AMNA NAWAZ: The Centers for Disease Control and Prevention released two new disturbing reports about mortality rates for mothers and babies in America, including some stark racial divides.
William Brangham explores these alarming trends.
WILLIAM BRANGHAM: We're going to hear from two of the researchers behind this new data.
First, look at maternal mortality.
New mothers are dying here at higher rates than mothers in any other industrialized nation.
And during the pandemic, that had gotten much worse.
In 2018, an average of 17 mothers died for every 100,000 births in America.
But, by 2021, that rate shot up to almost 33 mothers per 100,000.
This trend was far worse for Black mothers, more than double the national average, with almost 70 deaths per 100,000 births.
So, what is going on here?
Shanna Cox is the associate director for science for reproductive health at the CDC.
Shanna Cox, thank you so much for being here.
Can you help us understand a little bit about what you found here?
As I mentioned, maternal mortality has been bad in America for quite a few years, but got really bad during the pandemic.
What is it that stood out to you in this?
SHANNA COX, Associate Director for Science, Division of Reproductive Health, Centers for Disease Control and Prevention: Well, as you said, what we know is that too many women die from pregnancy-related complications each year.
And the increases that we saw from 2020 to 2021 were tragic.
We also know that pregnant women are at increased risk of severe illness from COVID-19.
And that likely contributed to some of the increases that we're seeing.
We also know that there are increases in maternal age, chronic conditions that are associated with pregnancy complications, such as hypertension, as well as social determinants of health, such as economic insecurity and housing insecurity.
So, all of these factors contributed to what we're seeing in increases in maternal deaths.
WILLIAM BRANGHAM: So the data is indicating that it was some of the social and health factors brought on by the pandemic.
We're not talking about viral deaths here.
We're talking about all the related things that people suffered through during the pandemic.
SHANNA COX: Yes, we have to think about all of those things.
This data really does highlight the numbers.
It's a canary in the coal mine, letting us know that this is something that we need to pay much more attention to and understand what the contributing factors are.
So, while we can't pinpoint one thing that is driving this increase, we can understand, what were the factors that were occurring at this time that may have contributed to this increase?
WILLIAM BRANGHAM: And can I ask you specifically about the -- these very stark numbers for Black mothers in America?
As I mentioned, in 2018, they were still ahead of the overall trend for all American moms.
But that trend continued and seemed to worsen.
Why do you believe that's the case?
SHANNA COX: There are longstanding disparities in pregnancy-related deaths between non-Hispanic Black and non-Hispanic white women.
There are many factors that can contribute to these disparities.
For example, we know that there are variations in the quality of care that are received in facilities that disproportionately serve Black women for both black and white women.
We also know that there are disparities in those pregnancy-related complications, such as hypertension.
But, most importantly, we also know, again, those social determinants of health also differ by race ethnicity.
We also have to acknowledge that historical trauma and racism, including structural racism, plays a part in the distribution of social determinants of health, and also play a role in those disparities.
But I also want to highlight these factors are not always protective for Black women.
For example, non-Hispanic Black women with a college degree are more likely to die from pregnancy-related complications than non-Hispanic women with a high school degree.
So we know that there's something specific about the experience of being Black in America that are driving these disparities.
WILLIAM BRANGHAM: OK, we want to turn now to that second data set from the CDC, this one about infant mortality, specifically, any sudden unexpected death of an infant.
The overall rate of infants dying is at record lows.
But during the first year of the pandemic, the deaths of Black infants spiked.
As you can see, it's the blue line second from the top.
So what do we know about why that trend is occurring?
Sharyn Parks Brown is an epidemiologist at the CDC.
Commander Parks Brown, thank you so much for being here.
Again, a similar question to you.
We had been making, it seems, progress on saving the lives of more young people and keeping them alive after they were born.
But then there was this sudden turn during the pandemic.
Did that spike that we saw come as a surprise to you?
CMDR.
