Increase in Maternal Mortality During COVID Underscores Need for Policy Changes

The rate of women who died during pregnancy or shortly after birth increased significantly during the first year of the COVID-19 pandemic, according to new data from the National Center for Health Statistics, and Black women continued to experience maternal death at rates more than twice the national average.

In 2020, there were 861 women who died during pregnancy or within 42 days after the end of pregnancy, compared with 754 women who died from maternal health causes in 2019. The maternal mortality rate for 2020 was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. (see table below)

The increase in maternal deaths during the pandemic was not unexpected, and reflects the hardships that COVID-19 placed on people giving birth, including limited access to prenatal care, increased stress, and lack of social support available before and after birth.

However, the data show that the 2020 measurement year marked the second successive year of significant increase in the national rate of maternal mortality, which, at 23.8 deaths per 100,000 live births, is a ratio that is far greater than other high-income countries.

The persistently high rate of maternal death among Black women deserves immediate attention. Study after study shows that structural barriers to health care, including racism, can lead patients to avoid or delay seeking care, be misdiagnosed, or receive inappropriate treatment. Multiple studies have shown that women who experienced racism and discrimination were more likely to have an infant born at low or very low birth weight.

Action is needed at every level, and policy changes in Medicaid have an important role to play in making widespread, structural improvements in health coverage that can create greater access to care for women of color before, during, and after pregnancy. More than half the states are working towards extending postpartum Medicaid coverage from its current end date of 60 days after the end of the pregnancy, to one year postpartum, and more are on the way as states are in legislative sessions now. Five states have already received federal approval via a Medicaid 1115 waiver to extend postpartum coverage for a longer duration, and to at least some people.

These extensions will benefit all pregnant people covered by Medicaid but will have an especially broad impact on women of color. About 65 percent of births among Black women are financed by Medicaid, compared with about 43 percent of births overall. Based on state activity so far, about 400,000 postpartum people each year will have access to the extended coverage this year, who would have previously lost coverage at 60 days before the policy change.  About 720,000 people each year would gain expanded Medicaid postpartum coverage each year if all states take action.

To view your state’s Medicaid postpartum coverage duration, as well as other pregnancy coverage options your state can adopt to increase the number of people eligible for coverage, see our state data hub here.

In Congress, the currently-stalled Build Back Better Act includes a requirement that all states extend postpartum Medicaid coverage to 12 months, as well as making significant investments in growing and diversifying the perinatal workforce, improving education and anti-bias training for health care providers, and supporting data infrastructure to better support and track maternal health outcomes for women of color.

Many of these investment opportunities were driven by the Black Maternal Health Momnibus, a package of several bills designed to comprehensively address all dimensions of the nation’s maternal health crisis. The Biden-Harris Administration also has administrative opportunities to make meaningful improvements in maternal health outcomes.

This new data confirms what many have known for a long time. The United States is experiencing an unacceptable maternal health crisis that is growing worse, and women of color are most at risk. It will take action from every sector—including Medicaid—to make the U.S. a safer place for mothers and babies to thrive.

Maggie Clark is a Senior State Health Policy Analyst at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.

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