Action Alert

Maternal Deaths on the Rise in the United States

Maternal Deaths on the Rise in the United States
United Methodist Women members joined hospital staff who were protesting the closing of the pediatric unit at John H. Stroger Hospital.

The state of Texas, known for its love of football and barbeque, has now become known for something else entirely: its climbing rate of maternal deaths. According to a new study, Texas now has the highest maternal mortality rate in the developed world.

The September 2016 study “Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues” found that the number of women in Texas who died from complications related to pregnancy doubled from 2010 to 2014. 

While Texas has certainly been in the spotlight, it is not an isolated case. The United States has seen a significant rise in maternal deaths in the last decade, not just Texas.

In fact, the United States is the only developed country in the world where maternal deaths have been increasing in the last few decades, according to the World Health Organization.

About 600 women die each year in the United States as a result of pregnancy or delivery complications.  That’s two to three times more than the number of women who die each year in other developed nations. 

Excluding California, which experienced a decline in maternal deaths, the rest of the United States saw a nearly 27 percent increase in maternal deaths since 2000, from about 18 maternal deaths to 24 per 100,000 births.

A Complex Issue

Maternal health is a complex issue. According to the U.S. Office of Disease Prevention and Health Promotion, maternal health can be affected by the mother’s pre-existing physical and mental health, age and access to quality healthcare at all stages of pregnancy.  The chances of experiencing life-threatening, pregnancy-related complications also increase for women of low socioeconomic status and for women of color.

African-American women are three times more likely to die from pregnancy-related complications, according to a 2007 study published in the American Journal of Public Health, even though their chances of having pregnancy-related complications (i.e. hemorrhages, among other complications) are about the same as other American women.  Socioeconomic status also plays a role. Women in poor communities are not only more likely to suffer from depression, asthma, obesity and diabetes — all of which are risk factors during and after a pregnancy — but also have less access to prenatal care and the healthcare system in general.   

There is no one explanation as to why the United States is seeing such high maternal mortality rates. The 2016 study explained that it could be from a variety of factors: better reporting on maternal deaths, mothers giving birth at older ages and thus increasing the chance of complications, increase in drug abuse and overdoses, and more mothers with chronic conditions such as obesity, hypertension and diabetes.

While there is no clear explanation for why the maternal mortality rates are going up now, Managing Director of Research at Amnesty International U.S. Rachel Ward says it speaks to a larger, systemic issue in the U.S. healthcare system.   

 “There is sadly no magic bullet that explains what is behind the high levels of maternal mortality in the United States,” Ward said in an interview with Al Jazeera. “It’s a combination of factors that speak to the systemic problems of failing to provide affordable, accessible, quality health services to all women in the United States.” 

Maternal Health and the United States’ Healthcare System

A 2010 U.S. Department of Health & Human Services study on women in the U.S. healthcare system found that while the quality of care for women in the United States has increased, access to healthcare has not improved and major disparities exist in preventive services and access to care when considering women’s race, ethnicity or socioeconomic status. 

Access to healthcare can be limited by location of services and the time and money it costs to get care.

A Commonwealth Fund 2010 report found that nearly 43 percent of the U.S. women polled went without recommended care or failed to fill prescriptions because of cost. 

“Women, particularly those in their childbearing years, are uniquely at risk for being unable to afford the care they need, having trouble with medical bills, and having high out-of-pocket costs," Commonwealth Fund Vice President Sara Collins said in a press release.  Almost 40 percent of women they polled spent $1,000 or more on out-of-pocket medical costs within a one-year period. Costs and access to care become worse for uninsured women, who are even more likely to go without recommended care due to cost or unavailability of services.

In Texas’ case, some health professionals argue that women’s inability to access care also stems from the shutting down of government-funded clinics. Due to cuts in funding for women’s health, more than 80 medical clinics have shut down in Texas, severely limiting access to medical care, especially for rural women and women of lower socioeconomic status.

Lack of care before, during and after a pregnancy can put the mother’s life more at risk.

The risk of pregnancy-related complications can be escalated even before a pregnancy. Lack of access to family planning services and contraceptives can lead to unintended pregnancies — an outcome that the CDC found correlated with higher chances for pregnancy-related complications.  Preconception care is not limited to family planning services; complications during pregnancy can also stem from chronic conditions such as hypertension, heart disease, diabetes, depression, genetic conditions, sexually transmitted diseases, tobacco use and alcohol abuse, inadequate nutrition, and unhealthy weight. If such conditions were left untreated or were unknown before a pregnancy, they could pose a risk to the mother’s and baby’s health.

