US maternal mortality continues to worsen, and there are large differences by race and state

July 7, 2023

Happy Friday!

JAMA reported this week that maternal mortality rates doubled in the ten years from 1999-2009 to 2010-2019. This rise was across all racial groups and preceded the COVID-19 pandemic, which increased maternal mortality further. Each dot on this graphic represents a state and a racial group. Those above the diagonal line increased in this time period, and almost no dots are below the line.

Source: Fleszar, et al JAMA July 3, 2023 LINK

Maternal outcomes are worst for Native Americans and Blacks and are worst in the South. This graphic gives a sense of the racial and geographic differences:

Source: Fleszar, et al JAMA July 3, 2023 LINK

This study, of course, is not perfect. The database could have incorrect racial and ethnic information, and death certificate information is not standardized across states. These researchers did not include deaths from suicide, homicide, or trauma - which are often included in other maternal mortality statistics.

Implications for employers:

-        Here’s a link to an article I wrote in Harvard Business Review this spring, “What employers can do to make childbirth safer.”  The gist is that employers can improve benefit design, demand more transparency and reporting to patients and employers from health plans, and push health plans to pay providers for value.

-        Employers can provide better data to employees on their maternity benefits, and offer resources to help identify and even cover doulas.

-        This spring, the FDA approved a new blood test to predict the risk of preeclampsia, which leads to severe hypertension and seizures and can cause death. This test will likely be performed as part of hospitalizations, so its cost will be borne by facilities that are paid per diem or global fees and will show up as a new charge for facilities paid fee-for-service.

Coming Monday:

Large study shows increased suicide among transgender individuals, and literature demonstrates that gender affirming care is associated with lower mental health risks

Have a great weekend!

Jeff