You've heard the statistics before: Despite being one of the most technologically advanced nations in the world, the United States has some of the worst health outcomes. This has been especially true, and disturbing, for maternal mortality, particularly among Black women, which reached 49.5 deaths for every 100,000 live births in 2022.
The U.S. Centers for Disease Control and Prevention published an encouraging report in May 2024 showing a reduction in maternal mortality from 32 deaths per 100,000 live births during the pandemic in 2021 to a rate of 22 deaths in 2022. Maternal mortality is particularly high among Black women in the US. In 2021, the rate reached 69.9 per 100,000 live births, declining to a rate 49.5 in 2022. Yet despite this progress, the U.S. maternal mortality rate is still many times greater than that in other developed countries — such as Sweden, where the rate was only five per 100,000 in 2022.
At a 2024 Cure Tuesday Talk, Elizabeth Garner, MD, MPH, Chief Scientific Officer of Ferring Pharmaceuticals US, pinpointed some surprising factors responsible for these statistics and highlighted a promising new initiative that may turn things around. She shared some shocking contributors to pregnancy-related deaths that are actually quite manageable, such as:
Mental Health
Garner contended that mental health — particular stress and depression — is one of the leading direct causes of maternal death. "Everybody is stressed these days. Add to that the stress of pregnancy, childbirth and growing your family, and naturally stress levels go up," she explained. "We don't have good supports for women in the postpartum period."
Opioids
Opioid use and overdose are very common, and both occur frequently in women. Opioids are a direct contributor to pregnancy-related deaths.
Zip Code
Where a woman lives is directly related to her pregnancy outcome. Garner described the impact of "maternity deserts" — areas where there are no obstetric practitioners or maternity wards and sometimes no hospitals at all.
"It is believed that about one-third of counties have maternity deserts, meaning that a third of people who live in counties of the United States don't have access to obstetric care," she noted. "If you have preeclampsia or bleeding after delivery, you have minutes to deal with it. If you don't have obstetric care close to you, that's a big problem."
Systemic Racism
There has been increasing attention to disparities in obstetric care between white and non-white women due to systemic racism. The concerns of women of color are often dismissed.
"This has really been brought to the forefront," said Garner. "We're talking about it. Women are talking about it and saying 'I'm not going to put up with this.'"
Money
Compared to other kinds of healthcare for which hospitals can charge high fees, maternal health is not a significant revenue stream. As a result, Garner explained, many maternity wards have been shut down. Venture capitalists and pharmaceutical companies have also not invested sufficiently in women's health.
"We have known for years that women's health has been underinvested," said Garner. "And if we're not investing, there is no money to support science. That's where the money needs to go — toward research to understand the basic mechanisms about what is happening in maternal health," Garner advocated. "It's very difficult for industry to develop new drugs if we don't understand the mechanism that's leading to a condition."
She noted that in all of the years of the FDA's existence, there have been only nine drugs developed specifically for obstetric use. "You cannot approve drugs without data, and data cannot be produced without research," she added.
Moving Forward with New Investments
The good news is that there is finally a significant and likely lasting increase in attention to women's health, and with significant dollars behind it. In November 2023, President Biden and the First Lady launched the first-ever White House Initiative on Women's Health Research. This $12 billion endeavor was created to advance a multidisciplinary research agenda and establish a nationwide network of research centers of excellence and innovation in women’s health.
"There's something different here. We've never seen a White House initiative or an executive order for $12 billion for women's health research," said Garner. "Something has changed. I do believe that this is a moment and that it's going to be sustained. This is also the first time I've ever seen investors getting super interested."
The payoff of such a commitment could have implications for everyone — not just women. "There's more and more evidence around the fact that addressing women's health issues will lead to economic advancements," Garner continued. "When women are healthy, everyone else is healthy. We just do better and the economy does better."