Giving birth in the United States has long been a dangerous business.
In 2021, an average of 32.8 women died from pregnancy-related causes per 100,000 live births, according to data recently released by the Centers for Disaster Control and Prevention (CDC). This is almost 11 times the rate of Greece, Poland or Iceland, the countries with the lowest maternal mortality rates, and almost three times the European average. For black women in the United States, the rate is much higher, at 69.9 per 100,000 live births.
But the numbers show a shocking risk for American women 40 and older. The number of births in this age group has increased over the years, but mortality has increased even more. In 2021, the global maternal mortality rate for women in their 40s was 138.5 per 100,000.
For black American women, it was 300.8 per 100,000 live births. For comparison, this is more than the overall death rate in Sudan and many other low-income African countries.
More children after 40 and higher mortality
Subsequent pregnancies generally carry a higher risk, although death rates does not always increase linearly with age. Even when they do, in countries comparable to the United States, the rates are much lower.
In the UK, maternal mortality among women aged 40 and over was 25.8 on average (pdf, p. 13) between 2018 and 2020. In Italy, the last reported rate (2016; pdf, p. 28) was 27.5 per 100,000 live births. In France, where the relative risk is four times higher than the average for women aged 40 and over, the rate was around 33 per 100,000 live births (pdf, p. 4) in 2015. While not all of the comparison data is as recent as in the United States, it is worth noting the magnitude of the distance. Moreover, despite backward progress in the United States, maternal mortality is an indicator that tends to improve over time.
The trend is alarming, especially given the growing number of women giving birth at age 40 or older. Although in the United States, the age of pregnancy tends to be lower than in other countries. In France and the United Kingdom, 5% or more of prpregnancies occur at age 40 or older, in Spain, almost 9% do soand in Italy 10%. In the United States, it is 3.7% in 2021, compared to 3.3% in 2018.