In 2021, the number of U.S. women dying from pregnancy-related issues rose a whopping 40% from the year prior, a new report from Centers for Disease Control and Prevention (CDC) shows, suggesting that the pandemic dramatically worsened the maternal mortality rate. And though the increase was significant across all racial and ethnic groups, Black women were 2.6 times more likely to die than white women and 2.5 times more likely to die than Hispanic women. 

The report found that 1,205 women died in 2021 from pregnancy-related causes, up from 861 in 2020, and up from 754 in 2019, which marks a 60% increase. Overall, the 2021 numbers are up nearly 89% from 2018, March of Dimes reports. Maternal mortality is defined as the death of a person who was pregnant or who had been pregnant within the last 42 days, from any cause related to or aggravated by pregnancy. 

Related: 84% of pregnancy-related deaths in the US are preventable, CDC says

The American College of Obstetricians and Gynecologists (ACOG) had previously warned that the pandemic might exacerbate the maternal mortality crisis. Additional data released in late 2022 from the Government Accountability Office found that Covid was a contributing factor in at least 400 maternal deaths in 2021, which could account for a large portion of the 2021 increase.

“Still, confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning news,” ACOG President Dr. Iffath Abbasi Hoskins said in a statement

Covid is especially dangerous for pregnant women

When pregnant, women can become especially vulnerable to infectious diseases such as Covid, thanks to an immune system that is somewhat suppressed to support the growing fetus.

A 2021 cohort study published in JAMA Network Open discovered that pregnant patients infected with Covid were 40% more likely to deliver their babies prematurely (birth before 37 weeks), had higher rates of intensive care unit (ICU) admission, an increased need for mechanical respirators and were 10 times more likely to die in childbirth than pregnant women without Covid.1Chinn J, Sedighim S, Kirby KA, et al. Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 PandemicJAMA Netw Open. 2021;4(8):e2120456. doi:10.1001/jamanetworkopen.2021.20456

Previous studies have shown that pregnant patients with Covid also experience higher rates of preeclampsia, kidney failure and cardiac events, an increased risk of blood clots and a higher rate of infection requiring antibiotics.2Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort StudyJAMA Pediatr. 2021;175(8):817–826. doi:10.1001/jamapediatrics.2021.1050 

Related: Getting COVID-19 during pregnancy can mean a higher risk of preterm birth—and maternal death 

Women who have been recently pregnant are also at a high risk for severe disease from Covid—especially within 42 days postpartum, notes the CDC. 

Getting vaccinated can help protect you from severe disease both during pregnancy and postpartum, but the most recent CDC data shows that just 71.4% of pregnant people have completed their primary Covid vaccine series before or during pregnancy. Just 16.3% of the U.S. population have received a bivalent booster shot, which are also recommended for pregnant people.

Still, Covid isn’t the only contributing factor when it comes to maternal mortality. “The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was—and still is—already a maternal mortality crisis to compound,” said Dr. Hoskins.

The pandemic exacerbated existing issues of systemic racism

In addition to increased health complications, experts fear the pandemic exacerbated existing issues of systemic racism that contribute to an already high maternal mortality rate. The U.S. has the highest maternal mortality rate of any industrialized nation, according to The Commonwealth Fund and the World Health Organization, and the impact is greatest and most acute for women of color.  

“So in terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality,” said Dr. Chasity Jennings-Nuñez, a California-based site director with Ob Hospitalist Group and chair of the perinatal/gynecology department at Adventist Health-Glendale, to CNN. “Until we begin to address those issues, even without a pandemic, we’re going to continue to see numbers go in the wrong direction.”

Related: Motherly’s State of Motherhood Report: Black Mothering in America

Access to prenatal care is a key factor in preventing maternal mortality, and one that is not equitable across all communities. In the U.S., about 6.9 million women have little or no access to maternal health care, according to March of Dimes. And many maternal deaths result from missed or delayed opportunities for treatment.

“The fact remains that the U.S. healthcare system has historically failed people of color, including during the crucial times of pregnancy and postpartum,” March of Dimes Senior Vice President and Chief Medical and Health Officer Dr. Elizabeth Cherot writes in a statement. 

“It’s imperative that we have reliable and consistent tracking measures in place across our country to help us evaluate and address maternal deaths. More work needs to be done to better understand who is affected by maternal mortality and the circumstances of their death,” she writes.

Reduced reproductive rights could continue to worsen the maternal mortality rate  

The pandemic isn’t the only factor impeding women’s access to reproductive care. We don’t yet have 2022 statistics, but it’s possible that even though Covid cases are trending downward, the maternal mortality rate could continue to climb as a result of Roe v. Wade’s overturn

Abortion restrictions can delay care for pregnancy complications, like a D&C for a missed miscarriage, and some rural maternity wards and women’s health clinics have closed as a result of the bans, leaving many women without options—and leaving some forced to carry a pregnancy to term that they do not want, and taking on personal health risks as a result. 

No pregnancy is without risk of potential complications, and pregnancy and childbirth can exacerbate existing health conditions or even bring about new ones.

“To be clear, the worsening U.S. maternal mortality rate cannot be addressed without addressing how each American can access safe abortion care if and when they need it,” Jen Villavicencio, MD, MPP, ACOG’s lead for equity transformation, said to MedPage Today. “The overturning of the longstanding protections for abortion access will serve only to set us back in the fight against rising maternal mortality.”