From time to time I like to look back into history and share photos I find in the Library of Congress archives. I have done that previously with breastfeeding, newborn health, and tuberculosis. Today, I am sharing photographs I found of rural midwives in the south.
I have often focused on maternal health and mortality around the globe especially where the deaths rates are the largest, but there is much-needed sustained discussion about maternal mortality in the United States. I have detailed the problem in several previous posts here including:
- New Company Launches to Combat Maternal and Newborn Mortality in the US
- Artist Puts Spotlight on Maternal Mortality and Obstetric Abuse in America
- Maternal Mortality in the United States: The Numbers May Surprise You
- Why Congress Needs to Pass the Maternal Health Accountability Act of 2014
Periodically I will share news and updates about what is happening in the maternal health space in the United States including the successes and failures to save more women’s lives as well as the key players who are making a difference.
The word is getting out that maternal and newborn mortality are an ever-increasing problem in the United States. As I have written before, the United States has the highest ratio of maternal mortality of any developed country in the world and yet we spend the most on health care globally.
While many (including scientists and health professionals) don’t know concretely why maternal mortality is continuing to rise in the US, the fact remains that the problem is not getting better. In fact, it is incrementally getting worse. In fact, according to recent findings from the Institute for Health Metrics and Evaluation the United States has a maternal mortality rate of 18.5 maternal deaths per 100,000 live births in the U.S., up from 12.4 deaths per 100,000 births in 1990.
Companies such as Merck that launched Merck for Mothers and Texts4Baby, for example, are working on innovative ways to reach and inform mothers about how they can be as healthy as possible during and after childbirth. Additionally, grassroots organizations and birthing centers like Florida’s CommonSense Childbirth and Arizona’s The Birthing Project are working in communities to help mothers and their newborns stay alive.
The United States has a maternal mortality problem. For the past 25 years the rate of maternal mortality has increased dramatically in America. In fact, the United States is one of eight countries including Greece, Afghanistan and sub-Saharan African countries where the number of mothers who die during childbirth is on the rise. Now each year, on average, 800 American women will lose their lives giving birth. Last year 1200 women died during childbirth in the United States, up 500 deaths since 2005.
To put this crisis into perspective globally, the United States has double the maternal mortality rate of Canada and three times the maternal mortality rate of France. When comparing maternal mortality rates with the Nordic countries it just becomes even more embarrassing. What’s worse, the United States has the highest maternal mortality rate of any industrialized country in the world.
See rates and statistics in Trends in Maternal Mortality: 1990 – 2013
What is especially disheartening about these statistics is doctors and researchers are baffled about why many mothers are dying during childbirth when they are afforded access to the best medical care in the world. Some point to the increased rates of diabetes and hypertension in overweight or obese women as reasons for the increased rate of maternal mortality. Others blame healthcare disparities and the rate of older women who are now having children. The problem is there is no definitive science on why more mothers are dying in the United States than any other developed country in the world.
What experts do know is that African-American women are three times more likely to die during childbirth. A recent study conducted by the California Department of Health found that the maternal mortality rate for African-American women was 46 per 1000,000 live births. For Asian and Caucasian women, the rate was 13 per 100,000 live births between 2003 – 2008.
“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.
Timoria McQueen, an African-American woman, suffered a postpartum hemorrhage after the birth of her daughter. She subsequently underwent a three-hour life-saving surgery to survive. Now, McQueen is a staunch maternal health advocate pushing to amend Health and Human Services’ Title V Maternal and Child Health Services Block Grant Program with the proposed Maternal Health Accountability Act of 2014 (H.R.4216).
Timoria McQueen (@timoriamcqueen) July 31, 2014
The Maternal Health Accountability Act of 2014, if passed, would require:
(1) mandatory reporting to the state department of health by health care providers and other entities of pregnancy-related deaths;
(2) establishment of a state maternal mortality review committee on pregnancy-related deaths occurring within such state;
(3) implementation and use of the comprehensive case abstraction form by such committee to preserve the uniformity of the information collected;
(4) annual public disclosure of committee findings; and
(5) collect, analyze, and report to the Secretary cases of maternal morbidity
The Act was introduced in the House in March 2014, but has stalled in Congress since.
How You Can Raise Your Voice
To find out how to contact your local Congress person and support H.R.4216: The Maternal Health Accountability Act of 2014 click here.
When we talk about sky-high maternal mortality rates we tend to look more closely at low-income countries like Afghanistan, Chad and Somalia that have the world’s highest maternal mortality rates in the world according to the World Bank. And, of course, sub-Saharan African countries need to desperately bring their numbers down. But when you look at rich, developed countries the United States has the highest maternal mortality rates among them and the rates are not declining. In fact, maternal mortality rates in the United States have doubled over the past 25 years. African-American women are 3x more likely to die during childbirth in the United States. And, Caucasian women are more likely to die during childbirth than women in 24 other industrialized countries. 21 mothers die per 100,000 live births in the United States. Compare that to Greece (3), Finland (5), and even the United Kingdom (12) deaths per 100,000 live births.
This year as we report on maternal mortality we will also include the United States in our news reporting because the numbers are high, increasing, and are baffling researchers and doctors. They do not know concretely what is causing the doubled maternal mortality ratios although they suspect obesity, high blood pressure, heart disease, health care disparities, and older mothers may be causing the steady spike in numbers in the United States.
According to Amnesty International the five main reasons women die in childbirth in the United States are:
- Embolism 20% – A blood clot that blocks an essential blood vessel, for example in the lungs
- Hemorrhage 17% – Severe blood loss
- Pre-eclampsia and eclampsia 16% – Disorders associated with excessively high blood pressure
- Infection 13%
- Cardiomyopathy 8% – Heart muscle disease
And, according to Merck for Mothers, a woman nearly dies in childbirth every two minutes, that is more than 50,000 women annually. See infographic. Around 650 women die during childbirth or shortly thereafter based on numbers from the CDC.
As we continue to report on maternal mortality around the world where the rates are in the hundreds per 100,000 we will not forget about the mothers who are also dying here in the United States, a country that spends the most in the world on health care.