Last week the National Center for Health Statistics (NCHS) released three reports and a long-awaited update on the current maternal mortality rate in the United States.  The three reports are:

• National Vital Statistics Reports, Volume 69, Number 1: Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths

• Series 3, Number 44: The Impact of the Pregnancy Checkbox and Misclassification on Maternal Mortality Trends in the United States, 1999—2017

• National Vital Statistics Report, Volume 69, Number 2: Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018s

This update is the first concrete data released in more than ten years.  This information is being accurately captured due to the addition of a checkbox on the data forms provided to the Centers for Disease Control (CDC) that help in identifying maternal mortality.  Two terms to understand are 1) maternal mortality - a death that occurs during pregnancy or within 42 days after the end of pregnancy and 2) pregnancy-related mortality - deaths that occur during pregnancy or within one year of the end of pregnancy.  The CDC is more confident than ever of capturing accurate information due to the revised reporting procedures. 

They state:

“As of 2018, implementation of the revised certificate, including its pregnancy checkbox, is complete for all 50 states (noting that California implemented a different checkbox than that on the U.S. Standard Certificate of Death), allowing NCHS to resume the routine publication of maternal mortality statistics.

o The question used by California only specifies if pregnant within the last year. Unlike the format used in the other states, it does not indicate detail on whether pregnant at the time of death, pregnant 42 days before death, or pregnant 43 days to 1 year before death.

• NCHS has adopted a new method (to be called the 2018 method) for coding maternal deaths to mitigate these probable errors. The 2018 method involves restricting use of the pregnancy checkbox to decedents aged 10–44.

• Based on the new method, a total of 658 deaths were identified in 2018 as official maternal deaths (deaths during pregnancy or within 42 days after the end of pregnancy). The official maternal mortality rate reported by NCHS for 2018 was 17.4 deaths per 100,000 live births”

The standardization of how data is reported will allow the CDC to strengthen their efforts on capturing accurate numbers and they are making public data files available to reporting agencies, investigators and research groups who are interested in conducting their own analyses.  There is also work being done on making sure that each state has (or is establishing) a maternal mortality review committee that works to identify, understand and reduce maternal mortality in each state.  With a better understanding of the circumstances and accurate information on the true number of deaths, a collaborative effort can be done to prevent future deaths.

As stated above, the overall maternal mortality rate was 17.4 deaths per 100,000.  Unfortunately, there continue to be wide racial and ethnic gaps between non-Hispanic Black women ( (37.1 deaths per 100,000 live births), non-Hispanic white (14.7), and Hispanic (11.8) women.

The 2018 rate is more than twice the rate for the last capture of this information, and it is believed that this increase is due to changes in reporting methods (the “checkbox”).  Analysis reveals that while too high, the rate has not significantly changed since 1999.

As information is further fine-tuned and evaluated, the message will only become clearer: too many people are dying during the childbearing year and Black families are dying at more than twice the rate of their white peers. Childbirth educators and other perinatal professionals must demand increased efforts to reduce these deaths (many of them unnecessary) and support our families in receiving the best evidence-based, respectful care possible.  It is simply not acceptable that surviving pregnancy, childbirth and the postpartum period is influenced by the color of one’s skin.  The bar must be raised immediately and we all must do our part.

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