The number of women who die during or as a result of pregnancy and childbirth has increased from 1990 to 2015. This puts the United States higher on the list. 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 maternal mortality rates have fallen by 43 percent worldwide since 1990, the United States is the only developed country where these rates have risen. Sadly, for every maternal death, approximately 75 to 100 more women suffer from a life-threatening complication during their pregnancy and/or childbirth.
Unfortunately, discrimination is a very real problem in the U.S. healthcare system. Between 1955 and 1985, the maternal mortality rate fell by 99%, but don’t get too excited—the numbers have been rising steadily ever since.
These figures clearly demonstrate the crisis in maternal mortality, with little consensus on the causes of the problem. We must eliminate reproductive oppression and ensure human rights in order 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 as a result of this? The answer remains unclear!
Can We Untangle the Causes?
The main factors are the profound lack of fairness or justice across racial, geographic, and socioeconomic lines. That said, African American women are three times more likely to die during childbirth and pregnancy than white women. This gap has seemed impossible to close for decades!
The Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong joined forces in 2014. Together, they produced a report on gender and racial discrimination in the U.S. healthcare system. These partners took the time to speak with Black women in Georgia, Atlanta, and Jackson, Mississippi, and found that there are still significant gaps in the available information regarding sexual health, sexuality, and access to appropriate services. Racial discrimination remains a reality in the U.S. healthcare system, even when women have equal educational and socioeconomic status.
It wasn’t until 2003 that a checkbox for “pregnancy” was added to the United States’ standard death certificate! The demographics of childbirth are also changing, leading to an increase in high-risk pregnancies. More women are having children later in life, and more women are managing pregnancies while living with chronic conditions, including obesity, diabetes, hypertension, and cardiovascular diseases. The rising number of C-sections is also believed to be a contributing factor.
Standardizing the Protocol
Reducing health-related deaths, pregnancy-related deaths, and childbirth-related deaths requires a multisectoral approach. Administrative and technical changes to the healthcare system are needed, along with community outreach programs and greater attention to the health consequences of socioeconomic disparities.
Until recently, there were no standardized medical protocols in place to address maternal health emergencies in the United States. In 2008, California implemented its own protocol. The results?
California saw a significant reduction in maternal mortality rates below the national average. These standardized protocols and models of care should be replicated nationwide. Patient safety bundles are an excellent way to introduce and standardize these protocols in our healthcare facilities. This ensures consistent care in clinics, hospitals, and private practices for conditions such as obstetric hemorrhage and preeclampsia, and helps prevent unnecessary cesarean sections.
The Alliance for Innovation in Maternal Health is one such initiative. It is a public-private national partnership that aims to save 100,000 women in the U.S. from severe morbidity and death. To achieve this, the goal is to improve access to preventive services and reduce low-risk cesarean deliveries.
Preventive services are vital because of the strong links between maternal health and chronic diseases such as obesity, hypertension, and diabetes.
Community Outreach Programs
MMRs vary across the United States; racial disparities and substance abuse are two of the main factors in most cases handled by community outreach programs.
A quick look at the maternal deaths recorded from 2010 to 2012 in the greater Philadelphia area revealed that women with substance abuse problems and multiple treatment experiences were present in every case. Some of the women were under child welfare supervision as both mothers and children. A majority of them exhibited behavioral issues.
Safe Start MOMobile is designed to bring care directly to community members and their homes rather than relying on mothers to seek out health facilities. Pregnant women must have a chronic condition such as hypertension or diabetes, a substance use disorder, a mental health diagnosis, or a history of 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? To empower vulnerable women so they can take charge of their own treatment and care! However, there is no single solution. Unfortunately, there are no easy answers or quick fixes that will reduce maternal mortality in the U.S. Promising initiatives around the world have been successful; why not here? These improvements require changes in programs and technical approaches!
We need a standardized protocol to expand outreach to at-risk minority groups, promote family planning, and increase the affordability and availability of long-acting reversible contraceptives. These options can prevent unwanted pregnancies and pregnancy-related emergencies.
As sad as it is to say, the U.S. maternal healthcare system is failing mothers. So much more can be done to help expectant mothers and their growing babies. Simple things like information and access to healthcare options are more readily available in wealthier neighborhoods.
