Aug 2, 2023 - Health

Giving birth in America continues to get deadlier

Illustration of a pregnant woman wearing a hospital gown with a pattern of exclamation marks on it.

Illustration: Aïda Amer/Axios

It's becoming ever more dangerous to give birth in America, especially for Black women, older women and those living in rural areas, according to a pair of new reports from March of Dimes and Milken Institute.

Why it matters: The dismal U.S. maternal health statistics are usually a sidebar in the abortion wars, but many experts believe that increasing the number of births by further restricting access to abortion will only worsen the situation.

Driving the news: More than 5.6 million women live in counties with little to no access to maternity care services, according to March of Dimes.

  • More than 300 hospital birthing units have closed since 2018, and there's been a 4% decline in hospitals that offer labor and delivery services in the last year alone.
  • A separate analysis released by the Milken Institute found that racial disparities in maternal mortality exist across age groups, but that risk increases earlier for Black women, potentially a sign of faster aging.

By the numbers: Nationally, the maternal mortality rate in 2021 was 32.9 deaths per 100,000 live births — nearly double the 17.4 deaths per 100,000 live births in 2018, according to the CDC.

  • But those numbers don't capture the differences between certain populations. Non-Hispanic Black women, for example, had a rate of 69.9 deaths per 100,000 live births in 2021 — more than 2.5 times the 26.6 deaths per 100,000 live births among non-Hispanic white women, per the CDC.
  • Some states have particularly high rates, too. Mississippi and Alabama, for example, both were above 63 deaths per 100,000 live births between 2018 and 2021, according to the Milken Institute.
  • And Black women 35- to 44-years-old in a group of 10 Southern states had a mortality rate of nearly 219 deaths per 100,000 live births in 2021, Milken found.

Between the lines: Many of the states with the highest mortality rates are ones with poor access to care — and where some of the strictest abortion restrictions are in place.

  • "Places where there are maternal care deserts are where you see poor outcomes. You can't say one causes the other, but they're definitely associated," said Katherine Sacks, the lead author of the Milken report.
  • And abortion restrictions are likely related to the growth of maternal care deserts. An analysis released this spring found that new doctors applying to medical residency programs were likelier to avoid states with the most stringent abortion curbs.
  • These states also have generally high at-risk populations to begin with, like communities of color and individuals with chronic health conditions.

Reality check: Most pregnancies are wanted, and maternal mortality's significance goes well beyond the abortion debate.

  • "Abortion restrictions, when they lead to increased death, that is partly because people who are denied abortions perhaps are more likely to fall into these risky categories," Sacks said.
  • "When giving birth is perhaps not safe for someone, that's a scary thing. That said, most of these births are not people who have been denied an abortion. This affects everybody."

The big picture: Rural communities writ large are struggling with health care access issues that go well beyond maternity care. And many obstetrics unit closures are about money, not politics.

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