Minnesota maternal mortality study reveals racial disparities in deaths

ROCHESTER, Minn. — High disparities exist for death following pregnancy among Black and Indigenous people in Minnesota, a new report shows.

Among people who die following pregnancy in Minnesota, at 23%, the portion who are Black is almost twice their representation within the overall population, which is just 13%. For Indigenous people who give birth, their proportion of Minnesotans who die following childbirth is 8%, or four times their portion of the general population.

The Minnesota Department of Health study is the first-ever in Minnesota. Overall, the state is well below the national average in maternal mortality.

“The health of our mothers is a key indicator of the health of our state,” Minnesota Commissioner of Health Jan Malcolm said in a statement. “Each maternal death is tragic, and the racial disparities we see in the data are alarming. We mourn those Minnesotans who died and the impact of the losses on families and communities. This report is a critical first step to finding ways to prevent these deaths both inside and outside health care settings.”

“In one of the healthiest states in the country, Black and Indigenous moms are dying at a rate that far outstrips their share of the population,” Dr. Rachel Hardeman said in a statement. Hardeman is director of the Center for Antiracism Research for Health Equity at the University of Minnesota and co-chair of the Maternal Mortality Review Committee.

Contributed / University of Minnesota

“This is not a coincidence. It is a reflection of the historical legacy of structural racism that has shaped current inequities in maternal mortality," she said. "These deaths are 100% preventable, and Minnesota has the opportunity to lead the way in implementing change within our communities to alter this trajectory. Structural racism is a fixable problem, and we all have a role to play in the solutions.”

The report looked at people who died within one year of giving birth between 2017 and 2018, of which there were 48. It separated these mortality events between those related to pregnancy, and those that were not, with the former, which made up 25% of the deaths, determined to be "100% preventable."

The state saw 12 deaths related to pregnancy, which corresponded to 8.8 deaths per 100,000 live births. This is just over half the national incidence in 2017 of 17.3 pregnancy-related deaths per 100,000 births.

The report found that the leading cause of overall maternal mortality in Minnesota during the year studied was vehicular accidents, followed by overdose, suicide/homicide, cancer and infection.

The deaths were slightly over-represented in parts of rural Minnesota, including the Northeast and Central regions, with the greatest disparity a doubling and tripling of rate in South-Central and Northwest Minnesota.

Overall maternal mortality was slightly under-represented in the metro region. Most of the 2017 deaths related to pregnancy (7 out of 12) were recorded in the metro, however. Causes ranged from infection to cardiomyopathy, cardiovascular conditions, embolism, blood and hypertensive disorders, injury and other ailments, but the absolute numbers were too small to be depicted as percentages.

“Our work identifies a significant need for focused services after pregnancy delivery, during what is now being called the fourth trimester,” Dr. Cresta Jones, associate professor at the U of M Medical School and co-chair of the Maternal Mortality Review Committee, said in a statement.

“Typically, individuals are not seen after delivery for 6-12 weeks, but earlier and more frequent post-delivery follow up will help identify patients most at risk, include those with substance use or a substance use disorder and those with other conditions placing them at higher risk of death by suicide.”