The CDC released a new report late last week, Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016, that reiterates the maternal mortality disparity between black mothers and American Indian/Alaska Native women and white, Hispanic, and Asian/Pacific Islander women. The numbers now seem worse than we originally thought. For example, black women who are college educated die in larger numbers than white women with less thana high school diploma. And, even in states where overall maternal mortality is low, black women still die in larger numbers.
In addition, the CDC acknowledges that “black women experience earlier deterioration of health because of the cumulative impact of exposure to psychosocial, economic, and environmental stressors.” In other words, a contributor to maternal death rates among black women is structural racism in healthcare settings.
The United Nations has designated Sierra Leone as the most dangerous place to have a baby. In fact, it has the highest maternal mortality rate in the world at 1,360 deaths per 100,000 live births. On average, most women have at least six babies in Sierra Leone.
In a previous post I mentioned the Aminata Maternal Foundation that helps pregnant women in Sierra Leone. An Australian organization, it was started by a woman, Aminata Conteh-Biger, who became a sex slave during the Liberian Civil War. Now, she is giving back to expectant mothers after so many years away from her home country.
This video shows the work of the Aminata Maternal Foundation and how it oftentimes becomes difficult for young pregnant girls to receive permission from family and elders to deliver in a hospital or health center. It also shows the frustration of healthcare workers who try to teach entire villages about the importance of proper maternal healthcare.
One of the leading causes of maternal mortality in the United States is hemorrhaging. In fact, according to the CDC hemorrhaging accounts for 11.2% of pregnancy-related deaths. Based on these increasing numbers since 1986 the Joint Commission, the country’s leading accreditation organization for hospitals, has created 13 new standards for perinatal safety for hospitals to properly care for women who hemorrhage during or after delivery. These standards were designed specifically to prevent, recognize and treat, as well as evaluate patients for transfer to critical care for not only hemorrhage but also severe hypertension/preeclampsia.
As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
On Tuesday the first congressional caucus on black maternal health launched on Capitol Hill. Led by Democrat congresswomen Rep. Alma Adams (D-NC) and freshman Rep. Lauren Underwood (D-Il.) the caucus’s mission is to ensure black women are not dying senselessly during or after childbirth
As has been noted here many times before black women experience maternal mortality rates four times higher than white mothers no matter black women’s socioeconomic status or even the level of education achieved. In general, the United States has the highest maternal mortality rate of any developed country. Black women fare the worst.