The United States fares far worse in preventing pregnancy-related deaths than most other developed nations, despite spending more than any other country on hospital-based maternity care.
Maternal death is rife. But with new legislation, the Preventing Maternal Deaths Act, the country might finally see a decrease in the number of women's lives claimed during and after pregnancy.
Maternal death is defined as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes," according to the World Health Organization. "To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death."
The maternal death rate is disconcertingly high in the United States — it's actually higher than any other developed nation, which is why the country ranks just 47th globally for its maternal mortality rate. The rate increased from 17 deaths per 100,000 live births in 1990 to 26 deaths per 100,000 live births in 2015, while the global maternal mortality rate (MMR) actually decreased by 44 percent during that same time period, the Maternal Health Task Force reports. According to the Centers for Disease Control and Prevention, about 700 women in the United States die each year as a result of pregnancy or delivery complications.
And maternal mortality disproportionately affects women of color, who are dying at 42 deaths per 100,000 live births compared to 12 deaths per 100,000 live births among white women as of 2010. According to a 2014 study from the National Latina Institute for Reproductive Health, in some parts of Mississippi where roughly 40 percent of the population is black, Hispanic, Latino, Asian or American Indian, the rate of maternal death for women of color exceeds that of the whole sub-Saharan Africa. In fact, the Center for American Progress reports that “African American women are three to four times more likely to die from childbirth than non-Hispanic white women, and socioeconomic status, education and other factors do not protect against this disparity.”
Among many reasons, a recent California survey suggests that doctors tend not to listen to African American women as carefully as they do white women. Other research suggests that women of color tend to have poorer access to high-quality reproductive health information and services than white women, and they experience more disrespect and abuse in the healthcare system. Meanwhile, a wealth of evidence indicates that stresses associated with daily racial discrimination can also induce poor perinatal outcomes including preterm birth and the delivery of a low-birth-weight infant.
The rate of maternal death for all women doesn't have to be so high, but the United States has failed to meet national goals for maternal mortality reduction, which means that the country is not on track to meet the Healthy People 2020 goal of a 10 percent reduction from 2007 to 2020. Treatable complications are often to blame for the mothers who are dying during and after pregnancy, according to a 2017 six-month investigation on maternal mortality in the United States from NPR and ProPublica, which is why there's been such a big push for the new Preventing Maternal Deaths Act.
The Preventing Maternal Deaths Act seeks to "mitigate [the aforementioned] statistics by supporting maternal mortality review committees and promoting national information-sharing through the Centers for Disease Control and Prevention (CDC) so that states can continue to learn from best practices and collaborate with each other," according to the Preeclampsia Foundation.
Maternal mortality review committees are multidisciplinary groups of local experts in maternal, infant and public health. The groups examine cases of maternal death by counting and characterizing deaths, as well as by putting committee recommendations into action in hospitals and communities.
The Preventing Maternal Deaths Act will help prevent future maternal deaths. Now that maternal mortality review committees have been authorized to receive federal funding, they can look into why so many American mothers are dying.
"This important bipartisan legislation is the beginning of efforts toward eradicating preventable maternal death and improving maternal and infant health in the United States," the Preeclampsia Foundation explains. "It will accelerate progress toward ensuring that every state has a high-functioning process for identifying the causes of maternal mortality and translating recommendations made by maternal mortality review committees to meaningful action. The legislation will also advance efforts among states to standardize the collection and analysis of data so that we can develop a national understanding of why mothers are dying in the United States and what it will take to reverse this tragic trend."
There's been a push for legislation to protect mothers to be and new moms for years. And the Preventing Maternal Deaths Act has finally passed in December 2018.
In 2017, a bipartisan group of 14 United States Senators — among them were Lisa Murkowski of Alaska, Cory Booker of New Jersey, and Bill Nelson and Marco Rubio of Florida — had asked the White House to commit to reducing maternal mortality. Specifically, they asked for more data, particularly surrounding women living in poverty and receiving government aid. Meanwhile, the House Ways and Means Committee sent letters to 15 hospitals chains operating 900 hospitals around the country, inquiring about the deaths of new mothers in their care. And other private initiatives went underway, including a grant program from the pharmaceutical company Merck & Co., which pledged to give $500 million to city-based organizations working to reduce the maternal mortality rate.
So there's been ample support for the Preventing Maternal Deaths Act, which the United States House of Representatives and the Senate introduced and the president signed in December. The Senate Health, Education, Labor and Pensions (HELP) Committee had unanimously approved, and the leadership of the House Energy and Commerce Committee's Health Subcommittee also expressed bipartisan support to pass the bill in September 2018, according to the Preeclampsia Foundation.
When it finally passed, the president of the American College of Obstetricians and Gynecologists (ACOG), Dr. Lisa Hollier, called the act "a major step toward eliminating preventable maternal deaths in our country."
AnnaMarie Houlis is a feminist, a freelance journalist and an adventure aficionado with an affinity for impulsive solo travel. She spends her days writing about women’s empowerment from around the world. You can follow her work on her blog, HerReport.org, and follow her journeys on Instagram @her_report, Twitter @herreportand Facebook.
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