Lack of care during a pregnancy can also lead to complications that put a mother’s life at risk.

According to the CDC, women who receive no prenatal care are three to four times more likely to die of pregnancy-related complications than women who do receive this care.  In 2010, the U.S. government set a health goal: 90 percent of women should be receiving adequate prenatal care.  What researchers found, however, is that 25 percent of all American women were not receiving this care; even less women of color were receiving adequate prenatal care.

The postnatal phase, though often neglected, is also a critical time for a woman’s maternal health and is when most maternal and infant deaths occur, according to the World Health Organization. Postpartum health issues can include infection, deep vein thrombosis, postpartum hemorrhage and postpartum depression.  The consequences of postpartum depression in particular can extend past the stage of the child’s infancy, affecting both the mother and the child’s development for years to come.

As most health plans only cover one postpartum visit, according to the American Association of Reproductive Health Professionals, all these health issues could go unnoticed easily. 

According to a 2013 Northwestern University study, about 20 percent of postpartum deaths are the result of suicide, making it the second most common cause of mortality in postpartum women.  About one in seven women experiences postpartum depression, yet many don’t seek medical help. 

Improving Maternal Health

There are three main governmental programs that seek to provide prenatal and postnatal care to more women in the United States.

  • Title V Maternal and Child Health Services Block Grant Program is a fund is given to the states to improve access to care, including prenatal and postnatal care for women, as well as provide services for their children. In 2014, the program reported that over 50 million pregnant women, infants and children were given care through this grant. 
  • Alliance for Innovation in Maternal Health (AIM) supports states and communities in implementing maternal safety bundles in hospitals, with the goal to prevent 100,000 maternal deaths and severe morbidities over the next five years.
  • The Healthy Start initiative  focuses on addressing the racial and ethnic disparities within maternal mortality by serving more than 60,000 women and families in 100 communities that are considered at risk. The purpose of the initiative is to improve women’s health before, during, and after pregnancy, and therefore impact both children’s health and the community. 
The Healthy Start initiative follows the work of similar projects conducted in California, the only state to see a reduction in maternal mortality. The California state government created the California Maternal Quality Care Collaborative (CMQCC) in 2006, and since then the state has seen an overall decrease in maternal deaths.  CMQCC is a collaborative organization comprised of government agencies, healthcare providers and hospitals, insurance agencies, and universities with the goal to end maternal mortality and racial disparities in maternity care. The organization analyzes and researches primary causes of death, creates evidence-based toolkits to address them and then spreads initiatives through its network to implement its findings.  By also considering racial disparities, the state has also managed to reduce maternal mortality among African-American women, whose maternal mortality rate tends to be three to four times higher nationwide. 

As the 2016 study revealed, however, the maternal mortality rate continues to rise in most states.

As Amnesty International USA Director of Policy and Research Nan Strauss, Council on Patient Safety in Women’s Health Care Chairperson Dr. Debra Bingham, and Pacific Institute for Women's Health founder Francine Coeytaux have said, the increasing maternal mortality in the United States is not just a public health issue; it’s a human rights failure. 

“…Too many women in the United States face shortages of providers and facilities and inadequate staffing; financial, bureaucratic, transport and language barriers; care that is not culturally appropriate or respectful; a lack of opportunity for informed decision-making and the lack of a system to ensure that all women receive high-quality, evidence-based care,” they wrote in a collaborative editorial on maternal health in the United States. “The comparatively high rates of maternal deaths in the United States is an indicator of the failure to ensure that women have guaranteed lifelong access to equitable, quality health care, including reproductive health services.”

Communities and nonprofits have been trying to fill the gaps and address this human rights issue.

As part of its Global Maternal and Child Health Initiative, United Methodist Women granted more than $1 million in 2015 to organizations that work to provide better health programs for women and children. In the United States, United Methodist Women has supported the work of organizations such as Curamericas Global in North Carolina, The Friendly Center in Ohio, Henderson Settlement in Kentucky, Moore Community House in Mississippi, Navajo United Methodist Center in New Mexico and the Wesley Community Center in Ohio.

United Methodist Women has also worked closely with the Chicago-based Center for Faith and Community Health Transformation, which helped plan and facilitate the National Seminar maternal health plenary. In Illinois, there were about 610 maternal deaths between 2002 and 2012, and a study found that one-third of these deaths were preventable. 

