America is in a maternal health crisis. According to new CDC data released this week, the rate of maternal mortality – defined as deaths during pregnancy or within 42 days of giving birth – rose by 40% in 2021. At a rate of 33 deaths for every 100,000 live births, 1,205 women died of maternal causes that year. That rate was more than twice as high for Black women, whose maternal mortality rate was 70 deaths for every 100,000 live births. The latest federal compilation of data from reviews of maternal deaths suggests that 84% were preventable.
Experts believe that 2021’s spike in maternal mortality can be attributed at least partly to the Covid-19 pandemic, though it’s not clear exactly how. Perhaps infection and exposure to the virus made pregnant women more vulnerable; perhaps the pandemic caused some women to delay or forgo prenatal care as hospitals strained to treat the surge of virus patients and shutdowns made all kinds of care harder and riskier to get.
But even before Covid-19, America has long been an outlier in maternal deaths, with dramatically higher rates of women dying in or as a result of childbirth than in peer nations. America has 10 or more times the rate of pregnancy-related death in Australia, Austria, Israel, Japan and Spain.
The women reflected in 2021’s data died from high blood pressure and from infections; they died from hemorrhage, and from blood clots, and from strokes. They died because doctors incorrectly administered epidurals, or botched C-section procedures, and they died because they weren’t given oxygen when they needed it.
More broadly, they died because pregnancy is a totalizing physical experience, one that challenges and changes the body in profound, irreversible ways that are kept from public discussion by ignorance and taboo, and they died because they lived in a country where medicine is rationed and unaffordable, where women’s healthcare has been starved of both talent and investment, and where disregard for both public health and for female pain has left vast swaths of pregnant people vulnerable in ways that reflect more on the values of their society than on the fragility of their bodies.
They also died, it should be said, from racist negligence. The racial disparities in the data are staggering: Black women are dramatically more likely to die in childbirth. Some of this can be attributed to the broad health disparities between Black Americans and other groups – the result of the strains of poverty, overwork, exposure to pollution, and vulnerability to violence that have long kept Black people in the US physically overtaxed and under-cared for.
But the higher rate of maternal mortality among Black women in America also appears to come from negligence and contempt directed at them by medical providers, who allow racist fictions about Black women’s tolerance for pain, or about their propensity for drug use, or about the worthiness of their lives, to infect their attitudes and degrade the quality of their care.
This seems to be what happened to Sha-Asia Washington, a 26-year-old Black woman from Brooklyn killed in 2019 by allegedly incorrectly administered anesthesia while delivering her daughter, Khloe, by emergency C-section. And it seems to be what happened to Shalon Irving, an epidemiologist at the CDC in Atlanta, who died after being sent home repeatedly from the hospital when she presented with symptoms of out-of-control blood pressure in the days after delivering her daughter, Soleil.
These are women who should be alive, pursuing their dreams; they should be raising their daughters, and making their friends laugh. Bias, negligence and indifference cost them their lives, cost their children their mothers, and cost us all the benefit of their talents and presence.
The maternal mortality rate in America is likely to get worse before it gets better. The dramatic increase in deaths in 2021 was the third consecutive year that the rate rose – the trend is only going in one direction. And the 2021 data was collected before the US supreme court’s June 2022 Dobbs decision, which reversed Roe v Wade and led to the enforcement of laws across dozens of states that forbid or delay medically necessary abortions. This means that pregnant women are getting sicker, and waiting longer for care; it also means that many doctors are now frightened of the legal repercussions they will face for intervening to save pregnant women’s lives. More bodies will accumulate; more lives will be cut short; more women will be lost to the cruelty, indifference, scarcity and fear that now pervades our medical system.
But the logic of the anti-choice movement and the Dobbs regime poses not just a logistical hazard to women’s health, but also a moral one. After all, the anti-abortion laws that are now in effect in a majority of states are wildly antagonistic towards pregnant women. They pose pregnancy and childbirth as punishment; they treat the pregnant patient as a person whose pain is deserved, a just consequence of recklessness or immorality.
It’s not hard to imagine how the logic of these bills might seep into the broader culture, creating social, professional and, yes, medical environments where pregnancy is treated as a moral failing, and pregnant women are regarded with open contempt. After all, how else do you describe a country that has made giving birth extraordinarily dangerous – and now is forcing more and more women to do it?
Moira Donegan is a Guardian US columnist