Tennessee pregnancy-related deaths have declined overall but disparities persist based on geographic, racial and economic lines. (Photo: Getty Images)
Pregnancy-associated deaths in Tennessee declined overall by 26% in 2022 after spiking during the height of the COVID epidemic, but disparities persisted along racial, economic and geographical lines, according to a new report released by the state’s Health Department.
Black women, unmarried women, poor women, women with less education and women living in urban areas continued to die at higher rates in Tennessee during their pregnancies and in the postpartum year that followed.
The kind of health insurance pregnant patients had played a key role, too. Pregnancy-related mortality rates among women relying on TennCare — the state’s Medicaid insurance program for people living in poverty — were nearly three times higher than those with private health insurance, the report found.
In the 33 counties that comprise the eastern third of the state, pregnancy deaths spiked alarmingly in 2022, a trend state officials attributed largely to substance use disorder. East Tennessee experienced a fourfold increase in these deaths in 2020-2022 compared with 2017-2019.
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“The burden of these deaths is not shared equally — significant disparities persist across racial, socioeconomic and geographic groups,” read the report, which noted 76% of the 2022 pregnancy-related deaths were preventable.
Tennessee’s annual review of pregnancy deaths, released in late December, encompasses 2021 and 2022, a period marked by the COVID pandemic and Tennessee’s abortion ban, making clear long-term trend lines difficult to assess.
Both COVID-era years saw an increase in pregnancy-associated deaths. In 2019, for example, Tennessee saw 63 such deaths.
In 2020, when the pandemic began, there were 98 maternal deaths.
In 2021, there were 134 — an increase the report’s authors noted also reflects the addition of new hospital discharge data.
By 2022, deaths had declined to 100.
In August 2022, Tennessee’s near-total abortion ban took effect, providing narrow exceptions for serious health risks in pregnant patients. Doctors and reproductive rights advocates criticized the law’s exceptions as so vague they prevented physicians from providing life-saving care.
After the law had been in place for two years, a three-judge state panel concurred with that view, ruling that portions of the state’s ban were vaguely worded. The panel in October 2024 temporarily blocked Tennessee’s ban as it applies to certain dangerous pregnancy complications.
A series of investigative stories by ProPublica chronicled maternal deaths from infection, hemorrhage and other pregnancy-related causes in other states that have largely banned abortions, and political pressure on state maternal mortality review committees to avoid highlighting these deaths.
Tennessee’s maternal mortality report was compiled by a multidisciplinary team of state government and private sector health care experts. The report focuses on maternal deaths between 2021 and 2022. The report encompasses the time period in which the state’s abortion ban took effect, but includes no reference to the state’s abortion policy or assessment of whether it played any role in Tennessee’s pregnancy deaths.
The report distinguishes between “pregnancy-associated” mortality — any death that occurred during pregnancy and in the year after childbirth — and “pregnancy-related” mortality, a subset of all maternal deaths specific to pregnancy complications.
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Pregnancy-associated mortality includes factors such as domestic violence and homicide — well-documented risk factors in pregnancy that are not directly linked to a patient’s ongoing physical health. Pregnancy-related mortality is specific to health conditions brought about or exacerbated by a pregnancy.
While deaths related to the pregnancy-related complications dropped overall by 15% in 2022 over the prior year, these deaths comprised a larger proportion of all maternal deaths.
Among the report’s recommendations are a series of education, screening and training improvements for hospitals and health care providers.
The report found that half of all contributing factors in pregnant patients’ deaths occurred at the provider level, including “failure to recognize early warning signs of complications.”
Recommendations include increasing state funding for high-risk pregnancy interventions and expanding health insurance coverage for women of reproductive age.
One recommendation aimed at law enforcement agencies encourages better lethality assessments in domestic violence incidents. Domestic violence claimed the lives of four pregnant Tennessee women in 2022.
Report- Maternal Mortality in Tennessee
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