Severe Maternity Morbidity In MA Nearly Doubled In A Decade, Data Says

MASSACHUSETTS — The prevalence of severe maternal morbidity nearly doubled in Massachusetts from 2011 to 2020, according to a first-of-its-kind report released this month by the Massachusetts Department of Public Health.

Officials said severe maternal morbidity involves unexpected complications of labor and delivery that result in significant consequences to the birthing person’s health. These can include life threatening conditions such as heart attacks, acute kidney failure, eclampsia, sepsis, and situations that require life-saving procedures, such as the removal of the uterus, to manage serious conditions, according to officials.

The report examined 678,382 deliveries, including both live births and fetal deaths, among 483,699 Massachusetts residents from 2011 to 2020.

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During this time period, Black non-Hispanic birthing people consistently demonstrated the highest severe maternal morbidity rates, with inequities increasing each year, according to the report. By 2020, the severe maternal morbidity rate for Black non-Hispanic birthing people was 2.5 times higher than that of white non-Hispanic birthing people, the report said.

But the report found that rates of severe maternal morbidity increased significantly for all birthing people, nearly doubling from 52.3 per 10,000 deliveries in 2011 to 100.4 per 10,000 deliveries in 2020. The rates increased by 7.8 percent per year on average for white non-Hispanic birthing people, 8.2 percent for Hispanic birthing people, and 10.5 percent for Asian/Pacific Islander non-Hispanic birthing people, according to the report.

The report also revealed inequities experienced by birthing people with disabilities, particularly for those with intellectual, vision, and mobility-related disabilities. According to the report, for every 10,000 deliveries, there were 131.6 deliveries with severe maternal morbidity among people with intellectual disabilities, 108.4 among people with a vision disability, and 94.6 among people with a mobility disability.

“When we look at maternal health outcomes through a lens of race and ethnicity, we see a different picture of our health care system,” Secretary of Health and Human Services Kate Walsh said in a Department of Health news release released alongside the report. “Birthing people, particularly women of color, face devastating levels of risk. We have a lot of work to do to improve outcomes, and this report is a call to action that tells us where we need to focus our efforts to address the root causes of maternal health complications and close the racial gap.”

Hafsatou Diop, MD, MPH, Director of the Division of Maternal and Child Health Research and Analysis at the Department of Public Health, said in the news release that "the fact that these rates and the gaps have continued to worsen over time indicates that Black non-Hispanic birthing people have not benefited from improved medical knowledge and care."

“It has been long recognized that racism – not race – is the risk factor, as it leads to discriminatory beliefs and behaviors toward Black non-Hispanic birthing people," Diop added.

Officials said that in 2022, the Department of Health established a multi-disciplinary Maternal Health Task Force to create and implement a maternal health strategic plan. The department said it is also using the CDC’s Levels of Care Assessment Tool to establish the levels of maternal care in MA.

The goal, according to officials, is for pregnant people at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the state.

The department is also implementing targeted interventions for medically underserved communities, officials said. These include remote blood pressure monitoring programs, which are currently being piloted at Baystate Medical Center Brigham and Women’s Hospital and Boston Medical Center, to improve awareness of obstetric warning signs for patients with hypertensive disorders including preeclampsia and eclampsia.

Hypertensive disorders are a leading cause of severe maternal morbidity and postpartum readmission, officials said.

“To improve peripartum health outcomes,” the report concludes, “state policy efforts must continue to target structural racism and ableism, as well as other socioeconomic and community drivers of adverse maternal outcomes, including access to and quality of primary and prenatal care.”