After a sharp rise in women dying in pregnancy, childbirth or postpartum earlier in the Covid-19 pandemic, rates decreased significantly in 2022, according to a new report from the US Centers for Disease Control and Prevention. However, Black women still had higher rates of maternal deaths than other women.

The US maternal mortality rate fell from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 per 100,000 in 2022, according to the report, published Thursday by the CDC’s National Center for Health Statistics.

“Comparing 2022 to 2021 data, the maternal mortality rate decreased substantially, and the decreases were seen broadly,” said Dr. Donna Hoyert, a statistician at NCHS and author of the report.

In total, according to the report, 817 women died of maternal causes in 2022, compared with 1,205 in 2021, 861 in 2020, 754 in 2019 and 658 in 2018.

Although the report did not examine why there was a decrease from 2021 to 2022, Hoyert said it could be associated with declines in Covid-19 infections.

“The number of the maternal records that mentioned Covid-19 among the causes of death decreased in 2022,” she said.

Covid-19 was the third leading cause of all deaths in the United States in the first two years of the pandemic, but there were about half as many deaths from it in 2022 as in the year before, making it the fourth leading cause in 2022.

“We absolutely did observe an upward tick in maternal as well as perinatal mortality related to the Covid pandemic,” said Dr. Angela Bianco, director of maternal-fetal medicine and professor in the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

“But we don’t know that that was directly related to Covid versus other issues that were potentially magnified by the Covid pandemic. Social drivers of health, adverse outcomes of health may have been further exacerbated by the impact of Covid, by decisions regarding vaccination, by access to care, by further marginalization,” said Bianco, who was not involved the new report.

“Whether it’s directly related to a Covid infection or indirectly related to the psychosocial and economic health ramifications of a widespread pandemic, that’s really difficult to tease out,” she said of the US maternal mortality rate, adding that overall, she remains “encouraged and surprised” by the recent downward trend of the maternal mortality data.

A study published last year in the journal JAMA Network Open found that the rate of pregnant women dying of delivery-related causes in US hospitals appeared to fall more than 50% from 2008 to 2021. But the decrease represents only in-hospital maternal deaths, not all types of maternal mortality, and many maternal deaths still happen outside the hospital setting, during pregnancy or postpartum.

Obstetrician and gynecologist Dr. Yolanda Lawson said she remains hopeful that the US maternal mortality rate is moving in the right direction.

“I think the next phase of this will be to ensure that policies around obstetrical care don’t stall our progress that we see demonstrated by these numbers,” said Lawson, president of the National Medical Association, who is testifying on maternal health disparities Thursday before the US Senate Committee on Health, Education, Labor and Pensions.

“We may not be in an ideal state, but if progress is being made, I would be highly disappointed if this much effort, funding, resources and attention had been made, and we saw absolutely no progress,” she said of the US maternal mortality rate.

The United States may be heading in the right direction, but the US maternal mortality rate has been on the rise since 2000, says Dr. Tosin Goje, director of Cleveland Clinic’s Center for Infant and Maternal Health, who was not involved in the new report.

“Many health systems in the U.S. and across the world are still recovering from the challenges presented by the COVID-19 pandemic. Therefore, we must be cautious and steadfast in our efforts,” Goje wrote in an email. “To continue moving the needle, we will need to deploy interventions and policies that are pro women’s health and monitor the maternal mortality trends post COVID-19 pandemic.

“Black women are three times more likely to die from a pregnancy-related cause than White women,” she added. “We should focus not just on decreasing the overall mortality rate, but addressing the racial disparities that exist.”

‘The disparity lingers and persists’

Despite the recent decline in the US maternal mortality rate, the new report said that in 2022, the maternal death rate for Black women was still higher than for other women. The rate among Black women was 49.5 deaths per 100,000 live births, compared with 19 deaths per 100,000 for White women, 16.9 per 100,000 for Hispanic women and 13.2 per 100,000 for Asian women.

“The disparity lingers and persists, as you can see from the data with Black women versus Caucasian women and others,” Lawson said, adding that a lack of adequate access to maternal health care plays a role in that disparity.

“Access is important from a lot of respects. We know that in this country, we’re having maternal health care deserts. We have states that have not expanded Medicaid in the face of seeing not only maternal and infant mortality but disparities,” she said. “We have to still continue to make sure that we are supporting states to put in quality improvement projects and initiatives.”

Rates for Black women have remained significantly higher than for White, Hispanic and Asian women over time, CDC data shows.

“Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias,” according to the CDC’s website. “Social determinants of health prevent many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.”

The new NCHS report also showed that rates of maternal deaths climbed with age. In 2022, there were 14.4 deaths per 100,000 live births for women younger than 25, compared with 21.1 per 100,000 for ages 25 to 39 and 87.1 per 100,000 for those 40 and older.

“It’s consistent over time that it increases with increasing age,” Hoyert said.

The new report included data on deaths from the CDC’s National Vital Statistics System and used the World Health Organization’s definition to define a maternal death as the death of a woman during pregnancy or within 42 days of the end of that pregnancy, due to “any cause related to or aggravated by the pregnancy or its management,” not including accidental or incidental causes.

‘A national call to arms’

The United States has continued to have the highest maternal mortality rate among other high-income countries.

“Because our stats have been rather abysmal, there’s been really a national call to arms to address our maternal mortality crisis, which is definitively disparately affecting women of color,” Bianco said.

This week, the US Department of Health and Human Services announced that $105 million in funding has been directed to support more than 100 community-based organizations across the country that are focused on improving maternal and infant health. The funding, through the administration’s Healthy Start Program, is intended to support the health care and social needs of both mothers and infants in communities in need.

“Through these Healthy Start awards we will support on-the-ground, community-based organizations who will work every day to help expecting and new moms get the health care and key supports – like transportation to prenatal care and food assistance – they need to have healthy pregnancies and healthy babies,” Carole Johnson, the administrator of the Health Resources and Services Administration, said in the announcement Monday.

There are also individual steps that women can take to reduce their own risks of maternal complications, Bianco said. For example, pregnant women are recommended to get vaccinated against Covid-19.

“The first thing to think about is your health before you even consider a pregnancy. So the best thing to do is to optimize your health before pregnancy. That means tobacco cessation; if you have a substance use disorder, seek help for that so that that’s manageable; if you need to lose weight, try and implement dietary changes and an exercise regimen,” Bianco said.

“There’s also your mental health. Mental health is very much directly correlated to maternal morbidity, maternal outcomes and mortality,” she said. “So if you can optimize your physical and mental health, have a strong support system in place, have providers that you can build a trusting relationship with, and then if necessary, also avail yourself of ancillary providers like birthing doulas to really have a more robust safety net in place and make sure that you’re in a hospital that provides all the necessary services for you – that’s really the best way to set yourself up for ideal outcomes.”