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Tag: maternal mortality

  • Early prenatal care, considered best for moms and babies, is on the decline in the US, data shows

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    Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows it’s been on the decline.The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3% in 2021 to 75.5% in 2024, according to data released by the Centers for Disease Control and Prevention on Thursday.Meanwhile, starting care later in pregnancy or getting no care at all has been on the rise. Prenatal care beginning in the second trimester rose from 15.4% to 17.3%, and starting care in the third trimester or getting no care went from 6.3% to 7.3%.“We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an OB-GYN at Duke University in North Carolina. When patients delay medical care during pregnancy, “we’ve missed that window to optimize both fetal and maternal care.”While the trend identified in the report held for nearly all racial and ethnic groups, the decrease in early prenatal care was higher for moms in minority groups. For example, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Getting late or no prenatal care raises the risk of maternal mortality, which is much higher among Black mothers.Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of when U.S. women started prenatal care had been improving.The earlier prenatal visits begin, doctors said, the earlier problems can be caught. Visits give doctors a chance to share health guidance, and can include blood pressure checks, screenings, blood tests, physical exams and ultrasound scans.The report doesn’t provide reasons why prenatal care is starting later. But the proliferation of maternity care deserts across the nation is a growing concern, said Dr. Grace Ferguson, an OB-GYN in Pittsburgh.Many hospitals have shut down labor and delivery units “and the prenatal care providers that work at those hospitals also have probably moved,” said Ferguson, who was not involved with the report.A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there’s no birthing facility or obstetric provider. Women living in these areas receive less prenatal care, the report showed.Ferguson, who provides abortions as part of her OB-GYN care, said post-Roe v. Wade abortion restrictions may play a part because some obstetricians are choosing not to practice in states with more restrictive laws.Alfonso, who was not involved in the CDC report, said he also suspects that access issues for patients are pushing prenatal care later, particularly in rural areas. Patients may have to travel farther to get to appointments and may struggle to find a practice that accepts their insurance, particularly if they have Medicaid.Doctors fear that things could get worse.“If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”

    Early prenatal care improves the chances of having a healthy pregnancy and baby. But a new federal report shows it’s been on the decline.

    The share of U.S. births to women who began prenatal care in the first trimester dropped from 78.3% in 2021 to 75.5% in 2024, according to data released by the Centers for Disease Control and Prevention on Thursday.

    Meanwhile, starting care later in pregnancy or getting no care at all has been on the rise. Prenatal care beginning in the second trimester rose from 15.4% to 17.3%, and starting care in the third trimester or getting no care went from 6.3% to 7.3%.

    “We know that early engagement in prenatal care is linked to better overall health outcomes,” said Dr. Clayton Alfonso, an OB-GYN at Duke University in North Carolina. When patients delay medical care during pregnancy, “we’ve missed that window to optimize both fetal and maternal care.”

    While the trend identified in the report held for nearly all racial and ethnic groups, the decrease in early prenatal care was higher for moms in minority groups. For example, first-trimester care dropped from 69.7% in 2021 to 65.1% in 2024 for Black mothers. Getting late or no prenatal care raises the risk of maternal mortality, which is much higher among Black mothers.

    Michelle Osterman, lead author of the report, said the overall findings represent a shift. Between 2016 and 2021, the timing of when U.S. women started prenatal care had been improving.

    The earlier prenatal visits begin, doctors said, the earlier problems can be caught. Visits give doctors a chance to share health guidance, and can include blood pressure checks, screenings, blood tests, physical exams and ultrasound scans.

    The report doesn’t provide reasons why prenatal care is starting later. But the proliferation of maternity care deserts across the nation is a growing concern, said Dr. Grace Ferguson, an OB-GYN in Pittsburgh.

    Many hospitals have shut down labor and delivery units “and the prenatal care providers that work at those hospitals also have probably moved,” said Ferguson, who was not involved with the report.

    A 2024 March of Dimes report found that more than 35% of U.S. counties are maternity care deserts, meaning there’s no birthing facility or obstetric provider. Women living in these areas receive less prenatal care, the report showed.

