Every pregnancy-related death in Missouri linked to mental health conditions, including substance use disorders, could have been prevented, according to a new five-year report from the Missouri Department of Health and Senior Services.
The legislature-mandated report reviewed pregnancy-related deaths between 2019 and 2023. During that period, 340 Missouri women died while pregnant or within one year after the end of a pregnancy — an average of 68 deaths each year.
The state's Pregnancy-Associated Mortality Review Board determined that 79% of pregnancy-related deaths were preventable. The board, which reviews each maternal death to determine whether it was related to pregnancy and identify contributing factors, found cardiovascular disease and mental health conditions were the leading underlying causes of pregnancy-related deaths, followed by infections.
Sarah Ehrhard Reid, chief of the Office on Women's Health at the Missouri Department of Health and Senior Services and the report's lead author, said many people mistakenly believe maternal deaths occur primarily during labor. Instead, the review found most pregnancy-related deaths occurred during the postpartum period.
"That's really important because it highlights the importance of getting postpartum care and following up with a primary care provider after your first six-week appointment, because that ongoing support can be life changing," Ehrhard Reid said.
State health officials said the findings are largely unchanged from the previous report, suggesting Missouri has not seen significant increases in maternal mortality but still has substantial room for improvement.
"To be clear, we want things to get better," Ehrhard Reid said. "But it's encouraging that they're not getting worse than what they were before."
The report also found significant geographic and racial disparities.
Missouri's Northeast region, which includes the St. Louis area, recorded the state's highest pregnancy-related mortality ratio at 42.8 deaths per 100,000 live births. The Southeast region had the lowest rate, at 25.2 deaths per 100,000 live births.
Black women were 2.5 times more likely than white women to die from pregnancy-related causes, a disparity that has remained largely unchanged from previous state reports. Nationally, Black women are more than three times as likely as white women to die from pregnancy-related causes, according to Centers for Disease Control and Prevention.
The report also found pregnancy-related mortality among Medicaid enrollees was nearly three times higher than among women with private insurance.
Ehrhard Reid said insurance status often reflects broader barriers to care rather than being the direct cause of poorer outcomes.
"When we see that disparity, for us it's often pointing to that underlying cause that they have less access," she said. "When we look at those contributing factors, we see access to care, transportation, and other social drivers of health like food, housing and clothing being a big part of what can lead to their ultimate demise. When you don't have those things, it's hard to keep an infection clean if you don't have running water."
