Racial/Ethnic Disparities in Pregnancy-Associated Death: The Critical Importance of Disaggregation by Cause of Death and Race/Ethnicity

Studies have reported large increases in the rates of pregnancyrelated death over the past several decades; however, a pivotal evaluation from the National Center of Health Statistics, which maintains a centralized database of all death certificates in the United States, indicated that much of the recent increase in maternal mortality was largely the result of improvements in data collection because of the addition of the pregnancy checkbox on the revised standard certificate of death in 20033,4 Despite the likelihood that the staggered introduction of the checkbox artificially amplified documented increases in maternal mortality, all states adopted the checkbox by 2017. [...]nonHispanic Black individuals had nine times the rate of pregnancy-associated deaths from homicide than did non-Hispanic White individuals (2020-2021 ). [...]NHOPI individuals had nearly six times the rate of pregnancy-associated deaths from suicide than non-Hispanic White individuals (2020-2021 ). Estimates of preventability of maternal mortality vary depending on the report; however, a recent study of data from 14 state maternal mortality review committees found that although 68% of maternal deaths were preventable, intervention could have prevented 100% of maternal deaths attributable to mental health conditions, including substance use disorders 6 Continued efforts to ensure culturally congruent screening and treatment across a broad range of mental health conditions and substance use disorders are critically needed throughout the pregnancy and postpartum periods. [...]although the study by Margerison et al. has important implications for maternal health, their evaluation has much broader importance for the field of health equity.