SHARYN PARKS BROWN, Centers for Disease Control and Prevention: Yes, this was absolutely a surprise for us.
So we were looking to compare the rates of sudden unexpected infant deaths prior to the COVID-19 pandemic to the first year of data after the COVID-19 pandemic began.
And, as you outlined, we did see that the overall SUID rate between 2015 and 2020 did not change.
But we did see that surprising increase in the SUID rate among non-Hispanic Black infants.
The other... WILLIAM BRANGHAM: May I just interject for a second?
CMDR.
SHARYN PARKS BROWN: Yes.
WILLIAM BRANGHAM: The SUID rate, this is the sudden unexplained infant death?
That's what you're referring to.
CMDR.
SHARYN PARKS BROWN: Sudden unexpected infant deaths.
WILLIAM BRANGHAM: Unexpected, yes.
CMDR.
SHARYN PARKS BROWN: Yes.
WILLIAM BRANGHAM: I'm sorry.
CMDR.
SHARYN PARKS BROWN: Yes.
WILLIAM BRANGHAM: Continue, please.
CMDR.
SHARYN PARKS BROWN: Yes.
So, along with us being surprised that the rate increased so starkly for non-Hispanic Black infants, it's important to point out that the racial disparities and the pattern of those disparities had been consistent from as far back as 1995, where we typically saw the highest rate of sudden unexpected infant deaths among American Indian, Alaskan Native infants.
But, in 2020, that flipped, so that non-Hispanic Black infants actually had the highest rate of sudden unexpected infant death, then followed by American Indian, Alaskan Native infants.
WILLIAM BRANGHAM: So, again, do you have a sense as to why this sudden spike occurred?
CMDR.
SHARYN PARKS BROWN: Similar to what my colleague stated about maternal mortality, we don't have data at this point to really explain why we observed this spike in infant mortality.
But, again, we also believe that there were some indirect effects of the COVID-19 pandemic.
So we know that a lot of the mitigation efforts disproportionately affected racial and ethnic minority communities, compared to non-Hispanic whites, white families.
So, things like exacerbation of housing insecurity, food insecurity, unemployment, changes in health care -- health care access, all of those things could have impacted, for instance, access to childcare, so that families had people who were not typically caring for their babies now were responsible for taking care of those infants.
We also saw changes related to housing instability.
Families may have been exposed to sleeping arrangements that they weren't used to.
So, where are they normally may have had access to a safe sleeping environment, like a crib for their infant, maybe due to sudden unemployment associated with the pandemic, they were without their safe sleeping arrangement, and may thereby have been putting their children in riskier sleep environments.
WILLIAM BRANGHAM: So that is one of the possible factors here, that children in a -- might be suffocation or something that we have thought of in the past as complicit in children suddenly dying?
CMDR.
SHARYN PARKS BROWN: Yes, so we could be talking about infants that are suffocating in their sleep environments.
But some of these babies, also, we don't have evidence that they have died of suffocation, but some of them just may die for other unexplained sudden reasons that are -- that they're more at risk for as a result of being in unsafe sleeping environments.
WILLIAM BRANGHAM: And, again, to this point about the specificity of how this seemed to be particularly amongst Black infants, as opposed to other lower socioeconomic or racial minorities in America, how do you explain that particular trend?
CMDR.
SHARYN PARKS BROWN: Well, that's something that -- again, this is one year of data.
And so we're going to continue monitoring to see if this spike that we observed in 2020 is just the artifact in the data or if it's something that is actually sustained, and also try to use some of our other data sources, like our Sudden Unexpected Infant Death Case Registry at CDC that has a lot of rich data on social determinants of health to try to really tease out what the factors were that could have been driving the increases that we observed.
So, that's a question that we will be continuing to monitor and do surveillance and research on.
WILLIAM BRANGHAM: All right, Sharyn Parks Brown and Shanna Cox, thank you both so much for being here.
SHANNA COX: Thanks for having us.
