GAO report finds maternal mortality rates higher in rural, underserved areas

Mothers in rural and underserved areas face a greater risk of dying during or shortly after pregnancy, according to a report from the Government Accountability Office (GAO).  

The report published publicly on Monday found mortality rates during or up to one year postpartum from pregnancy-related causes were higher in rural areas than metropolitan ones. An increased rate of maternal deaths was also recorded in areas considered underserved, meaning ones with fewer health care providers per capita. 

Using government data, the GAO found that in the least populous noncore counties, 23.8 maternal deaths per 100,000 live births occurred, and in micropolitan counties, there were 19.8 maternal fatalities per 100,000 live births. Both classifications are considered rural. 

Meanwhile, large metropolitan counties documented a maternal death rate of 14.6 per 100,000 live births. Medium metropolitan counties and small metropolitan counties both documented a fatality rate of 16.2 per 100,000. 

The GAO determined the maternal mortality rates using Centers for Disease Control and Prevention (CDC) data from the Pregnancy Mortality Surveillance System between 2011 and 2016, the most recent years available. 

The office also analyzed Agency for Healthcare Research and Quality data for between 2016 and 2018 on severe maternal morbidity (SMM), which refers to “unexpected outcomes of labor and delivery resulting in significant health consequences.”

Across the country, rates of SMM were higher in metropolitan areas, at 72.6 per 10,000 delivery hospitalizations, compared to rural ones, at 62.9 per 10,000 delivery hospitalizations. 

But within rural areas, Black people experienced increased rates of SMM at 93.7 per 10,000 delivery hospitalizations, compared to 61.1 for Hispanic or Latino people and 55.4 for white people. 

The GAO also examined SMM in underserved areas in North Carolina and New Mexico, where rates of SMM were higher in underserved areas. 

Michigan saw a 61.7 cases of SMM per 10,000 delivery hospitalization in underserved communities compared to a rate of 61.4 incidents per 10,000 in counties not considered underserved

The office recommended that both the CDC and the Health Resources and Services Administration consistently separate and analyze their maternal mortality rate data by rural and underserved areas to ensure funding to address the deaths. 

It also called for the Department of Health and Human Services’ workgroups focused on maternal health to collaborate in their efforts.

The report was released by House Ways and Means Committee Chair Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas), who requested it two years ago.

“The U.S. currently has the worst rate of maternal deaths in the developed world,” Neal and Brady said in a statement. “This is unacceptable and America’s mothers deserve better.”

“We strongly encourage the relevant agencies to adopt GAO’s recommendations, and in Congress, we will continue working to address the lack of consistent, nationwide data on maternal mortality, so that we can improve maternal health equity and outcomes in our nation and put an end to this terrible crisis,” they added.

—Updated at 3:04 p.m.