Opinion: We are in a maternal mortality crisis. How do we reverse the trend?
The U.S. has the highest maternal mortality rate among high-income countries. What are we doing about it?
The tragic death of Tori Bowie, a three-time Olympic medalist, highlights yet again that pregnant people, and particularly Black and Indigenous pregnant women, are at risk of dying during pregnancy, childbirth or the postpartum period.
As the nation grapples with our maternal mortality crisis — the U.S. has the highest maternal mortality rate among high-income countries — we are collectively faced with the fact that optimal health, even at Olympian levels, cannot completely protect pregnant and postpartum people from death. To truly understand rising maternal deaths, we must examine larger structural forces such as discrimination, including racism, classism and stigma.
Deeply considering the circumstances of each maternal death to identify opportunities to prevent it is the work of Maternal Mortality Review Committees. The review committees are multidisciplinary teams composed of experts in obstetrics, public health, nursing, forensic pathology, social work, mental health, behavioral health and community lived experiences. Together, the review teams conduct detailed reviews of deaths during pregnancy, childbirth and up to one year postpartum to determine whether a death was related to pregnancy. After identifying circumstances that may have led to the death, the committees then develop evidence-based strategies to reduce preventable maternal deaths.
As members of Utah’s Perinatal Mortality Review Committee — Utah’s MMRC — we know that the current state of maternal health in Utah, which has one of the highest birthrates in the U.S., reflects the grim reality of rising maternal deaths. A review of Utah pregnancy-related deaths from 2017–2020 presented at the Maternal Mortality Summit showed maternal deaths rose from 19 in 2017 to at least 30 in 2021. Mental health conditions contributed to 47% of deaths and substance use disorders contributed to 29%. Additionally, Black, Native Hawaiian/Pacific Islander and Native American pregnant people were disproportionately more likely to die in our state.
We are committed to honoring the memories of pregnant and postpartum people who have died in our state by gathering a fuller picture of the circumstances of their deaths and acting on the data we gather to prevent future deaths. We know that people with marginalized racial or ethnic backgrounds or stigmatized medical conditions experience differences in health care as well as differences in opportunities for health beyond our hospital or clinic doors.
Recognizing this, in 2022 Maternal Mortality Review Committees began collecting information on discrimination —including classism, racism and stigma against certain medical conditions — as a contributing factor to maternal deaths. We are diligently working to expand our information sources, including adding interviews with family members, to expand our understanding of how discrimination plays a role in the deaths of pregnant and postpartum individuals in our state.
As clinicians and members of the Utah Perinatal Mortality Review Committee, we are heartbroken by Tori Bowie’s death. We hear the nationwide plea to understand how deaths of Black and Indigenous pregnant mothers, in particular, will be prevented. In Utah, we, along with our colleagues and others working across the country, are committed to identifying the root causes of rising maternal deaths, including discrimination. We can, and must, reverse this trend so that Utah families can remain whole.
Marcela C. Smid, Torri Metz, Michelle Debbink and Ann Bruno work for University of Utah Health and serve on Utah’s Perinatal Mortality Review Committee. Smid is an associate professor in the Division of Maternal-Fetal Medicine. Metz is an associate professor in the Division of Maternal-Fetal Medicine and vice chair of research for the Department of Obstetrics and Gynecology. Debbink is an assistant professor in the Division of Maternal-Fetal Medicine and vice chair of equity, diversity, and inclusion for the Department of Obstetrics and Gynecology. Bruno is an assistant professor in the Division of Maternal-Fetal Medicine.