The rate of New Jersey Black women dying while pregnant, during delivery or one year after giving birth doubled over the course of two decades and outpaced all other races, according to a new study, adding more evidence to a significant racial divide in health care outcomes in the Garden State.
Data published last week in JAMA, the Journal of the American Medical Association, showed that the maternal mortality rate among Black women increased to 110 per 100,000 births between 2010 and 2019, compared with 54.5 between 1999 and 2009.
The rate of pregnancy, childbirth and postpartum deaths increased nationally and in New Jersey during that time period across all races, the study by the University of Washington and Mass General Brigham research hospital found.
Black and Native American maternity deaths rose 102%, followed by white women at 95%, Hispanics by 66% and Asians by 39%, confirming that New Jersey has had one of the country’s worst overall maternal mortality rates despite ranking high nationally in income level, education and health care.
“The numbers are appalling,” said Dr. Serena Chen, director of the Division of Reproductive Medicine at Cooperman Barnabas Medical Center in Livingston. “As a society, we have to decide to make maternal health a priority in order for this to change.”
Most pregnancy-related deaths preventable
More than 90% of pregnancy-related deaths in New Jersey from 2016 through 2018 were preventable, meaning there was at least some chance of the deaths being averted by one or more reasonable changes to patient/family, provider, facility, system or community factors, said a November report by the state Maternal Mortality Review Committee.
Gov. Phil Murphy’s administration and the New Jersey Hospital Association have focused on reducing the rate. Some progress has been made. A study by the association in January showed that cesarean sections and serious maternal complications around childbirth have decreased. But a significant racial gap in maternal care remains, especially among Black women, who are more likely to develop serious complications than white women do, including hypertension and hemorrhaging.
More:‘Birthing While Black’ project: What you should know about race and maternal health care
But Black women were still far more likely to die during pregnancy or childbirth, with a rate of 110 deaths per 100,000 last decade, far surpassing all others, the new report shows. The closest is Native Americans at 42. A chart is below.
“It’s essential to look at the disparities between populations that exist even in the ‘best’ states,” said Dr. Allison Bryant, co-author of the study and a maternal-fetal medicine expert at Mass General Brigham.
Using data on deaths and live births in each state from the National Vital Statistics System, researchers found that maternal deaths are often caused by vascular diseases, such as severe high blood pressure or blood clots.
“Maternal deaths share many of the same drivers as heart attacks, strokes and heart failure,” said Dr. Greg Roth, an associate professor of cardiology at the University of Washington.
In New Jersey, Black residents are far more likely than white, Asian and Hispanic residents to die from a range of diseases including asthma, heart disease, most cancers, diabetes and kidney disease, among others, according to data from the state Health Department.
And that extends to pregnant Black women.
The Health Department’s latest New Jersey Hospital Maternity Care Report Card, released in June, shows that Black mothers had the highest rate of obstetric hemorrhage, with 63 per 1,000 delivery hospitalizations, followed by Hispanic mothers, with a rate of 53 per 1,000. Black mothers also had the highest rate of severe maternal morbidity with transfusion, at a rate of 36.5 per 1,000 delivery hospitalizations.
The trend of women having children at older ages has increased risks across all races. But some studies suggest that Black women experience accelerated aging due to stress.
“When it comes to Black women, you take everything that’s affected all women and you multiply it,” said Dr. Monique Rainford, an OB-GYN at Yale Medicine and author of “Pregnant While Black,” which delves into disparities. “A Black woman’s biological age may be 7 to 10 years older than their actual age. That’s going to have a significant effect on pregnancy.”
Although New Jersey is home to some top-rated hospitals, not everyone has access to them.
“The great hospitals aren’t in certain neighborhoods,” Rainford said. “There are great health care resources in New Jersey, but not in certain neighborhoods.”
Black women dying in childbirth
The maternal mortality rate by race and ethnicity from 2010 to 2019 in New Jersey:
- Asian: 19 deaths per 100,000 births.
- Hispanic: 27.
- White: 30.
- Native Americans: 42.
- Black: 110.
How to make it better
Dr. Charletta Ayers, an associate professor of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School, said closing the disparity gap takes sweeping changes in public health policy, legislation, community engagement and patient education.
“The elephant in the room is addressing systemic racism,” she said.
Ayers said certain steps can make a difference, including:
- Expanding health care teams to include not only an obstetrician and nurses, but also midwives, doulas, community outreach workers and mental health providers.
- Increasing counseling for women before pregnancy to help reduce risks and improve overall health before conceiving.
- Educating patients and their families about pregnancy warning signs.
- Having institutional and hospital protocols for childbirth emergencies “so that it does not matter where a patient presents, they will be treated and access the same level of needed care.”
- Identifying risk factors based on everything from food security and proper nutrition to transportation and safe housing.
Doctors and other providers need to know the difference between providing “equal care” and “equitable care,” said Shanita Alvarez-Crawley, a social work manager at AtlantiCare Women’s and Children’s Services in South Jersey.
That means providers may need to spend more time with high-risk patients to provide them with the education and awareness they may need to carry a pregnancy to term healthy, deliver without substantial complications and care for the infant without serious postpartum problems, Alvarez-Crawley said.
“Many Black women have shared experiences where they felt that they were not being heard by their provider,” she said. “Or they were ridiculed when they complained of feelings of pain or that something was wrong during their experience.”
