ALBANY, N.Y. (NEXSTAR) — An audit from the State Comptroller’s Office released Tuesday concluded that pregnancy poses too many dangers. It claimed that the state hasn’t done enough to help mothers and pregnant New Yorkers—Black women in particular—survive the process of carrying and delivering a child.

Comptroller Thomas DiNapoli’s audit report underscores the fact that Black women die in New York at four times the rate of white women. A joint committee between the state and New York City identified 386 pregnancy-associated deaths between 2018 and 2020, with 121 being directly related to pregnancy. And Black Women accounted for about 42.1% of the maternal mortality rate there, while only making up about 14% of births.

Overall, the gap worsened during the pandemic, with the racial disparity characterizing this serious public health problem. Plus, according to the Comptroller’s Office, many of those deaths connected to factors like discrimination, mental health problems, and obesity, meaning that they could have been avoided.

Covering January 2018 to December 2023, the audit examined the results of Health Department (DOH) efforts to reduce deaths and health problems. New York’s rate of fatalities slowed after creating a Maternal Mortality Review Initiative in 2010. The audit found that most pregnancy-related deaths were among:

• Women older than 34 (54.6%)
• Unmarried women (60.3%)
• Those insured by Medicaid (64.5%)

And yet, pregnancy-related health conditions and death rates grew after the 2018 establishment of the Taskforce on Maternal Mortality and Disparate Racial Outcomes. The Comptroller report attributed this increase to deaths from substance abuse.

“Despite New York’s efforts to reduce maternal deaths and pregnancy-related health conditions, progress has stalled,” DiNapoli said in a written statement. “[DOH] needs to strengthen its oversight of policy initiatives and take steps to help ensure all mothers, regardless of race or ethnicity, have access to the highest level of care.”

Preventable deaths during or after childbirth—amounting to 78% in 2018, per DOH data—usually resulted from missed signs, ignored symptoms, financial issues, and other barriers to care. The state also has a high rate of cesarean sections—which sometimes contribute to maternal death—representing a little more than one in every three deliveries. And what’s more, New York doesn’t track health conditions associated with pregnancy or labor like depression, heart attacks, uterine ruptures, and hemorrhages.

Addressing ingrained racism in the healthcare system ought to improve maternal health, as would a public information campaign, the Comptroller report said. DOH also should communicate with health partners, hospitals, and other agencies, pushing for greater involvement in maternal health programs.

The Comptroller’s Office said that audits lower costs, manage operations, and meet taxpayer expectations. The maternal mortality audit—available at the end of this story—also suggested:

• Helping new mothers through home visits during their child’s first year
• Expanding Medicaid’s postpartum care and mental health coverage
• Better, safer hospital practices
• Tracking illnesses among pregnant people and those who just had a baby
• Evaluating the effectiveness and success of maternal health programs

“Think about infant and maternal mortality. The numbers are too high in the State of New York,” said New York Gov. Kathy Hochul on August 2. “A lot of these women are low-wage earners. If they leave their job to go to that doctor appointment for the monthly testing, they’re not bringing home money for their other children.”

Indeed, an analysis from WalletHub highlighted New York as one of the most expensive places to have a baby. We have some of the highest hospital delivery charges and average yearly baby costs.

Since the Dobbs decision, some New Yorkers gained a better understanding of how the personal intersects with the political. From a women’s health perspective, when the inherent risk of a pregnancy reacts with the impossible financial reality of raising a child, abortion is on the ballot.

According to a survey—available at the end of this story—from Nurx—nicknamed “Uber for birth control”—women in New York:

• Feel anxious given the political environment about abortion and IVF (55%)
• Feel anxiety about accessing in-person care for their reproductive and sexual health (43%)
• Lack confidence in their right to use contraception (43%)
• Face longer wait times for in-person sexual and reproductive health providers (33%)
• Use telehealth due to the political environment (33%)
• Consider moving or changing jobs over reproductive politics (24%)
• Experience shame from their provider about sexual and reproductive health (19%)
• Delay medical care over the political environment (19%)
• Now advocate for reproductive rights (19%)
• Seek emergency contraception (17%)
• Consider sterilization (5%)

CDC data indicated that, in 2022, most babies were born in New York in July, August, and October.

Related video: Legal challenges following SCOTUS Dobbs decision