African-American, Native American and Alaska Native women die of pregnancy-related causes at a rate about three times higher than those of white women, the Centers for Disease Control and Prevention reported on Tuesday.
The racial disparity has persisted, even grown, for years despite frequent calls to improve access to medical care for women of color. Sixty percent of all pregnancy-related deaths can be prevented with better health care, communication and support, the researchers concluded.
“Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our nation’s highest priorities,” said Dr. Robert R. Redfield, director of the C.D.C.
“I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventive care that can and does save lives.”
Maternal health among black women has emerged as an issue in the 2020 presidential campaign. Senator Kamala Harris, Democrat of California, and Senator Elizabeth Warren, Democrat of Massachusetts, have both raised the glaring racial discrepancy in maternal outcomes on the campaign trail.
“Everyone should be outraged this is happening in America,” Ms. Harris said on Twitter, blaming the deaths on racial bias in the health system.
The American College of Obstetricians and Gynecologists, which was not involved in the C.D.C. report, recently acknowledged that racial bias within the health care system is contributing to the disproportionate number of pregnancy-related deaths among minority women.
“We are missing opportunities to identify risk factors prior to pregnancy, and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for black women,” Dr. Lisa Hollier, immediate past president of the American College of Obstetricians and Gynecologists, said in a statement.
The United States has an abysmal record on maternal health, compared with other high-income countries. Even as maternal death rates fell by more than one-third from 2000 to 2015 across the world, outcomes for American mothers worsened, according to Unicef.
The C.D.C. examined pregnancy-related deaths in the United States from 2011 to 2015, and also reviewed more detailed data from 2013 to 2017 provided by 13 states’ maternal mortality review committees.
The agency found that black women were 3.3 times more likely than white women to suffer a pregnancy-related death; Native American and Alaska Native women were 2.5 times more likely to die than white women.
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Obstetric emergencies involving complications like severe bleeding caused most of the deaths at delivery. But cardiovascular disease — not typically associated with a young pregnant women — was a leading cause of pregnancy-related deaths.
Heart disease and strokes caused more than one-third of pregnancy-related deaths, the C.D.C. found. Cardiac disease, which disproportionately affects black women, may be present in a woman before pregnancy, but it also can be acquired during pregnancy, which doctors say acts as a sort of a “stress test.”
If heart disease goes undetected, it may become acute after the baby is born. Indeed, a greater proportion of the deaths among black women occurred in the later postpartum period, between seven weeks and a year after the delivery, compared with white women, the C.D.C. found.
“When we look at the proportion of pregnancy related deaths by cause, the proportion due to cardiomyopathy has been increasing,” said Dr. Hollier. “It can occur in all women, but it is more common among black women.”
One of the surprises in the new report was how often death occurred after childbirth. More than half of pregnancy-related deaths occurred after the day of the delivery, and the heightened risk to a new mother persisted for as long as a year.
Concern about high pregnancy-related death rates among black women has already resulted in some changes in policy. The American College of Obstetricians and Gynecologists this week released new guidelines for treating heart disease during pregnancy.
The standard postpartum doctor visit for new mothers is typically scheduled for six weeks after delivery. The group now says that postpartum care should be an ongoing process, rather than a single appointment, and that services and support should be tailored to the woman’s individual needs.
Women should have some contact with a care provider within the first three weeks postpartum, and a comprehensive visit no later than 12 weeks after birth. Women who qualify for Medicaid, the government health care program for low income people, because they’re pregnant often lose coverage sixty days after giving birth.
The C.D.C. found that 18.5 percent of pregnancy-related deaths occurred one to six days postpartum, and that 21.4 percent of these deaths occurred between the seventh and 42nd days after delivery.
A new federal law, the Preventing Maternal Deaths Act, provides grants to states that investigate pregnancy-related deaths, including deaths occurring up to a year after the birth.
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