North Carolina’s maternal mortality rate increased sharply during the pandemic, according to newly released data 

The death rate in in North Carolina for women within 42 days of giving birth doubled from 2019 to 2021, according to CDC data released by the investigative news organization MuckRock.

The death rate in 2019 was 22 per 100,000 births. The next year, the rate per 100,000 births increased to 29 then spiked to 44 in 2021.

“It’s a huge jump, especially in such a short period of time,” said Keisha Bentley-Edwards, a Duke University researcher who studies health equity. Black women continued to be more likely than white women to die from pregnancy-related causes.

“The biggest thing it shows is how fragile Black maternal health is,” Bentley-Edwards said in an interview.

The US has the highest maternal mortality rate among high-income countries, according to a Commonwealth Fund study. The nation’s maternal death rate worsened in the pandemic, the US Government Accountability Office and university researchers reported.

The national CDC data that MuckRock released last week focused on three states — including North Carolina. It showed not only the dramatic increase in maternal mortality but also the disproportionate impact on women of color.

A Policy Watch analysis of the MuckRock data shows that in 2020 and 2021 about 56% of the 119 Black women in North Carolina who died within a year of giving birth died from pregnancy-related causes.

For 163 white women in the state who died within a year of giving birth in those years, about a third died from pregnancy-related causes.

Among all races, COVID-19 was listed as a cause of death in 23 of 174 maternal deaths in North Carolina in 2021.

The data highlight the importance of continuing Medicaid coverage for women a year after giving birth, Bentley-Edwards said, because some of those deaths occurred months after delivery.

Last spring, North Carolina Medicaid extended postpartum health care to a year. The state had been cutting off postpartum coverage at 60 days.

Will Medicaid expansion help?

North Carolina policy makers for years have been discussing ways to reduce the maternal death rate. Last year, the state Department of Health and Human Services released a plan to improve maternal and infant health and reduce death rates, with a focus on health equity. One of the goals was to expand Medicaid to improve the health of all people of reproductive age.

A 2020 research study found that Medicaid expansion lowers the mortality ratio, meaning fewer maternal deaths per 100,000 births. Research published this year found reductions in postpartum hospitalizations in states that expanded Medicaid.

North Carolina is on track to expand Medicaid to more low-income adults, which Gov. Roy Cooper, a Democrat, has long advocated for.

Late last month, Republican legislative leaders announced a plan for expansion that would be enacted if there’s a state budget in place by June 30.

“Full-on expansion is the way to go,” said Sen. Natalie Murdock, a Durham Democrat who has sponsored legislation aimed at reducing Black maternal deaths. “You can get access to care before you are pregnant.”

Legislators have proposed various strategies aimed at improving maternal health. Last week, bipartisan groups of House members and senators filed companion bills that would have Medicaid cover doula services and offer incentives to providers of group prenatal care. Murdock is a cosponsor of the Senate version.

With the agreement that doulas are important comes the work to fund the services and then let people who need them know that they’re available, Murdock said.

Maternal deaths from drug overdoses

The state’s increasing rates of overdose fatalities are reflected in documented causes of maternal deaths.

North Carolina death certificates show that about a quarter of women who had died within a year of giving birth in 2020 and 2021 died from accidental drug overdoses: 38% of white women and 11% of Black women.

Last month, the state Department of Health and Human Services reported that overdose deaths increased 22% in 2021, setting a record.

Behind the overall increase in North Carolina’s overdose rate is the potent synthetic opioid fentanyl.

The state DHHS said last month that 77% of the state’s overdose deaths in 2021 probably involved fentanyl in combination with other substances. The potency and pervasiveness of fentanyl underscores the importance of people with substance use disorders being able to obtain medication to treat opioid addiction.

“Fentanyl is everywhere and the cutting agents added into it make it even more deadly,” said Hendreé Jones, professor in the OB/GYN Department at UNC and an expert on treating substance use disorders. “I’ve never seen it like this. It’s scary.”

Jones directs UNC Horizons, which offers prenatal and postpartum care for women with substance use disorders. Women are seen every two weeks throughout their pregnancy. Horizons’ services include a residential program for women and their children.

Complicated factors contribute to overdose deaths among birthing people, Jones said. Parents-to-be fear going to the doctor for prenatal care because they worry a positive drug test will mean their child will be taken from them, she said.

Parents who are in drug treatment may have no way to pay for it after their Medicaid coverage is cut off, she said. And the stresses of new parenthood could have people turning to coping mechanisms, which include substance use.

“Postpartum time is stressful. It’s stressful for all parents, including those who have substance use disorder,” Jones said. The affordable housing crisis contributes as well, she said. People experiencing homelessness or housing insecurity face the constant and pressing need to find shelter.

“It’s hard to stay in treatment when you don’t have a safe place to sleep at night or you don’t have a place to live,” she said.