According to the CDC, the top three causes of pregnancy-related deaths in 2011-2013 were cardiovascular disease (15.5%), non-cardiovascular diseases (14.5%), and infection or sepsis (12.7%). However, the cause was unknown in 6.1% of cases.3
The medicalization of birth has been blamed for increasing mortality rates. Interventions, including our high rate of cesarean delivery, currently more than 30% of all births, may be a contributor.
Although this is likely a contributor, the high rate of interventions may ultimately be a result of our unhealthy pregnant population. Racial disparities also continue to exist6. Black women are 4 times more likely to die from childbirth-related issues than white women.
Chronic stress and disease are major risk factors for maternal mortality. Even in the US, there are areas that lack access to prenatal and postnatal care. The problem may become worse with the repeal of the ACA if the proposed replacement does not require all health insurance to include prenatal care, and many women currently receiving Medicaid become no longer eligible.
The future of OB care is standardization. Growing efforts to implement standard approaches, evidence-based care, and maternal mortality review boards are all thought to improve OB care.5 Tool kits, especially for hemorrhage and pre-eclampsia, are gaining in popularity. We will also need to address racial disparities, education, the health of our people, and access to health care. Whether these measures will decrease the mortality rate is not certain, it is, at least, a good start.
Why are these numbers important? Why does the public react so emotionally to them? Are they a snapshot of the health of our population? Are they an insight into our priorities and how we treat women? Do we want to make maternal health needs a priority?
An editorial in Contraception back in 2011 addressed these issues using a human rights framework. The editorial argued that maternal mortality is an indicator of “the failure to ensure that women have guaranteed lifelong access to equitable, quality health care, including reproductive health services.”7
The issue of maternal mortality brings us back to the general health care debate. Is health care a right or a privilege? If we say it is a human right, then the rising maternal mortality is evidence that we are not protecting the rights of women.
Now that the mainstream media has brought this issue to our attention, how will we address these issues? With over $800 billion in Medicaid tax cuts proposed by the Trump administration,8 it is unlikely that maternal mortality will decrease any time soon. The proposed cuts will affect the most vulnerable in our country, including pregnant women. The topic is emotional because it highlights who we really are as a country — and many don’t seem to like who we have become.
- Martin N and Montagne R. The Last Person You’d Expect to Die in Childbirth. Pro Publica. Updated May 12, 2017.Available at: https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system. Accessed on May 21, 2017.
- Health Statistics and Information Systems: Maternal Mortality Ratio. World Health Organization. Available at: http://www.who.int/healthinfo/statistics/indmaternalmortality/en/. Accessed on May 21, 2017.
- Pregnancy Mortality Surveillance System. US Centers for Disease Control. Updated January 31, 2017. Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. Accessed on May 21, 2017.
- MacDorman MF, Declercq E, Cabral H and Morton C. Is the United States Maternal Mortality Rate Increasing? Disentangling Trends from Measurement Issues.. Obstet Gynecol. 2016;128(3): 447–455. doi: 10.1097/AOG.0000000000001556
- Agrawal, P. Bulletin of the World Health Organization: Maternal Mortality and Morbidity in the United States of America. World Health Organization. 2015;93:135. doi: 10.2471/BLT.14.148627
- Maron, DF. Has Maternal Mortality Really Doubled in the US? Updated June 8, 2015. Available at: https://www.scientificamerican.com/article/has-maternal-mortality-really-doubled-in-the-u-s/. Accessed on May 21, 2017.’
- Bingham D, Strauss N, Coeytaux F. Maternal Mortality in the United States: A Human Rights Failure. Contraception. 2011;83: 189–193.
- Lee MJ and Luhby T. Trump Budget: $800 Billion in Medicaid Cuts. CNN. Updated May 22, 2017. Available at: http://www.cnn.com/2017/05/22/politics/medicaid-budget-cuts/index.html. Accessed on May 21, 2017.