Maternal & Infant Health
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Disparities in maternal deaths persist, what role can midwives play in reducing deaths and disparities?

April 12, 2021
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For the last several years, The Center for Community Solutions has focused much of our research and advocacy on understanding and reducing the maternal mortality and morbidity rates for Ohio’s women. Despite bringing more attention to the issue of maternal mortality over the last several years, the United States remains one of the most dangerous places to give birth, especially for Black women. The most recent data available from the Centers for Disease Control and Prevention (CDC) (released in the fall of 2019) tells us that these disparities persist, and persist at staggering levels. The overall pregnancy-related[1] mortality ratio (PRMR) is 15.0 to 17.0 maternal deaths per 100,000 births.[2] For Black women, the PRMR is 40.8 deaths per 100,000 births, for white women it’s 12.7 deaths per 100,000 births. For American Indian/Alaska Native women, the ratio is 29.7 deaths per 100,000 births. Disparities increase even further for Black and American Indian/Alaska Native women older than age 30. The PRMR for both groups older than 30 is four to five times higher than white women in this age range.

 The United States remains one of the most dangerous places to give birth, especially for Black women.

At the end of 2019, the Ohio Department of Health (ODH) released a report on pregnancy-related deaths. The overall rate of deaths from 2008 through 2016 (14.7 per 100,000 births) is similar to the national rate.[3] Black mothers in Ohio are similarly dying at a higher overall rate, 29.5 deaths per 100,000 live births compared to 11.5 deaths per 100,000 live births of white women.

 The introduction of midwives and doulas is just one component of a robust strategy that should be explored to reverse and eliminate maternal deaths.

Both CDC and ODH reports state the majority of these pregnancy-related deaths are preventable. And both reports identify the need to understand the disparities that exist and encourage implementing ways to address those problems. The CDC report states that “significant racial/ethnic disparities in pregnancy-related mortality need to be addressed. Further identification and evaluation of factors that contribute to racial/ethnic disparities are crucial to inform and implement prevention strategies that will effectively reduce disparities in pregnancy-related mortality.” One such strategy employed throughout the world is making midwives and doulas more widely accessible. These are professionals who are part of a spectrum of individuals who are better equipped to provide culturally-informed care for pregnant women across many backgrounds. In the coming weeks, Community Solutions will explore, through a series of research pieces, background on midwives, what access to midwifery services looks like and outcomes for women and babies with midwife-assisted deliveries. The introduction of midwives and doulas is just one component of a robust strategy that should be explored to reverse and eliminate maternal deaths, and the disparities in those deaths.  

[1] Pregnancy-related deaths are defined as the death of women as a result of pregnancy or delivery within one year of giving birth.  

[2] Emily E. Petersen, MD; Nicole L. Davis, PhD; David Goodman, PhD; Shanna Cox, MSPH; Carla Syverson, MSN; Kristi Seed; Carrie Shapiro-Mendoza, PhD; William M. Callaghan, MD; Wanda Barfield, MD. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016, Weekly / September 6, 2019 / 68(35);762–765  

[3] A Report on Pregnancy-Associated Deaths in Ohio 2008-2016 The Ohio Department of Health 2019

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