Black and Indigenous Kansans are more likely to die from pregnancy

WICHITA, Kansas — Black women remain more likely to die from pregnancy than any other group in the U.S. But the problem is even worse in Kansas.

New research from the Institute for Health Metrics and Evaluation and Mass General Brigham finds Black maternal mortality in Kansas rose sharply between 1999 and 2019 and often exceeded neighboring states.

“This is really a bright flag for policymakers to attend to a problem that should be completely preventable,” said senior author and University of Washington professor Dr. Greg Roth.

The paper, published Monday in the Journal of the American Medical Association, is the first to analyze long-term maternal mortality trends by race and state.

The research found that, in 2019, Black mothers were more than twice as likely to die from pregnancy-related causes in Kansas as in Missouri, Nebraska and Colorado — and significantly more likely than in Oklahoma.

“What we’re seeing in Kansas is unique,” said Sharla Smith, an associate professor of population health at the University of Kansas Medical Center.

The state sees many of the same causes of maternal deaths that are prevalent elsewhere, including severe bleeding after birth, infections, high blood pressure and mental illness. But Smith said bigger, structural factors matter.

“There’s a higher level of racial segregation in Kansas,” she said. “There’s a lower level of public health spending compared to other states in the region. There’s a higher level of unintended pregnancy.”

Between 2016 and 2018, 57 Kansas women died due to pregnancy, a rate of 49.5 per 100,000 live births. Eight were Black — a rate of 97.5 per 100,000 live births, around 2.5 times the rate for white mothers.

Last year, Kansas extended postpartum Medicaid coverage for up to 12 months after birth. But the state remains one of only a handful that has yet to expand Medicaid under the Affordable Care Act.

That means residents are more likely to be uninsured than their peers in other states — and more likely to enter pregnancy with unaddressed health conditions that can be exacerbated by the stress of pregnancy and childbirth.

The impact on a pregnancy can be lasting, Smith said, even though women become eligible for Medicaid once they become pregnant.

“We know that having the ability to obtain health insurance prior to pregnancy is definitely a contributor to having a safe and healthy pregnancy,” she said.

The study also found that Kansas had one of the country’s largest increases in mortality for American Indian and Alaskan Native mothers — a rise of more than 200% from 1999-2009 to 2010-2019. It also saw one of the biggest rises in maternal mortality for Asian, Native Hawaiian and other Pacific Islanders, although the rate remains lower than other groups.

Dr. Caitlin Chiles, director of primary care at Hunter Health, an Urban Indian Health Center in Wichita, said barriers to accessing mental health care and higher rates of illnesses like diabetes and hypertension can make pregnancy more dangerous for the populations in her care.

“If they’re not getting adequate care and they go into a pregnancy with those conditions uncontrolled,” she said, “then it just makes them higher risk for the rest of the pregnancy.”

The clinic’s patient population also has a higher risk of giving birth to babies with low birth weight than Kansas overall, one of the leading drivers of infant mortality.

Chiles said some problems stem from doctors ignoring women who raise concerns about their pregnancy — something she sees the consequences of in her role on the Sedgwick County Fetal and Infant Mortality Review Board.

“It’s so frustrating to hear some of the cases where women are like, ‘I know something is wrong’ — and then they don’t get believed,” she said.

The U.S. has the highest maternal mortality rate of any developed country, and the Centers for Disease Control and Prevention has determined that over 80% of its pregnancy-related deaths are preventable. The majority occur more than a week after delivery; maternal mortality figures include death during pregnancy and up to one year afterward.

Roth, the paper's senior author, said he hopes the findings motivate policymakers to prioritize finding solutions — and lowering the specific barriers to prenatal and postnatal care that Black and Native American mothers face.

“It’s not just about access to the same old care, but smarter, more efficient, more appropriate care,” he said. “That includes outreach rather than waiting for women to come in with symptoms. And that includes building a robust primary care system — so women are connected to health care even before they know that they’re pregnant.”

Rose Conlon reports on health for KMUW and the Kansas News Service.

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