When everyday Americans think about women dying during childbirth it is probable that their initial thoughts travel directly to Africa where it is quite well known that maternal mortality is rife. Chances are their thoughts never focus on the deaths and near deaths during childbirth that women experience right here in the United States. After all, the overwhelming consensus is that the United States has the best medical care, superior health workers and health system in the world despite some of its inherent challenges. This thinking renders maternal mortality in the US thoroughly inconceivable to many even while data reveal it should not be inconceivable at all. In fact, maternal mortality is on the rise in America having doubled over the past 25 years all while global maternal deaths are steadily declining. Globally, maternal mortality was effectively reduced by 44 percent according to the World Health Organization.
The United States, while not the overall leader in maternal mortality among all countries, it is the leader among all developed nations. The United States ranked number 33 out of 179 countries in Save the Children’s 2015 Mothers’ Index Ranking and 46th in the world due to the rate of women who die from pregnancy and childbirth complications. Compared to other developed countries, the United States’ ranking is abysmal, especially with Norway, Finland, and Iceland ranking in the top three overall. Even countries like Estonia and Belarus, whose GDPs are considerably lower than ours, far outrank America.
Earlier this month at Blogher’s annual conference I sat on an esteemed panel of maternal health advocates hosted by Merck for Mothers, a 10-year, $500 million initiative to end maternal mortality globally. The panel included Dr. Priya Agrawal, Executive Director of Merck for Mothers, Katherine Schwarzenegger, a millennial who advocates for maternal health, Matt Logelin, who lost his wife mere days after she gave birth to their daughter, and Mark Allen, a Senior Program Manager for Merck for Mothers.
During the panel we discussed the maternal health complications women routinely face in low-and-middle income countries. We also honed in on maternal mortality in the United States thanks to the discussion spurred on by Matt Logelin who lost his wife, Liz, to a pulmonary embolism a few days after she gave birth to their daughter in 2008. His point, which was well taken, is that, yes, maternal mortality heavily plagues poor women in low resource countries, but it also happens here in a country where Americans spend the most on health care than any other country in the world.
Logelin called on women to be advocates for their own health and to ask as many questions as possible of their health care provider during their prenatal visits and during and after childbirth. If women don’t become advocates for their own health, who will?
It is imperative to note that while women across the board and of all races die from childbirth and post-delivery complications in the United States, black, non-Hispanic women bear the greatest maternal mortality burden even when there are controls for education and socioeconomic factors. Merck for Mothers is working with professional health organizations in part across the country to fund research examining the racial maternal health disparities in the United States. In 2011, for example, 42.8 black women out of 100,000 live births died due to pregnancy, childbirth or post-delivery complications. That is compared to 17.3 for other races and 12.5 deaths for white women.
For years, doctors and researchers were stumped when they tried to understand why more black women died while giving life. Now, they know that many women are entering pregnancy less healthy and older with hypertension, diabetes, and other maternal morbidity risk factors. Researchers also know that black women often face systemic and systematic racism in health care settings. All of these cumulative factors cause maternal mortality rates to soar in the United States especially among black women.
“African-American people generally have worse health outcomes than Caucasian people…but not to this degree, not four-fold,” said Conrad Chao, a clinical professor of obstetrics and gynecology at the University of California, San Francisco.
While working across the globe for better maternal health outcomes, it is heartening to know Merck for Mothers is working to also save the lives of mothers in the United States because there is overwhelming need. To date, Merck for Mothers is working in 16 states and has helped provide better quality maternal health care to 1.8 million American women since 2011.
The United States is the forgotten child when it comes to maternal mortality,” said Dr. Priya Agrawal, Executive Director of Merck for Mothers. “We learned very quickly that even in our backyards we had to do something. Maternal mortality has more than doubled in the United States. The trend is going in the wrong direction.”
I was a guest of Merck for Mothers for their #EndMaternalMortality panel at Blogher 2016.
Photos courtesy of Merck for Mothers