The number of women that die during or as a result of pregnancy and childbirth has increased from 1990 to 2015. This puts the United States higher on the scale. Regardless of whether we spend 2.5 times more per person on healthcare than the OECD average, maternal mortality rates in the US continue to be far too high.
While globally, MMRs have decreased by 43 percent since 1990, the US is the only developed country where those numbers have increased. Sadly, for every maternal death, about 75 to 100 more women are suffering from a life-threatening complication during their pregnancy and/or childbirth.
Unfortunately, discrimination is an insanely real thing taking place in our healthcare system in the US. Between 1955 and 1985, the maternal mortality rate decreased by 99%, but don’t get too excited because the numbers have steadily increased since then.
These numbers provide clear evidence of the crisis in maternal mortality, with little consensus on the causes of the issues. We must eradicate reproductive oppression and secure human rights to achieve reproductive justice.
There are three medical causes of these preventable maternal mortality rates in the US are as follows:
- Hypertension (High Blood Pressure)
- Blood Clots In The Lungs
- Blood Loss
But the critical question is, why are more women dying because of this? The answer remains unclear!
Can We Disentangle The Causes?
The main factors are the profound lack of fairness or justice across race, geography, and socioeconomic status. That said, African American women are three times more likely to die during childbirth and pregnancy than white women. This gap has been seemingly impossible to close for decades!
The Center for Reproductive Rights, National Latina Institute for Reproductive Health, and SisterSong teamed up in 2014. Together, they produced a report on gender and racial discrimination in the United States healthcare system. These partners took time to speak to black women in Georgia, Atlanta, and Jackson, Mississippi, finding that there are still wide gaps in the available information about sexual health, sexuality, and access to proper services. Racial discrimination remains a reality in the healthcare system in the US, even when women have educational and socioeconomic parity.
It wasn’t until 2003 that a checkbox for ‘pregnancy’ was added to the United State’s standard death certificate! The demographics of childbirths are also transforming, which results in high-risk pregnancies. More women have children later in life, and more women deal with pregnancy with chronic conditions, including obesity, diabetes, hypertension, and cardiovascular diseases. The increasing number of C-sections are also believed to be a contributing factor.
Standardizing Protocol
Reducing health, pregnancies, and childbirth-related deaths requires a multisectoral approach. Administrative and technical changes to the healthcare system are needed, along with community outreach programs and more attention to the health consequences of socio-economic disparities.
Until recently, no standardized medical protocols were in place to deal with maternal health emergencies in the United States until recently. In 2008 California implemented its own protocol. The results?
California saw a considerable reduction in MMRs below the national average. These standardized protocols and models of practices should be replicated everywhere. Patient safety bundles are an excellent way to introduce and standardize the protocols in our health facilities. Ensuring consistent care in clinics, hospitals, and private providers for conditions like obstetric hemorrhage and preeclampsia and preventing unnecessary c-sections.
The Alliance for Innovation in Maternal Health is one such initiative. It’s a public-private national partnership that hopes to save 100-thousand women in the U.S. from severe morbidity and death. To do this, the goal is to improve access to preventative services and reduce low-risk caesarian deliveries.
Preventative services are vital because of the strong links between maternal health and chronic diseases like obesity, hypertension, and diabetes.
Community Outreaches
MMRs look different throughout the United States; racial disparities and substance abuse are a couple of the main factors in most cases community outreach sees.
A quick look into the maternal deaths listed from 2010 to 2012 in the greater Philidelphia area revealed that women with substance abuse problems and multiple experiences with treatment were found in every case. Some of the women were under child welfare supervision as mothers and children. A majority of them showed behavioral issues.
Safe Start MOMobile is designed to bring care directly to the community members and their homes instead of depending on mothers trying to enter the health facilities. Pregnant women must have a chronic condition like hypertension or diabetes, substance abuse, a mental health diagnosis, or intimate partner violence to be eligible for MOMobile. Community health workers will work directly with women to provide in-home visits throughout the entire pregnancy and up to four months postpartum.
The goal? Empowering vulnerable women, so they take responsibility for their own treatment and care! However, there is no single answer. Unfortunately, there are no easy answers or quick wins that will reduce maternal mortality in the US. Promising efforts around the globe have had success; why not us? The improvements require programming and technical changes!
We need a standardized protocol for increased outreach to at-risk minority groups, family planning, and increasing affordability and availability of long-lasting reversible contraceptives. These options can prevent unwanted pregnancies and pregnancy-related emergencies.
As sad as it is to say, the US maternal healthcare system is failing mothers. So much more can be done to help expecting mothers and their growing babies. Little things like information and access to healthcare options are found in more prosperous neighborhoods.
