a great understanding of the challenges that postpartum people face and how best to intervene to improve health and well-being after birth.”
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In their study, published in the journal Health Affairs on November 6, Daw and her team launched the Postpartum Assessment of Health Survey, collecting data on postpartum health in the year after giving birth.
“Our study is the first large-scale multistate survey focused on postpartum health,” Daw said. “We measure health care access, use, health outcomes and social determinants of health for a sample of commercially insured and publicly insured people in the year after birth. We find huge gaps in access to care: 1 in 5 postpartum individuals reports delaying or not getting care they needed after birth. This is worrisome when we know that 2 out of 3 maternal deaths are preventable with timely medical care.”
Between 2018 and 2021, maternal death rates in the U.S. rose from 17.4 per 100,000 live births to 32.9, according to data from the CDC, more than double the rates in 1999, which were estimated to be 13.2 per 100,000 live births.
“There is some debate as to the extent that this is a real increase versus a reflection of changes in reporting of maternal deaths,” Daw said. “What is clear is that maternal mortality in the U.S. today is higher than all other comparable countries and that there are stark racial and ethnic disparities.”
Maternal death rates vary considerably between states, ranging from 10 deaths per 100,000 live births in California to 43.5 per 100,000 in Arkansas, according to data from 2018 to 2021.
“Generally, we see much higher mortality rates in the South,” Daw said.
The major causes of maternal mortality vary depending on how recently the mother was pregnant.
“For example, hemorrhage is the most common cause during pregnancy and birth, but heart conditions and mental health-related conditions [including substance use and suicide] are the drivers of mortality in the year after birth,” Daw said.
Between 2018 and 2021, Daw said the deaths among pregnant women increased 52 percent, with a significant jump in 2021.
“There was a clear rise in maternal mortality during the COVID pandemic,” Daw said. “We haven’t yet seen the effects of increasing abortion restrictions, but a large body of research shows that being denied an abortion affects health and long-term economic outcomes.
“Further, many of the states instituting abortion restrictions have the highest maternal mortality rates and the weakest existing social supports for families, exacerbating the risks that birthing people already face in those states.”
So what can be done to protect new mothers?
“Most of the effective interventions for reducing maternal mortality such as safety checklists have been focused on intervening in the hospital around the time of birth,” Daw said. “Policies aimed to improve postpartum health, such as the new state adoption to extend of public coverage for pregnant women from 60 days postpartum to one year [which is being adopted by 38 states], are promising avenues to improve health care access after birth.
“However, our findings are clear that these efforts need to be coupled with strategies to improve health care continuity, ensure that coverage actually translates to improved access, and to address the large social needs that exist for low-income families after welcoming a new child.”
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.