Maternal deaths up in Ky., U.S., especially among Blacks; state's rate is sixth in nation; drug and substance abuse are big factors

National Center for Vital Statistics graph, via Centers for Disease Control, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Pregnancy-related deaths continue to be on the rise across the nation, going up nearly 40 percent between 2020 and 2021, according to the Centers for Disease Control and Prevention.  

The National Center for Health Statistics found that 1,205 women in the U.S. died from pregnancy-related causes in 2021, up from 861 deaths in 2020 and up from 754 deaths in 2019, or nearly 60%.

The national maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019. The report also found that maternal death rates increased with maternal age.

The report did not provide state-level data, but data provided to Kentucky Health News by the CDC shows that in 2018-21, 38.9 Kentucky women out of 100,000 died while they were pregnant or within 42 days after childbirth.

During that period, Kentucky had the nation's sixth highest maternal mortality rate, one that was 65% higher than the national rate of 23.5 deaths per 100,000 births. And when compared to surrounding states, Kentucky had the third highest rate, behind Virginia and Tennessee, both with rates of 41.7 deaths per 100,000 births. 

That said, the CDC calls for caution when comparing state maternal-death data because the actual numbers are small and reporting systems vary by state.  

The United Health Foundation's America's Health Ranking report, using federally available data, shows Kentucky's annual maternal death rates were 24.3 per 100,000 births in 2020; 29.7 in 2021; and 34.6 deaths in 2022. 

To address this issue, Kentucky legislators established the Maternal Mortality Review Committee in 2018 to review all maternal deaths from any cause that occurred during pregnancy or within a year of delivery.

Key findings in the annual 2021 report, for 2013-19, include: 91% of maternal deaths in 2018 were deemed to be preventable; 16% were pregnancy-related; 52% were pregnancy-associated, meaning that the death resulted from a cause unrelated to pregnancy; and 52% had substance-use disorder linked to the death. 

It also found that of the 339 maternal deaths that occurred in 2013-19, 21 of them, or 6%, were by suicide and 128 of them, or nearly 38%, were accidental, meaning that the death occurred from an "inadvertent event," which includes, among other things, overdose deaths. For example, in 2019 alone, the report found that 44% of the accidental deaths were from drug overdose. 

A bill to ensure greater access to information and resources for mental-health care before and after the birth of a child passed out of the legislature this year and has already been signed into law. 

Senate Bill 135, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, calls on the state Cabinet for Health and Family Services to create written information on perinatal mental-health disorders, including postpartum depression, and make it available on its website. It also requires the cabinet to provide access to online clinical assessment tools to help providers detect the symptoms of perinatal mental-health disorders.

The cabinet is also charged with creating a panel of maternal- and infant-health experts to explore the issue of perinatal mental-health disorders, including prevention, treatment and gaps in service. The panel is required to report its findings to the Interim Joint Committee on Health, Welfare and Family Services and the Advisory Council for Medicaid Services on or before Nov. 1 of each year.

CDC photo

In 2018, Black women in Kentucky had a maternal pregnancy-related death rate of 40.2 deaths per 100,000 births -- three times the rate of white women, at 13.1 deaths per 100,000 births. 

Maternal deaths among black women are higher across the nation. In 2021, the CDC report found that the maternal mortality rate for Black women was was 69.9 deaths per 100,000 births, which was 2.6 times the rate for white women, at 26.6 deaths per 100,000 births. 

Black Maternal Health Week is April 11-17 and the Louisville Coalition for Black Maternal Health is holding programs each day to bring awareness to this issue. The list of events can be found on their Facebook page. 

The state report points to a number of risk factors impacting maternal mortality, including, "tobacco use, obesity, racial disparities, depression, opioid use, and other social determinants of health such as transportation, access to care, domestic violence, and a rural state."  It also notes that conditions such as diabetes, hypertension, or other health conditions require additional follow-up and management during the pregnancy.

That said, the state report found that 21% of the women who died had received no prenatal care and 26% of them had had less than four visits during their pregnancy.