New research calls into question the severity of the nation's maternal mortality crisis, finding that flawed data has inflated death rates over the past two decades.
The study, published March 12 in the American Journal of Obstetrics & Gynecology, centers on a change in the way pregnancy was noted on death certificates beginning in 2003. That year, the National Center for Health Statistics added a checkbox to death certificates to indicate whether the person was pregnant or had recently been pregnant, which was meant to improve the detection of maternal deaths.
The pregnancy checkbox led to "egregious errors," including hundreds of people ages 70 and older listed as having been pregnant at the time of or in the year before death. Cancer deaths and those from other causes were also misclassified as maternal deaths if the box was checked, researchers said.
When the research team looked at death certificates that listed pregnancy as a cause of death, as opposed to looking at those that had the pregnancy box checked, they found maternal mortality rates were lower and stabilized over time.
"Identifying maternal deaths by requiring the mention of pregnancy among the multiple causes of death provides a more accurate, clinically coherent and compelling perspective on maternal mortality in the United States, and can serve as an evidentiary basis for clinical and public health initiatives," the study said.
Under the revised tracking method, the study found the maternal mortality rate was 10.2 per 100,000 live births from 1999 to 2002, and 10.4 from 2018 to 2021. By comparison, with the pregnancy box, the National Vital Statistics System showed the mortality rate was 9.65 per 100,000 live births from 1999 to 2002, jumping to 23.6 in 2018 to 2021.
Despite an overall reduction in maternal mortality, significant disparities remain, with disproportionately high rates among Black pregnant women. For some experts, this was the main takeaway.
"We should be targeting a lot of our public outreach to focus on conditions that are affecting patients of color while they're pregnant," Colleen Denny, MD, associate professor in the department of obstetrics and gynecology and director of family planning at NYU Langone Hospital in New York City, told The Washington Post.
View the full findings here.