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Stark disparities persist in Missouri’s maternal mortality rate

Women on Medicaid, Black women are more likely to die within a year of pregnancy

multi-year report analyzing maternal mortality in Missouri and published Monday found that women on Medicaid are eight times more likely to die within one year of pregnancy than their counterparts with private health insurance.

It also found Black women in Missouri were three times more likely to die within a year of pregnancy than white women.

The annual report published by the Missouri Department of Health and Senior Services and compiled by the state’s Pregnancy-Associated Mortality Review board assessed maternal deaths from 2017 to 2019.

It found that each year an average of 61 Missouri women died while pregnant or within one year of pregnancy, putting the state’s pregnancy-related mortality ratio at 25.2 deaths per 100,000 births. Overall, 74.5% of deaths were determined to be preventable — with a little over half of those deaths occurring between 43 days and one year postpartum.

The report found disparities continued to persist in which women are at a higher risk of dying during or after childbirth.

Mental health conditions were the leading underlying cause of death, with all pregnancy-related deaths attributed to a mental health condition determined to be preventable. Patients whose birth was covered by Medicaid made up the largest percentage of pregnancy-related deaths at nearly 53%.

Among the top recommendations outlined in the report was for the state legislature to extend Medicaid coverage for pregnant Missourians to one-year postpartum — an effort lawmakers failed to accomplish this past legislative session.

Meanwhile, a bill passed in 2018 by lawmakers to authorize the extension of Medicaid benefits to a year postpartum for women with substance use disorders was quietly paused by the Department of Social Services earlier this year.

Other recommendations include funding Medicaid expansion by 2023, establishing a statewide “Perinatal Psychiatry Access Program” to assist with providing mental health care, such as treatment for substance use disorders and improving screening and treatment for mental health conditions during and after pregnancy.

Missouri’s maternal mortality rate has increased since the early 2000s, and Monday’s report underscores the state’s abysmal ranking that has previously been in the bottom quarter of states nationwide.

“Maternal mortality events, those where a mother dies during or shortly after pregnancy, are internationally viewed as an indicator that may be used to judge the overall health of a country, state, or community,” Monday’s report read.

The report identified a variety of factors that contributed to Missouri’s maternal mortality rate, including late entry into prenatal care, especially for Black residents, and challenges ensuring rural patients can access adequate care for high-risk pregnancies — although pregnancy-associated deaths most frequently occurred in the state’s metro areas.

Mental health conditions, such as substance use disorders and depression, were the leading cause of death, followed by cardiovascular disease. Among deaths caused by an injury, overdoses were among the most frequent, followed by firearms, including homicides.

“In half of these cases, the records provided to the PAMR program indicated a history of (domestic violence),” the report read. “In each of these homicides, the perpetrator was a current or former partner.”

The majority, or 63%, of pregnancy-related homicides were Black women, while pregnancy-related suicides were all among white women, according to the report.

The report also assessed the prevalence of other health issues like obesity, hypertension and diabetes, and factor’s like a woman’s age, education level and whether they had health insurance.

The report noted that while three years of data allows for a more comprehensive analysis, numbers should still be approached with caution as the overall dataset is small.

A recent analysis by The New York Times found that states with higher maternal mortality rates and weaker social safety nets tend to be more likely to ban or restrict abortions. Abortion is now illegal in Missouri, except in the case of medical emergencies, after the fall of Roe v. Wade.

This article by Tessa Weinberg is published by permission of The Missouri Independent.

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