Abstract
Scholars recognize sex and race as social determinants of health. However, demography research often ignores their derivatives (racism and sexism) and their contribution to racial inequality in maternal mortality. Based on weathering, the presence of both racism and sexism experienced in the United States likely leads to accelerated aging for women of color. Guided by intersectionality and weathering, this study examined the maternal mortality rates in the U.S. from 2015 through 2019 using formal demographic techniques. We measured maternal mortality rates two ways—using (1) maternal causes as an underlying cause of death and (2) as one of multiple causes of death. The Reproduction Rights Composite Index, created by the Institute for Women’s Policy Research, served as a proxy for states-groups’ support of women’s health and gender equality. The overall maternal mortality rate was 59.4 (per 100,000 live births) using the underlying cause of death and 84.0 using the multiple cause of death for Black women, a 45% gap. This gap was greater for white women (83%), where the underlying cause of death maternal mortality rate was 24.2 while the multiple cause of death rate was 44.5. Controlling for age and women’s reproductive rights’ support, Black women’s maternal mortality rates were typically double that of white women. Further, Black women’s maternal mortality rates in their early twenties aligned with the maternal mortality rates of white women in their mid-thirties or older. Such findings reveal a complex relationship between gendered racism, weathering, and maternal mortality.

Source Authors’ calculations using data from the National Center for Health Statistics. The states in the supportive states-group are California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, West Virginia, and the District of Columbia

Source Authors’ calculations using data from the National Center for Health Statistics. The states in the moderately supportive states-group are Alaska, Arizona, Colorado, Delaware, Florida, Georgia, Iowa, Kentucky, Maine, Mississippi, New Hampshire, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, and Wyoming

Source Authors’ calculations using data from the National Center for Health Statistics. The states in the unsupportive states-group are Alabama, Arkansas, Idaho, Indiana, Kansas, Louisiana, Michigan, Missouri, Nebraska, Oklahoma, South Dakota, Tennessee, and Wisconsin
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Data Availability
All of the data from this study are publicly available via the National Center for Health Statistics.
Code Availability
Not applicable.
Notes
Although our analysis is focused on the health outcomes of women due to data limitations, we recognize that transgender people who do not identify as women also give birth and their birth-related outcomes should be studied in subsequent studies.
While the United States has at least two other ways it specifically studies maternal mortality—the Pregnancy Mortality Surveillance System (PMSS) and state and municipal-level Maternal Mortality Review Committees (MMRC), this data was not available for the manuscript due to causes not in the control of the authors (e.g. existing data sharing agreements prohibiting sharing of data, data suppression for sake confidentiality, lack of access).
Parity refers to the number live births of a woman. For example a woman with one live birth would have a parity of one.
All states in the United States and the District of Columbia have Maternal Mortality Review Committees except Vermont and North Dakota.
According to the ICD-10-CM (2021), geriatric pregnancy, formally known as elderly primigravida and multigravida (Diagnosis Code O09.5) is applicable to “pregnancy for a female 35 years and older at expected date of delivery.”.
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Patterson, E.J., Becker, A. & Baluran, D.A. Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States. Popul Res Policy Rev 41, 1261–1294 (2022). https://doi.org/10.1007/s11113-021-09691-2
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DOI: https://doi.org/10.1007/s11113-021-09691-2