By Sarah Johanek, MPH

A government report released in October confirms that during COVID, maternal health worsened, racial disparities grew, and rates of maternal mental health disorders rose.

Maternal deaths increased during the COVID-19 pandemic, and the pandemic was a contributing factor in 25% of all maternal deaths in 2020-2021, as found in the recent report published by the Government Accountability Office (GAO). GAO conducted this research because the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes a provision for GAO to report on its pandemic oversight efforts.

Additionally, GAO was asked to research the impact of COVID-19 on maternal health. This report analyzes the available research on maternal health outcomes and disparities during the pandemic. This includes reviewing CDC’s recent data on maternal mortality, data from the National Vital Statistics System, and agency documents, and conducting interviews with stakeholders. This report was sent to congressional addressees and outlined how the pandemic increases the risk for adverse outcomes for pregnant people and the increasing racial disparities among pregnant people. It also highlights the HHS Agencies’ efforts to address maternal health outcomes and disparities during the pandemic.

Key highlights from this report include:

Maternal Mortality and Disparities:

The mortality rate for Black women increased from 44 per 100,000 live births in 2019 to 68.9 in 2021, while the mortality rate for White women increased from 17.9 per 100,000 live births to 26.1 in 2021.
The mortality rate for Hispanic and Latina women was 12.6 per 100,000 live births and was lower than the mortality rate for White women in 2019, but significantly increased to 27.5 per 100,000 live births and surpassed the mortality rate of White women by 2021.
COVID-19-related deaths accounted for the increase in deaths in 2021, which was 25% of all maternal deaths in 2020 and 2021.
The mortality rate for COVID-19-related deaths was 13.2 per 100,000 live births among Black women, 8.9 among Hispanic women, and 4.5 among White women.
Maternal deaths have increased by nearly 80% since 2018.
The risk of death for pregnant women increased by more than three times in August and September of 2021 due to the Delta variant, compared to previous months.

Adverse Health Outcomes:

The percentage of preterm and low birthweight births increased in 2021, compared to 2020.
Those with COVID-19 were at a greater risk of having preterm and low birthweight births, and being admitted to the intensive care unit during delivery, compared to women without COVID-19.

Adverse Maternal Mental Health Outcomes:

There was a higher percentage of those in the postpartum period reporting symptoms of depression before and during pregnancy in 2020, compared to 2016.
Anxiety, depression, and stress may have increased during the pandemic because of social isolation and fears of COVID-19.

Social Determinants of Health:

Stakeholders noted that the pandemic exacerbated social determinants of health like access to care, child support, transportation, or technology, one’s living environment and employment status, and disproportionately affected racial and ethnic minorities and socially disadvantaged groups.
The inability to social distance and the likelihood of being essential workers among low-income communities increased the risk of COVID-19 and maternal mortality.
Stakeholders reported that structural racism causes disparities in social determinants of care and increased the risk of severe illness from COVID-19 among pregnant people of color.

Maternal Deaths, 2018 through 2021 graph

This report should further make the case to the Senate, which is set to vote on their mental health bill package, that the TRIUMPH for New Moms Mental Health Act is necessary to create a national maternal mental health strategic plan.

Armed with this additional data, we expect Congress will continue to actively address maternal mental health disparities in this coming congressional session. 2020 Mom is poised and ready to share our years worth of work identifying systemic barriers and solutions.

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