    Ferguson, who provides abortions as part of her OB-GYN care, said post-Roe v. Wade abortion restrictions may play a part because some obstetricians are choosing not to practice in states with more restrictive laws.

    Alfonso, who was not involved in the CDC report, said he also suspects that access issues for patients are pushing prenatal care later, particularly in rural areas. Patients may have to travel farther to get to appointments and may struggle to find a practice that accepts their insurance, particularly if they have Medicaid.

    Doctors fear that things could get worse.

    “If this trend continues,” Alfonso said, “I worry about kind of what that would mean for morbidity and mortality for our moms.”

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  • Drug overdose revealed as leading cause of maternal deaths in US

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    Accidental drug overdose has emerged as the leading cause of death among pregnant and postpartum women in the United States, a new study has revealed.  

    Researchers from Columbia University found that overdoses, homicides and suicides together account for a substantial share of deaths during pregnancy and shortly after birth—often exceeding medical causes that dominate the public discussion around maternal health. 

    In their study, the team analyzed U.S. death certificate data to identify all deaths among pregnant and postpartum women within 42 days of delivery between 2018 and 2023.  

    “Overdose and violence are not typically on our radar when it comes to thinking about approaches to reducing maternal morbidity and mortality, but these events are far more common among pregnant and postpartum women than we think,” paper author Dr Hooman Azad said in a statement.  

    The analysis found that accidental overdose led mortality causes with 5.2 deaths per 100,000 births. Homicide and suicide followed, with a combined rate of 3.9 deaths per 100,000 births. 

    The research also highlighted disparities. Accidental overdose and suicide were more common among white women, while deaths via homicide was seen more frequent among Black women. 

    More than three-quarters of violent deaths involved firearms, underscoring the role of gun violence in maternal mortality. 

    Timing mattered as well. Over half of overdose and violence-related deaths occurred during pregnancy itself.  

    By contrast, the next four most common causes—cardiovascular disease, infection, hypertension and hemorrhage—were more likely to occur in the immediate postpartum period. 

    Despite fluctuations during the COVID-19 pandemic, the overall maternal death rate remained relatively steady across the six-year period studied. However, the composition of those deaths has shifted.  

    As medical care to prevent and manage obstetric complications has improved over the past two decades, a growing body of research shows that non-medical causes such as overdose and violence make up an increasing share of maternal deaths. 

    Tracking these trends has historically been difficult because of inconsistent methods for documenting pregnancy status on death records. Improved standardization in recent years has allowed researchers to see the patterns more clearly. 

    For Azad, the findings point to missed opportunities in care.  

    “The take-home message is that we may not do as good a job in screening for drug use and intimate partner violence among our pregnant patients as we do for medical complications,” he said. 

    Azad argues that maternal health efforts must broaden beyond clinical complications to include social and behavioral risks.

    He concluded: “We have an opportunity to refocus our efforts on preventing drug overdose and violence with multidisciplinary care that includes referrals to mental health care and social services throughout pregnancy—which could save hundreds of lives.”

    Do you have a tip on a health story that Newsweek should be covering? Do you have a question about maternal deaths? Let us know via health@newsweek.com.

    Reference

    Azad, H. A., Goin, D., Nathan, L. M., Goffman, D., Rajan, S., Reddy, U., D’Alton, M. E., & Laraque-Arena, D. (2026). Overdose, Homicide, and Suicide as Causes of Maternal Death in the United States. New England Journal of Medicine, 394(7), 722–723. https://doi.org/10.1056/NEJMc2512078

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  • California surgeon general sets goal of reducing maternal mortality by 50%

    California surgeon general sets goal of reducing maternal mortality by 50%

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    California’s surgeon general has unveiled a new initiative to reduce maternal mortality and set a goal of halving the rate of deaths related to pregnancy and birth by December 2026.

