Missouri saw more deaths during or after pregnancy per capita between 2018 and 2020 than in the previous three-year period that ended in 2019, according to a report published this week by the state Department of Health and Senior Services.
The report from the Pregnancy Mortality-Associated Review Board found 32 people died per 100,000 live births, up from about 25 per 100,000 from 2017 to 2019.
About one-third of the 210 deaths were attributed to hypertension, cardiac issues or other pregnancy-related health problems, said Ashlie Otto, who oversees maternal health at the department.
The report found Black women, older women and those with lower education levels were more likely to die during or after pregnancy.
Many people think of hemorrhaging and other birthing-related health issues when they think of maternal mortality, Otto said. But overdoses, suicides and other mental health problems were the leading causes of death in Missouri’s pregnant and postpartum women.
“We should be alarmed as a state,” Otto said. “It takes a village to raise children. And when we don't support our moms, then that's when things can happen. So I think that we really need to pay attention to this and put in supports and make sure our communities are coming together to support our moms and our families.”
During the three-year period, 12 people died in suicides, double the number from the last report.
Homicide was the third-leading cause of death for new mothers, the report found.
The number of homicides increased during the period that included the first year of the coronavirus pandemic, said Dr. Karen Florio, a maternal and fetal medicine specialist at the University of Missouri and chair of the board that released the report.
“In Missouri, we have a very high prevalence of gun violence,” she said. “And with all of the stresses of COVID, we saw a rise because people were contained within their homes of domestic violence. And whenever a person is pregnant, they will experience a higher rate of domestic violence, and it tends to escalate.”
Most new mothers died between 43 days and one year after they gave birth, which indicates a need for continuing health coverage, Otto said. The highest rate of mortality was among women who had a Medicaid-covered pregnancy.
In the years included in the report, Missouri only offered Medicaid to new mothers for 60 days after they gave birth. Cutting off insurance after two months made it more likely mothers would suffer from untreated and potentially fatal health issues, Otto said.
“If an individual has cardiac issues during pregnancy or even in the postpartum period, it may not be completely resolved at 60 days,” she said. “If they don't have insurance, it's really hard to follow up with cardiologists or other specialists … and [get] those prescriptions refilled if you don't have insurance coverage.”
The state legislature earlier this year voted to extend Medicaid coverage for new mothers for a year after birth. Doctors hope that will mean fewer women die after giving birth.
In addition to recommending that the state extend Medicaid coverage, the board called for Missouri to create a state-sponsored telehealth program similar to one launched in Massachusetts that would connect new moms to mental health and addiction treatment.
