Maternal Mortality

Maternal Mortality in Kansas

Kansas

The World Health Organization (WHO) defines maternal mortality as “female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.” The maternal mortality rate in the United States rose steadily from 1990 to 2015, and in 2018 the U.S. had the highest rate of 11 developed countries. Additionally, substantial disparities in maternal mortality persist by race and ethnicity. After March 2020, a substantial increase in maternal deaths was reported, coinciding with the COVID-19 pandemic. 

The Centers for Disease Control and Prevention (CDC) monitors pregnancy-related mortality at the national level. Their surveillance expands the follow-up period to within one year of the end of pregnancy and conducts thorough reviews of each death. The leading causes of pregnancy-related deaths are cardiovascular diseases, infection or sepsis, hemorrhage (bleeding), hypertensive disorders (high blood pressure) and other non-cardiovascular medical conditions, including mental health conditions. According to the CDC, cardiovascular conditions account for more than one-third of perinatal mortality. Complications with cesarean deliveries also play a role in maternal mortality. Causes of pregnancy-related deaths vary by race/ethnicity. One study identified the most common causes as:

• Cardiovascular and coronary conditions among non-Hispanic Black mothers.
• Mental health conditions among Hispanic and non-Hispanic white mothers.
• Hemorrhage among non-Hispanic Asian mothers.
• Mental health conditions and hemorrhage among American Indian/Alaska Native mothers.

The prevalence of maternal mortality is higher among: 

• Black and American Indian/Alaska Native women compared with Asian/Pacific Islander, Hispanic and white women.
• Women without any college education. However, racial and ethnic disparities eclipsed differences in education level, with college-educated Black women still experiencing far higher maternal mortality rates than white and Hispanic women without a high school education.
• Women ages 40 and older, who have a maternal death rate nearly 16 times that of mothers under 40.
• Women who live in rural areas compared with those who live in urban areas. Hospital closures in rural areas have decreased access to services such as obstetrics, further contributing to difficulties in maternal care.

According to the WHO, the majority of maternal deaths resulting from pregnancy-related complications are preventable. Approximately two-thirds of deaths from pregnancy-related complications could be prevented by improving the quality of medical care. Strategies to reduce and prevent maternal mortality include:

• Preconception health: A healthy pregnancy begins before conception. Improving women’s health across the lifespan and preventing and treating chronic disease may result in healthier pregnancies with fewer complications.
• Collaboration with midwives and doulas: A study found that incorporating midwives as part of the care team during pregnancy and postpartum recovery is associated with better maternal health outcomes. Areas without nearby hospital services could also benefit from midwifery care. 
• Medical care improvement: Improvements to hospital protocol and patient safety tools have been effective strategies to reduce maternal mortality. In one study, a collaborative quality improvement program reduced severe maternal morbidity from hemorrhage. Systems to detect early warning signs during prenatal visits may prevent delays in diagnosing and treating conditions that lead to maternal death. The Alliance for Innovation in Maternal Health program offers quality improvement toolkits, maternal early warning systems and other resources to support and guide quality improvement efforts in health care facilities. 
• Maternal Mortality Review Committees (MMRCs): MMRCs are made up of various medical professionals tasked with identifying and investigating maternal deaths. They attempt to determine the preventability of maternal deaths and recommend focused approaches to prevent future deaths and reduce disparities in maternal mortality. Nearly all U.S. states have MMRCs, and many have established legislation requiring a review of maternal deaths. 

Many factors are likely associated with the increased risk of death among women of color. Efforts to improve access to and quality of care, reduce the prevalence of chronic conditions among women and address structural racism and implicit bias in health and health care may help close the racial and ethnic gap. The CDC provides concrete steps that individuals, health care providers, health systems, communities and states can take to reduce maternal mortality, particularly among Black women disproportionately affected by it.

Reducing the maternal mortality rate is a Healthy People 2030 leading health indicator.

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