    Health officials say that more than 80% of maternal deaths nationwide are preventable. California has achieved a much lower rate of such deaths than the U.S., but maternal mortality resurged in recent years amid the COVID-19 pandemic, state data show.

    “We have the lowest rate in the country. Now we can do better,” California Surgeon General Dr. Diana E. Ramos said in an interview.

    Ramos was joined in announcing the effort Tuesday by First Partner Jennifer Siebel Newsom, the wife of Gov. Gavin Newsom.

    In California, leading causes of such deaths include heart disease, bleeding, “behavioral health” issues such as mental illness and substance use, and infection. More than a fifth of pregnancy-related deaths in California occur the day of delivery, but the majority happen in the days, weeks and months that follow, according to state data.

    The crisis has been especially stark among Black women, who have faced a maternal mortality rate more than three times that of white women in California. In Los Angeles County, there has been a public outcry in recent years over the deaths of women like April Valentine, 31, and Bridgette Burks, 32 — Black mothers who left behind devastated families.

    Health researchers have faulted numerous factors for the higher rates of maternal mortality among Black women, including the physical effects on the body of enduring years of racism; higher rates of diabetes and other chronic conditions that increase risk; and inequities in the care received by Black patients.

    California officials said they are also concerned about rising rates of maternal mortality among Latinos and Asian/Pacific Islander communities in the state.

    The “Strong Start & Beyond” initiative, officials said, would help patients understand potential risks before they become pregnant and prompt earlier action to address hazards such as heart disease. It would also alert Californians to doula services and other programs intended to support people before, during and after birth.

    Ramos said California had reached the lowest rate of maternal mortality in the nation through its system of reviewing maternal deaths and other efforts centered on hospitals, physicians and other healthcare professionals. Up until now, “the focus has been primarily on the healthcare setting,” she said.

    But “if we keep on doing the same thing — just focusing on the healthcare team — we’re going to get the same results,” Ramos said. Health officials and experts decided they needed to bolster that work, “and that’s why we’re bringing in the patient.”

    “It seems so simple, but oftentimes, the pregnant person doesn’t feel like they have a voice or they have the information they need to make informed decisions,” Ramos said.

    U.S. Secretary of Health and Human Services Xavier Becerra said in a statement accompanying the launch of the new effort that “reducing maternal mortality isn’t a ‘should,’ it’s a ‘must.’ California gets it.”

    The planned strategies outlined in the California Maternal Health Blueprint, released Tuesday, include a new questionnaire that patients can take at home to assess their risk of pregnancy complications and get recommendations for next steps based on their results.

    As an obstetrician-gynecologist, Ramos said she found that it was often at their first prenatal appointment that a patient would first hear, “You’re going to be a high-risk patient.’ And more times than not, patients would say … ‘I wish I would have known that I could have done X, Y or Z to decrease my risk.’”

    California officials also want all medical facilities in the state to use an existing screening tool for gauging the risk levels of pregnant patients.

    Ramos said those results could help guide where patients go for births. Hospitals with limited resources could refer patients with a higher risk of complications — such as someone who “is going to be at risk for hemorrhage, is going to be at risk for ICU admission” — to the medical facilities best equipped to handle them.

    The new effort comes as pregnant patients may face dwindling choices for hospital births: Nationally, roughly 1 in 25 obstetric units closed in 2021 and 2022, according to a March of Dimes report.

    Under “the modern fee-for-service healthcare model … hospitals must fund round-the-clock capacity but are only reimbursed when their facilities and staff are in action,” wrote Dr. Anna Reinert, an assistant professor of clinical obstetrics and gynecology at USC’s Keck School of Medicine, in a recent op-ed.

    “So if not enough deliveries are happening, expenses outweigh reimbursement. This drives hospitals to get out of the baby delivery business altogether,” Reinert wrote.

    California has faced a wave of such closures in the last decade, including at many hospitals in Los Angeles County. A CalMatters analysis found that such closures had disproportionately affected Black, Latino and low-income communities. Among the latest hospitals to announce it would shut down a labor and delivery unit is USC Verdugo Hills Hospital in Glendale, which plans to halt maternity care on Nov. 20.

