Press Release  New DPH report reveals rates of severe maternal morbidity in Massachusetts nearly doubled over a decade

Boston — The prevalence of severe maternal morbidity nearly doubled in Massachusetts from 2011 to 2020, with Black non-Hispanic birthing people consistently experiencing the highest rates of labor and delivery complications among all races and ethnicities, according to a first-of-its-kind report by the Massachusetts Department of Public Health (DPH). 

Severe maternal morbidity (SMM) involves unexpected complications of labor and delivery that result in significant consequences to the birthing person’s health. Such complications include life-threatening conditions (such as heart attacks, acute kidney failure, eclampsia, and sepsis), as well as situations that require the need for life-saving procedures (such as the removal of the uterus) to manage serious conditions. 

“Massachusetts has the best health care system in the country, but this report shows that there is much more work that we need to do to address racial and gender inequities in health care. It is essential that everyone has access to comprehensive, high-quality and inclusive maternal health care,” said Governor Maura Healey. “We can and must do better for mothers, for kids and for families – and our administration is committed to doing just that.”

“We can’t address what we’re not measuring, and this report shines a painful light on what we’ve known to be true for a while – women of color are not receiving the high-quality maternal health care that they need and deserve,” said Lieutenant Governor Kim Driscoll. “We are working across our administration and with partners in government and health care to reduce racial disparities in health care.”

The new report retrospectively examined 678,382 deliveries, including both live births and fetal deaths, among 483,699 Massachusetts residents from 2011 to 2020. During this 10-year period, Black non-Hispanic birthing people consistently demonstrated the highest SMM rates, with inequities increasing an average of 10.1 percent each year. In 2011, the gap between SMM rates for Black non-Hispanic and white non-Hispanic birthing people was two-fold. By 2020, the SMM rate for Black non-Hispanic birthing people was 2.5 times higher than that of white non-Hispanic birthing people, indicating a 25 percent increase in the gap over that time.   

The report found that rates of SMM increased significantly for all birthing people, nearly doubling from 52.3 per 10,000 deliveries in 2011 to 100.4 per 10,000 deliveries in 2020, with an average annual increase of 8.9 percent. SMM rates increased by 7.8 percent per year on average for white non-Hispanic, 8.2 percent for Hispanic, and 10.5 percent for Asian/Pacific Islander non-Hispanic birthing people.  

The report also revealed significant inequities experienced by birthing people with disabilities – particularly for those with intellectual, vision, and mobility-related disabilities. For every 10,000 deliveries, there were 131.6 deliveries with SMM among people with intellectual disabilities; 108.4 among people with a vision disability; and 94.6 among people with a mobility disability, rates that were significantly higher than those for people without such disabilities.  

“When we look at maternal health outcomes through a lens of race and ethnicity, we see a different picture of our health care system,” said Secretary of Health and Human Services Kate Walsh. “Birthing people, particularly women of color, face devastating levels of risk. We have a lot of work to do to improve outcomes, and this report is a call to action that tells us where we need to focus our efforts to address the root causes of maternal health complications and close the racial gap.”

“This report provides a comprehensive and sobering look at the worsening problem of inequities in severe maternal morbidity,” said Department of Public Health Commissioner Robert Goldstein, MD, PhD. “DPH will continue to share these data transparently as we work to urgently address the structural and systemic barriers in our health care and public health infrastructure that contribute to these troubling outcomes.”  

“The fact that these rates and the gaps have continued to worsen over time indicates that Black non-Hispanic birthing people have not benefited from improved medical knowledge and care,” said Hafsatou Diop, MD, MPH, Director of the Division of Maternal and Child Health Research and Analysis at DPH. “It has been long recognized that racism – not race – is the risk factor, as it leads to discriminatory beliefs and behaviors toward Black non-Hispanic birthing people.” 

Identifying innovative ways to address racial inequities in SMM is a priority for DPH. In 2022, the department established a multi-disciplinary Maternal Health Task Force to create and implement a maternal health strategic plan. DPH also is addressing critical gaps in direct maternal and child clinical care using CDC’s Levels of Care Assessment Tool to establish the Levels of Maternal Care in MA. The goal is for pregnant people at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the state.

In addition, DPH is implementing targeted interventions for medically underserved communities, with the goal of improving outcomes for those most impacted by SMM. This includes remote blood pressure (BP) monitoring programs, which are currently being piloted at Baystate Medical Center, Brigham and Women’s Hospital and Boston Medical Center to improve awareness of obstetric warning signs for patients with hypertensive disorders, including preeclampsia/eclampsia. Hypertensive disorders are a leading cause of severe maternal morbidity and postpartum readmission. DPH is also working with MassHealth to explore coverage options for remote BP monitoring programs.

Overall, the data in the report underscore the need for enhanced monitoring and support for all birthing people, with specific attention directed toward those groups at greater risk. In addition, the report highlights the importance of collecting and using data to identify and understand inequities and to inform approaches to address serious public health problems. 

The report is the state’s first to specifically focus on maternal and child health using DPH’s Public Health Data Warehouse, which was created by legislative statute in 2017.  

“To improve peripartum health outcomes,” the report concludes, “state policy efforts must continue to target structural racism and ableism, as well as other socioeconomic and community drivers of adverse maternal outcomes, including access to and quality of primary and prenatal care.” 

More information on the Commonwealth’s Maternal Mortality and Morbidity Initiative can be found here.

DPH Severe Maternal Morbidity (SMM) Data Brief Overview and Policy Initiatives

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