Maternal Morbidity and Mortality: Exploring Racial/Ethnic Differences Using New Data from Birth and Death Certificates

Abstract

Persistent racial/ethnic disparities in maternal morbidity and mortality in the United States have been documented and are complex and multifaceted. Furthering the understanding of the origins of these differences is a public health priority. This chapter explores racial/ethnic differences in maternal morbidity (maternal transfusion, ruptured uterus, unplanned hysterectomy, and ICU admission) using new data from birth certificates for 41 states and the District of Columbia that adopted the 2003 U.S. Standard Certificate of Live Birth . Racial/ethnic differences in maternal mortality are examined using new data from death certificates on the three periods of maternal death relative to the pregnancy–pregnant at the time of death, died with 42 days of an ended pregnancy, or died 43 days to 1 year after an ended pregnancy for the 39 states and the District of Columbia that have adopted the 2003 U.S. Standard Certificate of Death. Rates (per 100,000 live births) of maternal morbidity and mortality were estimated for non-Hispanic white, non-Hispanic black, non-Hispanic Asian , and Hispanic women. Racial/ethnic disparities in maternal morbidity were examined in logistic regression models after adjusting for demographic, health/clinical, and healthcare access confounders. Racial/ethnic differences were evident for all four morbidities and in all three periods of maternal mortality but were larger for maternal mortality than morbidity. Non-Hispanic black women had among the highest rates for both morbidity and mortality whereas Hispanic women had among the lowest rates for mortality. These new data will be an important resource in tracking trends and differentials in maternal morbidity and mortality.