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    Emily Alpert Reyes

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  • Sen. Jon Ossoff sat down with The Atlanta Voice to talk about working for Georgia’s Black families

    Sen. Jon Ossoff sat down with The Atlanta Voice to talk about working for Georgia’s Black families

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    Photo by Kerri Phox/The Atlanta Voice

    Georgia Senator Jon Ossoff, in his trademark suit without the tie, walked over to a position in front of the new Ebenezer Baptist Church, where a group of people were waiting. Among the people waiting were school-aged Black children on a field trip, former U.S. Ambassador to the United Nations and Atlanta Mayor Andrew Young, and other local and statewide civil rights leaders.

    “I’m here to thank these distinguished civil rights leaders,” Ossoff said as he explained how he got the Federal Prison Oversight Bill, which he first introduced in 2022, passed. The bill was recently signed by United States President Joseph R. Biden. 

    Following the press conference on Tuesday morning, Ossoff dropped by The Atlanta Voice office to speak with newspaper leadership about other moves he is making to improve the lives of millions of Black families around the state.

    Photo by Kerri Phox/The Atlanta Voice

    The Atlanta Voice: What makes you want to fight for Black families the way you continue to do in the U.S. Senate?

    Sen. Jon Ossoff: When I ran for the Senate I focussed on health, jobs, and justice. When I think about the challenges faced by Georgia’s African American community, the health disparities in our state are vast, the gap in economic opportunity and empowerment are vast. The justice gap also remains vast, so I have focused legislative energy, both in terms of oversight and reform efforts and tangible deliverable resources appropriated to the state of Georgia on addressing those critical gaps.

    AV: What has some of that legislative energy wrought?

    JO: There’s a huge shortage of facilities and resources for Black Georgians. That’s on the southside of Atlanta, but also in rural communities across the state. That’s why I have appropriated funds for example, to Southern Regional Hospital. That’s why I appropriated funds to clinics in rural areas in Georgia, as well as to transportation services that help folks in rural and underserved areas get to their appointments, get to the pharmacy, get what they need.

    AV: There is a huge gap between Black and white women in maternal services in Georgia. What’s up with that?

    JO: The maternal health gap in Georgia, the racial divide is so extreme. Georgia has been at the bottom of the national rankings, basically last or second to last, in maternal health overall for over a decade. By some measures in recent years, maternal mortality for Black women in Georgia has been higher than maternal mortality in Iraq, a country that has been in a state of active conflict for more than two decades.

    Georgia Senator Jon Ossoff (above) with a copy of The Atlanta Voice inside a conference room at The Atlanta Voice office on Tuesday, August 5, 2024. Photo by Kerri Phox/The Atlanta Voice

    Editor’s note: Ossoff recently held a senatorial hearing highlighting the testimony of OBGYN’s and maternal health doctors from Georgia. During the hearing Georgia’s six-week abortion ban was the main topic of discussion.

    JO: We heard testimony about women who were miscarrying, who were unable to get health care until they became sicker, sicker, and sicker. We heard testimony about a Georgia woman who had to leave the state, fly to Massachusetts to get healthcare, lost the pregnancy while traveling, and then upon arriving in Massachusetts went into sepsis. The extreme laws in Georgia are criminalizing the practice of obstetric medicine and worsening our shortage of OB GYN doctors in Georgia, who provide that vital prenatal care.

    AV: Medicaid is very important to millions of American families, and particularly to the state’s Black families, so why do you think it’s not as equally important to some of Georgia’s leaders?

    JO: Georgians pay the same federal taxes as residents of every other state in the country, but we are one of just 12 who refuse to get those resources back to help working families access health care. It doesn’t just deprive working families of healthcare, it deprives our hospitals of revenue. Because of there being insured patients coming through the door, there are uninsured patients coming through and the hospitals have to foot the bill. 

    AV: That might be why hospitals like Atlanta Medical Center were so easy to close?

