Maternal mortality report finds Black, rural, Medicaid mothers more likely to die after childbirth

[April 30, 2021]  By RAYMON TRONCOSO
Capitol News Illinois
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SPRINGFIELD – The Illinois Department of Public Health on Thursday issued its second report on maternal mortality rates in the state, which found there were 103 pregnancy-associated deaths in Illinois in 2017 – the highest number of any year in that decade.

The report looked at deaths during or after pregnancy from 2016 to 2017, with 175 pregnancy-associated deaths logged during the two-year span.

The report, presented Thursday by IDPH Director Dr. Ngozi Ezike, IDPH Deputy Director Shannon Lightner and Maternity Mortality Review Committee Chair Dr. Robin Jones, found that Black women were almost three times as likely to die within one year of pregnancy than white women.

The number of maternal deaths per capita was also higher in rural regions of the state, and most of the deaths would have been preventable if the mothers had better access to health care.

“The committees determined that 83 percent of the pregnancy-related deaths were potentially preventable, meaning that there was some chance that the death could have been avoided if reasonable changes could have been made at the provider hospital, community system or patient levels,” Lightner said.

The “Illinois Maternal Morbidity and Mortality Report 2016-2017” defines maternal mortality as when an individual died while pregnant or within one year of pregnancy regardless of the outcome of the birth.

A distinction is made between pregnancy-associated deaths – which include any death that occurs during or within one year of pregnancy from any cause; and pregnancy-related deaths – which include any death that occurs during or within one year of pregnancy due to complications with the pregnancy or any condition or ailment caused or exacerbated by pregnancy.

Illinois reviews maternal deaths through two different committees. One reviews deaths suspected to be medically related to pregnancy, while the other reviews deaths resulting from homicide, suicide or drug overdose.

Since 2008, the ratio of pregnancy-associated deaths per 100,000 live births has increased in Illinois.

Black residents were almost three times as likely to die within one year of pregnancy as white residents, and a similar disparity exists between residents on Medicaid during their pregnancy versus those on private insurance.

The highest rates of pregnancy-associated deaths per 100,000 live births was observed in rural regions of the state at 83, while the lowest rates were found in suburban Cook County and the surrounding collar counties.

The disparity between Black and white maternal death rates in the new report was about half what it was in the state’s first report, which analyzed mortality rates in 2015. But Ezike said the gap was not closed by progress for Black Illinoisans.

“In our first report we indicated that Black women were more than six times as likely to die from a pregnancy-related condition as white women,” Ngozi said during the presentation. “It is not due to conditions improving for Black women, but it's instead due to worsening conditions for white women, especially due to mental health conditions, including substance use disorder and suicide.”

Cover of the Illinois Department of Public Health's Illinois Maternal Morbidity and Mortality Report 2016-2017. (Credit: Illinois Department of Public Health)

The report found 60 pregnancy-related deaths between 2016-2017. About 40 percent of these were caused by mental health conditions such as depression, schizophrenia or substance abuse disorder. At about 8 percent each, the next three most common causes of pregnancy-related deaths were pre-existing medical conditions, hemorrhage and hypertension disorder

The causes of death seemed to have high racial disparities. Over half of pregnancy-related deaths for white and Hispanic residents were due to mental health conditions, while they accounted for about one in 10 deaths for Black women.

The next three highest causes of pregnancy-related deaths accounted for just 3 percent of deaths for white residents, while they were responsible for 46 percent of deaths in Black residents and 33 percent of deaths in Hispanic residents. All hemorrhage deaths recorded happened to Black women.

Most deaths occurred during pregnancy, while about a third happened between two months to a year after childbirth.

The Pritzker administration recently expanded Medicaid coverage for Illinois mothers, increasing the length from 60 days following childbirth to 12 months.

“Women who were on Medicaid at the time of delivery were more likely to have a death occur in that time period that's after the two months postpartum period,” Lightner said. “Looking at disparities, as we've pointed out, Black women are more likely to die of medical related causes including pre-existing chronic disease, hypertension, you know, things that are going to need more ongoing health care. And so, extending Medicaid beyond that 60-day window will give women of color more opportunity to take care of their health, to address those ongoing needs, and hopefully go into their next pregnancy healthier.”

The state’s first maternal mortality report was released in 2018 and looked at deaths occurring in 2015. The second report, delayed by the coronavirus pandemic, has been released after three years, although it covers a longer period than the first report.

According to Lightner, the lag in data analysis is something IDPH was actively addressing thanks to a grant from the U.S. Centers for Disease Control and Prevention.

“Previously our maternal mortality review process was done completely through volunteer efforts, and now we have two full-time staff dedicated to this effort,” she said.

“Our data lag will improve, it will never be able to be in real time, because of the time it takes to gather and abstract records of women who died, but we do not wait to look at those deaths and make quality improvement efforts… then hopefully we will see as we catch up with our reviews the maternal mortality rates go down and some of these disparities, really narrow.”

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government and distributed to more than 400 newspapers statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.