Co-directed by the Rev. Dr. Shirley Fleming and Rev. Dr. Kirsten Peachey, the Center takes a community-based approach to promoting public health and social justice in Northern Illinois. The Center works with EverThrive Illinois on this coalition’s grassroots Campaign to Save Our Mothers & Babies, which combats the racial disparities in maternal and child health by working with healthcare providers, educating the public and advocating for legislation and maternal health programming.

In Illinois, there were about 610 maternal deaths between 2002 and 2012, and a study found that one-third of these deaths were preventable.

Global Snapshot: Women’s Maternal Health

While the United States’ increasing maternal mortality rate is alarming, nearly 99 percent of all maternal deaths actually occur in developing countries.  In 2015, more than 300,000 women died from pregnancy-related complications.  According to the World Health Organization, the majority of maternal deaths in developing countries are caused by severe bleeding, infections, high blood pressure during pregnancy, complications from delivery, unsafe abortion, or diseases during pregnancy, such as HIV/AIDS or malaria.

The majority of maternal deaths occur in sub-Saharan Africa and South Asia. Most of these deaths are preventable; however, access to adequate health care is a major barrier to healthy pregnancies. Access can be limited by lack of income, long distances to facilities, lack of information and cultural practices, according to the World Health Organization.  The risk of maternal mortality also increases for women if they are in areas of conflict, are adolescents, live in rural areas and if they live in poverty. 

However, maternal mortality has dropped by 47 percent since 1990 worldwide, due to the efforts by governments, NGOs, healthcare providers and community activists. 

The international community adopted the United Nations’ Millennium Development Goal (MDG) to improve maternal health in 2000. The goal was to reduce maternal mortality by 75 percent between 1990 and 2015.  Since they have not reached this level, the United Nations included maternal mortality again under the new Sustainable Development Goals; this time, the international community is to get the global maternal mortality rate down to 70 per 100,000 births by 2030.

United Methodist Women’s Support

United Methodist Women supports organizations that are working to reach this goal and promote maternal health in their communities. In Nicaragua, Accion Medica Cristiana trains midwives and provide supplies to maternal health houses, where women can find safer birthing conditions than at home. In the Republic of Georgia, the Union Women Center also works on improving maternal health. With United Methodist Women’s support, the group works to mobilize ethnic rural women, as well as men, youth, doctors, religious leaders and local government, to increase the quality of reproductive and maternal health in the community.

“The Global Maternal and Child Health Initiative address [the United Nations'] Sustainable Development Goals number three and five. The two goals will empower women, promote gender equality and increase health care availability,” said Andris Salter, assistant general secretary for mission opportunities for United Methodist Women. “They are at the heart of United Methodist Women’s beginnings in 1869 and at the heart of our work today.” 

Posted or updated: 12/2/2016 12:00:00 AM
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Take Action:

  • Get active! Attend events or volunteer for one of UMW’s National Mission Institutions and other partners that work on this issue:
  • Meet your Congressional representatives or contact them through the Congressional switchboard: (202) 224-3121. Urge them to support the following bills:
    • Quality Care for Moms and Babies Act (H.R.4695 & S.466) would improve the quality of maternity care under the Medicaid and CHIP programs, which at-risk women utilize the most, by developing maternity care quality measures.
    • Bringing Postpartum Depression Out of the Shadows Act of 2015 (S.2311 & H.R.3235) would help states establish and expand programs to screen for and treat postpartum depression.
    • Reach Every Mother and Child Act of 2015 (H.R.3706 & S.1911) would direct the White House to establish a Maternal and Child Survival Coordinator role in the USAID Department and to create a five-year plan to ending preventable maternal, infant and child deaths globally.
    • Health Equity and Accountability Act of 2016 (H.R.5475) would attempt to address racial and ethnic disparities by improving access to healthcare and working to make services more culturally competent for minority individuals.
    • Improving Access to Maternity Care Act (H.R.1209 & S.628) would study and address areas where there are shortages of maternity care health professionals and quality care, including during labor, birthing, prenatal care and postpartum care.
    • 21st Century Women's;Health Act of 2015(H.R.3562 & S.674) would create grants for family planning service projects, expansion of family planning and preventive health services, and training of nurse practitioners specializing in women's health care. The bill would also require state Medicaid programs to offer free preventive care.

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