    JO: They don’t have an insured patient population, because the state still refuses to expand Medicaid. And really, the only reason is that the underline legislation was advanced by former United States President Obama. There are still those lingering petty political grievances over the Affordable Care Act from more than a decade ago. So we have to think about health and in particular maternal health and the health of Black women. 

    AV: Part of that health is eating right, correct? There are so many counties in this state that aren’t as fortunate to have supermarkets and farmers markets within minutes like we do in Atlanta.

    JO: I’m introducing legislation called the Fresh Foods Act to help incentivize grocery stores, whether they are local community family-owned grocers or big supermarkets, to open new locations in underserved areas where they will sell fresh fruits and vegetables. If you’re somewhere there’s no hospital, no health clinic, no grocery store offering fresh fruits and vegetables, the state hasn’t expanded Medicaid, so there’s a lack of access to health insurance, it’s not like it’s a mystery why health outcomes are so much worse. 

    AV: Why are organizations like Big Brothers Big Sisters of Metro Atlanta, for example, so important for you to get federal funding?

    JO: I look at my job as a legislator and I think about it in the context of an entire human life. I thought about how we can focus on mentorship to children and adolescents, so I delivered resources for the organizations that specialize in mentorship, but for organizations here [in Georgia] that are healing place mentors and mental health professionals in schools too. 

    Photo by Kerri Phox/The Atlanta Voice

    Editor’s Note: Mentorship and mental health resources, after school opportunities, community centers, and safe public parks are also things Ossoff mentioned were targets of his funding efforts. “These are all areas where I have delivered resources to upgrade facilities on the southside of town and in rural communities, and will continue to do so,” he said.

    AV: Lastly, I want to talk to you about the Federal Prison Oversight Act that you helped get to the president’s desk and now into law. How important was that bill to you personally, and to Georgia’s Black families that are so oftentimes most affected? 

    JO: My political upbringing and my first introduction to public life was working as a very young man for Congressman John Lewis. What’s happening behind bars across the country is a humanitarian crisis. It makes a mockery of the Eighth Amendment of our Constitution which prohibits cruel and unusual punishment. 

    It is an issue that I care about, it is an issue where I’ve focused oversight and investigative resources. And now with passage of the Federal Prison Oversight Act, we have passed the most significant prison transparency and inspection legislation in many, many years. 

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    Donnell Suggs

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  • More Pregnant People Are Overdosing, and Stigma Plays a Role

    More Pregnant People Are Overdosing, and Stigma Plays a Role

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    March 30, 2023 – For Hendree Jones, PhD, executive director of an addiction clinic in Chapel Hill, NC, too many of her patients wait to seek addiction treatment because they’re afraid of facing backlash. They fear having their children taken away or going to jail and leaving them behind in an unsafe environment if they test positive for drugs.

    Jones, who runs UNC Horizons, a drug treatment facility for pregnant women and their children, said she’s seen a number of cases where these fears have been realized. Most recently, one of her patients made it through pregnancy, but when her newborn tested positive for drugs, child welfare stepped in. The woman desperately wanted help with her addiction, but there were concerns that she might not be able to take care of her baby. 

    “We were able to advocate for her so she could bring her child along to the treatment facility, but all too often these families end up separated,” Jones said. 

    The introduction of fentanyl into the drug supply has been driving an increase in overdose deaths among the entire population, and pregnant people show these same patterns of addiction. A recent article published in JAMA found that among pregnant and postpartum people, drug overdose deaths increased by 81% from 2017 to 2020. Recent reports have also shown that maternal mortality is on the rise in the United States and overdose rates are partially driving the increase.

    Pregnant people also face additional barriers to care. For starters, penalizing them for drug use has become more common in recent years as a result of the opioid epidemic. States like California and nearly a dozen others now have laws on the books that classify drug use as child abuse and can result in many parents losing custody of their children, according to an article in JAMA Pediatrics.

