The March editorial for the journal Contraception frames rates of maternal mortality in the United States “not just a matter of public health, but a human rights failure.” The authors, from WomanCare Global, AWHONN, and Amnesty International, explain the problem:
The rise of maternal deaths in the United States is historic and worrisome. In 1987, maternal death ratios hit the all-time low of 6.6 deaths per 100,000 live birth. These ratios were essentially maintained for more than a decade. Around 2000, the ratio began to increase and has since nearly doubled, hovering between 12 and 15 deaths per 100,000 live births between 2003 and 2007…’near misses’ (maternal complications so severe the woman nearly died) have also increased by 27% between 1998 and 2005, now affecting approximately 34,000 women a year; and appalling disparities in maternal health outcomes exist between racial and ethnic groups, and among women living in different parts of the United States.
The authors draw attention to troublesome disparities, noting that “for the last 50 years, black women who give birth in the United States have been approximately four times as likely to die as white women,” although they do not seem to have higher rates of medical complications that are common causes of maternal death and hemorrhage. They also note that 25% of white women, 32% of black women and 41% of American Indian and Alaska Native women do not receive adequate prenatal care.
Authors Francine Coeytaux, Debra Bingham, and Nan Strauss explore possible reasons for the increase in maternal mortality, including lack of access to prenatal care, primary care, and insurance, inadequate or poor quality intrapartum care, limited postpartum care, overuse of medical interventions, and a lack of data collection and accountability.
They conclude with a call to action focused on systemic change, rather than smaller interventions in the health of individual women, arguing that “system-level improvements ensuring a uniformly high quality of care are also needed, and these improvements are beyond the control of the individual woman or an individual provider.” Action steps outlined in the piece include initiating, supporting and advancing legislation to reduce maternal mortality through improving care and reducing disparities, expanding data collection and analysis, and investigating more thoroughly why maternal deaths and injuries happen in the U.S. and taking steps to reduce those causes.
This and other editorials from Contraception are freely available online.