Severe complications during labor and delivery in Massachusetts nearly doubled over the past decade, according to a report released Wednesday by the state Department of Public Health.
The report found Black women are at the highest risk of serious complications, like heart attacks, acute kidney failure, sepsis and other potentially life-threatening conditions — and, while complications increased across all races, racial disparities only worsened during that nine-year review period.
“The most troubling finding was that for Black non-Hispanic birthing people, the rate of severe maternal morbidity in 2011 was twice that of white non-Hispanic birthing people,” said Department of Public Health Commissioner Dr. Robert Goldstein. “But by 2020, it was two and a half times higher. This represents a 25% increase in that gap over the decade.”
The new report retrospectively examined just over a half-million hospital discharge records of Massachusetts residents between 2011 and 2020. Those that met the criteria for severe maternal morbidity rose from roughly 1 out of every 200 deliveries at the start of the review period to 1 in 100 in 2020. Rates of severe complications were significantly higher for people over the age of 40, as well as those who are Black or who have an intellectual disability.
Health experts and community advocates both say the disparities in the data reveal the need for officials to target structural discrimination that creates inequitable maternal health care.
Colin Killick, executive director of the Disability Policy Consortium, told GBH News that the medical system often fails to understand disabled patients’ needs or devalues them. Still, he was surprised the report’s findings of just how many people with disabilities experience severe complications during labor and delivery.
“I hope that finally this means that major entities in this field will reach out to our community and ask us what they can do and really engage us, and engage the disabled patients as partners in this effort,” he said. “Because otherwise, I think that this disparity is going to only continue and may even get worse.”
Rebecca Hart Holder, president of Reproductive Equity Now, also expressed dismay over the statistics in the report. In a statement, she said Massachusetts has a responsibility to step up and improve these health outcomes.
“We must remember that these data points are more than numbers. We’re dealing with people’s lives and livelihoods and we cannot wait to act any longer,” she said.
Dr. Fifi Diop, director of the Division of Maternal and Child Health Research and Analysis at the Department of Public Health, agreed the state needs to act to improve these health outcomes.
“Traditionally, we have blamed Black patients for their complications, or even for dying,” Diop said. “The argument is that they come to pregnancy sicker, overweight or obese or older. ... But the truth is that, actually, that's not an individual problem. It's a societal and structural problem: whether or not people have access to healthy food, clean water, insurance coverage and access to health care — these are policies and structural decisions.”
Diop said the state and health care workers need to “work upstream” to better support pregnant people from medically underserved communities. The Department of Public Health has already taken several steps toward that goal, including funding anti-racism training for medical providers and establishing a statewide maternal health task force.
“So far, the task force has met three times,” said Diop, “and the goal of the task force is to develop [and] draft a strategic plan with specific and actionable objectives by September 2023.”