    They may also be turned away from emergency rooms or aren’t believed when they say that they’re in pain from withdrawal, Jones said. According to an October 2022 report from the White House Office of National Drug Control Policy, pregnant people are 17% less likely to be accepted into a treatment facility than the general public and when they are accepted, they’re often met with disdain. 

    Many women are treated so badly within health care settings that they go in once for treatment and never go back, Jones said. While we’re seeing a greater understanding around addiction as a medical condition within many populations, that same understanding has not been extended to pregnant people. “It takes a lot of guts to walk into a treatment facility and say you need help and when there isn’t a compassionate response, these women get scared and leave,” she said.

    Only around 19% of treatment facilities in the U.S. treat pregnant people, and in recent years that number has been on the decline, according to a report from the American Counseling Association. The decline is due to poor funding and the pandemic, when social distancing forced many facilities to reduce residential numbers. Staffing these treatment centers with properly trained counselors has also become more difficult because people are dropping out of the profession, not entering it. All of this has resulted in a lack of care for those who need it the most, said Emilie Bruzelius, an epidemiologist at Columbia University in New York who studies how the opioid crisis has impacted child welfare.

    “Nobody starts using opioids when they’re pregnant. It’s people who have opioid use disorders and then may or may not have access to treatment and the social support that they need to get through it,” said Bruzelius.

    Additionally, for many people who are able to stay drug-free during pregnancy, the postpartum period can become even more dangerous. Bruzelius’s research shows that the greatest number of opioid deaths happen after the birth of a child. A February 2021 study published in the Journal of Women’s Health found that the risk of overdose was highest 7 to 12 months after pregnancy.

    “Pregnancy can be a motivating time for women to seek help, but as time passes the risk of relapse is higher in the postpartum period, and if women have managed to cease drug use during pregnancy, their risk of overdose gets even higher because they don’t have the same tolerance that they had before,” said Bruzelius.

    The postpartum period is already at a critical point because of the risk of postpartum depression and an overall lack of postpartum health care. While pregnant people might see their obstetrician weekly, most only have one visit with their doctor after giving birth. And for the most at-risk population, this just isn’t sufficient, Bruzelius said. “There are so many stressors that come with a new baby, and stress is not conducive to drug use cessation.”

    Still, when people are able to get the help they need, research has shown that it works. Patients who are treated with methadone and buprenorphine (two medications widely used for the treatment of heroin dependence) are much less likely to die, according to a report from the American College of Obstetricians and Gynecologists.

    “There is clear-cut evidence showing that these medications help women have better outcomes, and there’s no evidence to show that they negatively impact the development of the fetus,” said Nora D. Volkow, MD, director of the National Institute on Drug Abuse. 

    In some cases, when pregnant people use these medications, their babies may be born with neonatal abstinence syndrome (NAS), caused by withdrawal from drugs they’re exposed to in the womb. This outcome is more pronounced with the use of methadone over buprenorphine. Volkaw said one of the recommendations for treatment is to breastfeed because if the mother is taking these medications, breastfeeding can help to alleviate some of the withdrawal symptoms in the baby.

    While there aren’t enough facilities available to pregnant people to meet the current need, there are examples of treatment centers that are doing it right. UNC Horizons, a state-of-the-art facility, for example, not only helps pregnant people with addiction but also treats the underlying trauma that causes them to relapse. 

    Other treatment facilities, like Hope Clinic at Massachusetts General Hospital in Boston, provide addiction and psychiatric care throughout pregnancy and early postpartum when people are most vulnerable to dying. 

    According to Volkaw, we can’t expect pregnant people to get help if their basic needs aren’t met. They need to be able to trust that those in the health care system have their and their children’s welfare in mind. 

    Rather than treating these people as criminals, we need to understand that this is a medical condition and without treatment many women will die, Volkaw said. 

    At a most basic level, Volkaw said, these people need to be able to bring their children with them to treatment. In some cases, they may need transportation, financial help finding a safe place to live, and proper nutrition. 

    “These are elemental needs and if they aren’t met, it becomes very hard for women to stay in treatment whether or not they’re pregnant,” she said.

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