Maternal Mortality

As a board-certified anesthesiologist with more than 29 years of experience, I have dedicated my career to safeguarding lives. In recent years, however, I have witnessed a terrifying shift in our healthcare landscape—one that threatens the safety of pregnant women across America. The implementation of restrictive reproduction laws in states like Georgia, Texas, Florida, and North Carolina has created a public health crisis. These laws endanger the lives of women, and we must act now to protect them.

The tragic deaths of Amber Nicole Thurman and Candi Miller in Georgia highlight the devastating consequences of these laws. These women, both pregnant, lost their lives unnecessarily due to delays in emergency care, caused by legislation that hinders physicians from providing evidence-based treatment. Their deaths were preventable. We must say their names with honor and remember their stories as a sobering reminder of what is at stake. Maternal mortality rates in the United States are already the highest among developed nations, and restrictive reproductive laws are making matters worse. According to the CDC, the national maternal mortality rate was 23.8 deaths per 100,000 live births in 2020. For Black women, this number is even more alarming at 55.3 deaths per 100,000 live births. States that have enacted restrictive reproductive laws, like Texas and Florida, are seeing even worse outcomes. Texas, for instance, experienced a 30 percent increase in maternal deaths after implementing stringent reproduction laws in 2021.

In North Carolina, around 20 percent of women live in OB-GYN deserts, areas where there are no obstetricians. More than 30 percent of the state’s 100 counties lack any OB-GYN doctors at all. This forces women to travel long distances—sometimes more than a 100 miles—for care, further delaying lifesaving interventions.

According to the CDC, North Carolina’s maternal mortality rate stood at 21.9 deaths per 100,000 live births in 2018, the most recent year for which state-specific data is available. This troubling statistic gained further depth in 2020, when the North Carolina State Center for Health Statistics reported 39 pregnancy-related deaths, underscoring the ongoing nature of this crisis. Perhaps most alarming is the stark racial disparity in maternal health outcomes. Black women in North Carolina face a significantly higher risk, being 2.9 times more likely to die from pregnancy-related causes than their White counterparts. This disparity is starkly illustrated in the 2020 statistics, where the maternal mortality rate for Black women in the state was a staggering 56.8 per 100,000 live births, compared to 18.9 for White women. These numbers not only highlight a health crisis but also point to deep-rooted systemic issues that demand urgent attention.

In July 2023, the state enacted a 12-week reproductive ban. While it’s too early to have concrete data on its impact, research from other states suggests that such restrictions can lead to increased maternal mortality. For instance, a study in the American Journal of Preventive Medicine found that states with the most restrictive abortion policies had a seven percent higher maternal mortality rate compared to states with less restrictive policies.

A 2023 study published in the American Journal of Obstetrics and Gynecology found that about 60 percent pregnancy-related deaths are preventable, with delays in diagnosis and treatment contributing significantly to these tragedies. This finding underscores the critical importance of timely and accessible maternal health care.

As of 2023, North Carolina does not have specific legislation regarding IVF. However, concerns have been raised nationally about how reproductive restrictions might impact IVF practices, adding another layer of complexity to the reproductive health landscape in the state. It’s important to note that while these statistics provide a general picture, the full impact of recent policy changes may not be fully reflected in the data yet. The 12-week reproductive restrictions ban, enacted in July 2023, is too recent for its effects to be quantified in current maternal mortality statistics. However, the anecdotal stories I hear from colleagues reflect a concern about the long-term effects of these policies on worsening maternal health and deaths in North Carolina.

The cruelty of these laws cannot be overstated. Physicians are now hesitant to perform life-saving procedures like dilation and curettage (D&C) for miscarriages, or surgery for ectopic pregnancies, due to fear of legal repercussions. This delay causes excruciating pain for patients, and in some cases, leads to preventable deaths. The medical community has warned repeatedly about the risks, yet lawmakers continue to push these draconian policies. As someone who has stood in operating rooms, watching as lead physicians are forced to call the time of death for patients who could have been saved, I cannot remain silent. The war on reproductive rights is not just an attack on women—it is an attack on families. It affects everyone: sisters, daughters, wives, colleagues, and friends.

What makes this situation even more egregious is that in the past, women like Amber and Candi would have received timely care. In fact, I recall a case where a pregnant woman who had been shot survived because her care team—including OB-GYN and trauma surgeons—was able to provide the necessary emergency treatment. Had these restrictive laws been in place then, they might have hesitated out of fear of retaliation from the state.

Physicians take their Hippocratic Oath seriously. Saving a life regardless of one’s religion, skin color, political party affiliation, how rich or poor you should always take precedence; I know I did.

At times the most expert or skilled person that can save your life may be a woman, a Black or minority woman at that. Bigotry may not be in your best interests when you deny expertise based on bias.

According to ProPublica, which has been instrumental in investigating maternal deaths, many of these deaths are due to poor access to care, systemic racism, and now, legislative interference in reproductive health. I thank ProPublica for shining a light on this issue and for caring about the lives of American women. I am requesting men and women of all races, religions and political parties to think of their loved ones particularly the children and future leaders of America and stop this anti women discrimination movement.

As we reflect on these tragedies, we must also take action. We must elect leaders who prioritize evidence-based medicine and public health over political ideology. I stand with the editors of Scientific American in their support of Vice President Kamala Harris for President, because her leadership is rooted in science, compassion and a commitment to public safety. We must rally behind leaders who believe in the right of women to receive the healthcare they need to survive pregnancy and childbirth.

The maternal death crisis in the U.S. is preventable. If we do not act now, the consequences will be devastating—more women like Amber and Candi will lose their lives needlessly. We all have a role to play in this fight. For the sake of our daughters, our sisters, and our friends, we must speak out against these dangerous laws and support those who are working to protect women’s health. This is not just a women’s issue; it is a human rights issue, and we must stand together.

The lives of American women depend on it.

Charlene Green, MD is a retired anesthesiologist in Greensboro, N.C. She is a co-founder of 2nd Shift Playbook, a community of professional women supporting women. Visit the website: info@2ndshiftplaybook.com.