Tennessee consistently ranks among worst in the nation for maternal mortality

Deaths tied to childbirth continue to rise in Tennessee, and researchers are working to paint a clearer picture of the causes.

Two studies have come out in the past few weeks. One revealed that the trend is getting worse, notably in Tennessee. Another looked at what kind of negative experiences mothers face in health care, such as verbal abuse, and what contributes to whether they will have those experiences.

Tennessee consistently ranks among the worst in the nation for maternal mortality. That term refers to deaths associated with pregnancy, occurring within a year of the birth. That timeline is extended past the immediate birth because some causes of death, such as mental health or substance abuse struggles, happen months after the baby is delivered. Like most public health issues, maternal mortality is a complicated problem with several causes. Among them are poor access to health care — be that from poor health insurance or living in a maternity care desert, like many rural Tennesseans — pre-existing health conditions, and racial biases in health care.

The Journal of the American Medical Association issued a study in July that found that rates of maternal death are growing across the country. Tennessee ranked among the top five states in the nation for growth among white and Hispanic patients. Over 20 years, their maternal mortality rates more than doubled.

The Centers for Disease Control and Prevention examined mistreatment in maternal care, and the agency released those findings last week. That’s a pretty broad concept. Dr. Wanda Barfield, the reproductive health director for the CDC, clarified in a briefing.

“When we talk about mistreatment, we’re talking about receiving no response to requests for help,” Barfield said. “Being shouted at or scolded, not having their physical privacy protected and being threatened with withholding treatment or made to accept unwanted treatment.”

About one in five of the 2,400 respondents reported some form of mistreatment, but the rate was even higher for women of color. The rate for black and Hispanic patients was about 30%.  It’s well established that black women face the highest rates of bias and obstacles in maternity care, and because of that, they experience the highest rates of maternal mortality. In 2021, black women died at more than double the rate non-Hispanic white women did.

The CDC study also found that people with either Medicaid — which is called TennCare in Tennessee — or no insurance reported higher rates of mistreatment.

Tennessee is one of several states with a mortality review committee. In 2021, it made recommendations that  overwhelmingly focused on mental health. The committee said for patients to communicate all mental health struggles to their doctor, and said their friends and family should decrease access to firearms, the idea being that suicide is a major contributor to maternal mortality.

Throughout the special session over the past couple of weeks, lawmakers discussed a dire need for mental health services in Tennessee. Members agreed to route $50 million out of TennCare and into community mental health centers across the state, but that is a one-time thing.

Tennessee is one of 36 states that have extended Medicaid coverage for new moms. Vice President Kamala Harris was tweeting this week about how important it is for states to do that.

The United States has one of the highest rates of maternal mortality in the developed world.

We called on states to extend Medicaid coverage for postpartum care from 2 to 12 months.

We started with 3 states—now 35 states have answered the call.

— Kamala Harris (@KamalaHarris) August 8, 2023

Under traditional Medicaid, coverage stops 60 days after birth. As we know, maternal mortality measures deaths for a year, and nationally about half of these deaths occur a few months after delivery. The extension means they get to keep their coverage for one year.

It’s important to note that Tennessee is one of only 10 states that have not accepted Medicaid expansion under the Affordable Care Act. That policy largely offers coverage to low-income working adults who can’t afford traditional health insurance. Medicaid without expansion covers low-income adults who are pregnant. With Medicaid expansion, more of those low-income patients would have coverage before they got pregnant.