Rising maternal death rates in the U.S. may have been sharply overstated due to flawed record-keeping, according to new research. The study found that mortality held steady and was in line with other developed nations over two decades, challenging the widely reported increase in maternal deaths.
Maternal health statistics have become a critical public health focus, especially with millions of women living in areas with limited access to maternity care and more restricted access to abortion. However, the study in the American Journal of Obstetrics & Gynecology suggests that the 2003 inclusion of a checkbox on death certificates to indicate if a woman was pregnant at or close to the time of death has led to an increase in misclassified maternal deaths.
Researchers reviewed National Center for Health Statistics (NCHS) data from 1999 to 2021 and focused on deaths that required a mention of pregnancy among the causes on a death certificate. They found that overall maternal deaths were stable, at just over 10 per 100,000 live births for the periods 1999 to 2002 and 2018 to 2021. In contrast, maternal death rates recorded by the Centers for Disease Control and Prevention (CDC) rose from 9.65 per 100,000 to 23.6 per 100,000 for those periods. Deaths resulting from obstetric causes such as hemorrhaging or preeclampsia decreased over those time periods, while deaths from indirect causes like hypertension aggravated by pregnancy rose. Non-Hispanic Black women still had disproportionately high rates of maternal death, with striking disparities due to ectopic pregnancy, cardiovascular conditions, and kidney and other diseases.
Cande Ananth, chief of the division of epidemiology and biostatistics at Rutgers Robert Wood Johnson Medical School and senior author of the study, stated, “The CDC has acknowledged in the past that errors were artificially inflating numbers, but their efforts to correct those errors haven’t worked.” Ananth also highlighted that recent increases in the official numbers are partly driven by the tendency to include more cancers unrelated to pregnancy in maternal death rates.
The CDC’s most recent maternal death report for 2021 found an almost 40% jump in deaths over 2020, with rates for Black women 2.6 times higher than for white women. However, the study’s findings raise questions about the accuracy of these reported increases in maternal death rates and call for a reevaluation of the methods used to track and classify maternal deaths in the U.S.
