Birth looked different during COVID-19, said Jessica Anderson, a member of the Colorado Maternal Mortality Committee. What’s supposed to be one of the most magical — and gut-wrenching — moments of a parent’s life became isolating.
“By wearing masks, there’s so much connection that, you know, comes with facial expressions,” Anderson said. “It looks different, right, feels different for the provider and the patient.”
Experts and groups worry that increased challenges due to the pandemic may have led to negative social, health and economic consequences for pregnant people — in dire cases, even maternal death. Women not getting the care they needed during COVID-19 is not a new phenomenon, particularly for women of color. Organizations statewide have worked to address the core issues — mental health and drug abuse — that often lead to maternal death.
The U.S. has the worst maternal mortality rate among 11 high-income nations. And for women of color, it’s even worse. Data from the Centers for Disease Control and Prevention shows that in 2020, non-Hispanic Black women died at rates of 55.3 deaths per 100,000 live births compared with 19.1 for non-Hispanic white people and 18.2 for Hispanic people. The overarching number of maternal deaths has steadily been increasing over the past few years, with a surge of 18% from 2019 to 2020 during the height of COVID-19 .
Colorado’s Maternal Mortality Review Committee tracks data on deaths during pregnancy and up to a year after birth and develops solutions to reduce the frequency. After Gov. Jared Polis signed the Maternal Mortality Prevention Act into law in 2019, the committee was formally created within the Colorado Department of Public Health and Environment.
The committee found that from 2014 to 2016 there were 94 deaths, with most attributed to suicide, drug overdose, injury, homicide and cardiac conditions. Mental health or substance use contributed to almost 60% of deaths, while mental health alone contributed to about 25% of deaths. About 76.6% of the deaths were preventable, the data from the Maternal Mortality Prevention Committee showed. New data has not been released since 2016, and the committee is working on tracking deaths during COVID-19 to offer more recent data.
Despite being only about 1% of the state’s population, Native Americans have been among the populations most impacted in Colorado. The committee found that in Colorado, people of Native American descent were 4.8 times more likely to die during pregnancy or soon after giving birth than non-Native people. The percentage of pregnancy-associated deaths among the Native American population in Colorado was higher than that of Native Americans nationwide.
The deaths were preventable, and the data showed what the key issues were. That motivated groups including the Colorado Perinatal Care Quality Collaborative, known as CPCQC, to use the data to implement state-level initiatives to tackling maternal death.
In Colorado, “maternity deserts” have increasingly become a cause of concern as rural areas are left without the proper resources and care for people during and after pregnancy. As women of color are some of the most vulnerable to maternal death, racism and discrimination in the health care industry are also core concerns in Colorado. Programs such as CPCQC are working to provide more in-depth resources to tackle the causes of maternal death on both a systematic and individual level.
The CPCQC has four projects in the works, one of which focuses on substance use disorder in the state. Around 37% of women who were pregnant or recently gave birth that died from intentional or unintentional overdose had opioids in their system.
Jessica Anderson, who is on the board, described the program as “an evidence-based approach” through collaboration with hospitals.
The program aims to use the data about maternal death to implement care in hospitals that meets the needs of pregnant and postpartum people. Currently, 72% of Colorado births occur in hospitals that are members of CPCQC.
The AIM Substance Use Disorder Learning Collaborative project is one example. Working with hospitals, they aim to provide guidelines and standards for screening, intervention and referral to treatment for substance use disorder and perinatal mood and anxiety disorders. By enacting these programs, CPCQC aims to improve care and lower maternal mortality rates in the state.
Each program is a part of the puzzle health care groups are trying to solve systematically — that includes biases and racism in the health care system, maternity deserts in counties without hospitals or maternity care and lack of prevention on issues such as mental health and substance abuse.
“When we talk about how do we tackle that, it’s big. It’s eliminating the structural, interpersonal biases, the discrimination that exists,” Anderson said.
“I feel like individuals, professional organizations are really starting to tackle that. But we still have a lot of work to do.”