Maternal mortality refers to deaths due to complications from pregnancy or childbirth. The U.S. maternal mortality rate measures the rate of deaths from any cause related to or aggravated by pregnancy, childbirth, or within 42 days of termination of pregnancy.
The United States has the highest maternal mortality rate of any developed country, and the maternal mortality rate is higher than it has been in decades. Based on the most recent data from 2018, the U.S.'s maternal mortality rate is 17.4 deaths per 100,000 births. The United States is also the only developed country to see maternal mortality rates rising. This is attributed to a few findings in an NPR report, including that hospitals are generally unprepared or underprepared for maternal emergencies during childbirth. Additionally, some doctors entering into maternal-fetal medicine could complete their training without training in a labor-delivery unit.
Recently, states have passed legislation leading to stricter abortion laws, which opponents worry could result in higher maternal mortality rates. They argue that because doctors are concerned about losing their licenses, they might hesitate to perform an abortion on a patient even if it is a medical emergency. Additionally, mothers might turn to illegal, unsafe abortion options to circumvent the new restrictions.
States with the Lowest Maternal Mortality Rates
California has the lowest maternal mortality rate of 4.0 deaths per 100,000 births. From 2006 to 2013, California's maternal mortality rate declined by 55%, from 16.9 to 7.3 and continued to decline after that. California is leading the way to reduce the number of maternal mortalities thanks to the formation of the California Maternal Quality Care Collaborative in 2006. This committee found that death from two well-known complications, hemorrhage and preeclampsia, can be prevented through recognition, teamwork, and a list of thoroughly-practiced treatments. Because of this type of preparation in hospitals, California doctors and nurses have saved hundreds of lives.
Massachusetts's maternal mortality rate of 8.4 per 100,000 births makes it the state with the second-lowest maternal mortality rate in the United States. Overall, Massachusetts is the second-healthiest U.S. state and has the highest concentration of primary care physicians at 247 per 100,000 residents. Massachusetts's maternal death review has been around for more than 20 years. The committee recommended a requirement for all hospitals to have a procedure in place for hemorrhages in 2014. Massachusetts is overall one of the healthiest states for women and children, with low rates of uninsured women and the lowest teenage birth rate in the U.S.
Nevada is tied with Massachusetts for the second-lowest maternal mortality rate in the country of 8.4 deaths per 100,000 births. In May 2019, Governor Steve Sisolak signed legislation to create Nevada's first statewide Maternal Mortality Review Committee. Despite Nevada's low maternal mortality rate, the state ranks poorly for women and children's health overall. Nevada has one of the lowest family medicine, pediatric, and obstetrician/gynecological physicians per capita and a high percentage of uninsured women during pregnancy.
Connecticut has the fourth-lowest maternal mortality rate in the United States of 10.5 deaths per 100,000 births. In Connecticut, midwives may be the answer to decreasing the rate since they are often more attentive throughout pregnancy than OB-GYNs. There are 211 licensed nurse-midwives in Connecticut who are required to have advanced nursing degrees and additional training in midwifery. Midwives are linked to higher rates of physiologic birth and fewer adverse neonatal outcomes.
Colorado has the fifth-lowest maternal mortality rate in the United States of 11.5 per 100,000 births. Half of all deaths in Colorado among pregnant women and those within the first year after giving birth result from self-harm, such as suicide and overdose. Colorado doctors, midwives, and mental health experts are focusing on reviewing medical files, prescriptions, coroners' reports, and even suicide notes to help saves lives from pregnancy-related complications, drug abuse, and suicide. Colorado physicians and policymakers believe that maternal mortality review committees are the key to saving lives.
States with the Highest Maternal Mortality Rates
Louisiana's maternal mortality rate of 58.1 deaths per 100,000 births is the highest in the United States. The rate is about four times higher for Black mothers than for white mothers, which boils down to implicit bias. 59% of Black maternal deaths are preventable, compared to 9% of white maternal deaths. Louisiana's Joint Commission will be looking for new standards around pregnancy-related medical problems such as hemorrhaging and hypertension to be in place starting in January 2021.
Georgia has the second-highest rate of maternal mortality of 48.4 per 100,000. Georgia's maternal mortality review issued a 2017 report that said the areas of greatest concern include inadequate follow-up of cardiovascular symptoms in pregnant women and failure to recognize and treat hypertension or hemorrhages soon enough. Researchers have reported that in more than one-third of cases, they were unsure of when prenatal care began for mothers and confirmed that some who died received more prenatal care at all. Black mothers in Georgia are more likely to die from pregnancy, as they are in the rest of the United States, especially in the state's rural areas.
Indiana's maternal mortality rate is 43.6 per 100,000, making it the third-highest in the country. There are 33 counties in Indiana with no hospital or a hospital, but the hospital has no OB-GYN services. The Indiana State Department of Health plans to survey every birthing and delivery facility in the state to make sure they are meeting its new rules, such as requiring at-risk moms to deliver at facilities with appropriate technology, equipment, and personnel on hand to manage these emergencies. Additionally, the state will hire nurses, midwives, and advanced practice nurses to go into some of Indiana's rural hospitals to provide prenatal care.
4. New Jersey
New Jersey has the fourth-highest maternal mortality rate of 38.1 deaths per 100,000 births. According to the 2018 Health of Women and Children Report, New Jersey had the highest mortality rate among Black mothers of 102.3 deaths per 100,000 births. In January 2019, a package of 14 bills was advanced by state lawmakers that included awareness, education, evaluation protocols, and Medicaid coverage to combat the alarming maternal mortality rate.
Arkansas has the fifth highest maternal mortality rate in the United States of 37.5 per 100,000. Conway Regional Hospital OB-GYN Amy Johnson said that part of what contributes to the high rate in Arkansas is overweight and obese mothers at higher risk of developing life-threatening problems during pregnancy. This is a common issue among southern states. HB1440 was passed in Arkansas to create a maternal mortality review committee to help understand pregnancy-related deaths and improve maternal health and prevent these deaths in the future.