Maternal mortality risk high and rising for American Indian, Alaska Native, Black women

Key takeaways:

• From 1999 to 2019, American Indian, Alaska Native and Black women experienced large maternal mortality ratio increases.
• All U.S. racial and ethnic groups had increased ratios during this period.

Although maternal mortality ratios increased for U.S. women of all races and ethnicities from 1999 to 2023, American Indian, Alaska Native and Black women, specifically, had increased risks for pregnancy-related death, researchers reported.

Laura G. Fleszar, MPH, researcher at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, and colleagues conducted an observational study using U.S. vital registration and census data from 1999 to 2019 for pregnant or recently pregnant women aged 10 to 54 years to calculate maternal mortality ratios — the number of maternal deaths per 100,000 live births— among different racial and ethnic groups in the separate states.

“Experts in maternal mortality have called for improvements in and augmentation of data,” Fleszar and colleagues wrote. “State- and race and ethnicity-specific maternal mortality data serve as important evidence for communities, clinicians, public health professionals, policymakers and other stakeholders who are making efforts to prevent maternal deaths and reduce inequities.”

Overall, there were 1,210 estimated maternal deaths in 2019, which was an increase from 505 in 1999. Maternal mortality ratios in most U.S. states were higher among American Indian, Alaska Native and Black women in 2019 compared with women of other races and ethnicities.

Researchers observed an increase in median state maternal mortality ratios from 14 in 1999 to 49.2 in 2019 among American Indian and Alaska Native women. In addition, researchers observed maternal mortality ratio increases from 26.7 in 1999 to 55.4 in 2019 among Black women. Comparatively, maternal mortality ratios increased from 9.6 to 20.9 among Asian, Native Hawaiian or other Pacific Islander women, 9.6 to 19.1 among Hispanic women and 9.4 to 26.3 among white women during the same period.

For each year between 1999 and 2019, Black women experienced the highest median maternal mortality ratios. American Indian and Alaska Native women experienced the largest maternal mortality ratio increases between 1999 and 2019.

All racial and ethnic groups in the U.S. had increases in median maternal mortality ratios since 1999, with American Indian, Alaska Native, Asian, Native Hawaiian or other Pacific Islander and Black women experiencing their highest median maternal mortality ratios in 2019.

Florida, Kansas, Illinois, Rhode Island and Wisconsin demonstrated the largest percentage increases in maternal mortality ratios, which were more than 162%, for American Indian and Alaska Native women. For Black women, Louisiana, New Jersey, Georgia, Arkansas and Texas had the largest percentage increases in maternal mortality ratios, which were more than 93%.

“Comprehensive mortality surveillance for all states via vital registration identifies states and racial and ethnic groups where maternal mortality is increasing,” the researchers wrote. “Maternal mortality persists as a source of worsening disparities in many U.S. states, and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis.”