“AIM”ing to Reduce U.S. Maternal Mortality

During the past several weeks, you would be hard-pressed not to find an article about the dismal maternal mortality rates in this country. In fact, it was a study published in our very own Green Journal that sparked the latest national conversation (with Texas at the epicenter) about why the most modern, industrialized country in the world is failing so miserably at reducing the numbers of deaths associated with pregnancy and childbirth. However, the truth of the matter is, we already know why.

When taking a closer look at Texas, one of two states that were outliers in the study by MacDorman, et al., it was discovered that its maternal mortality rate had doubled between 2010 and 2012 to “levels not seen in other U.S. states.” When taking an even closer look, a Texas task force found that African-American women accounted for a disproportionate share of those deaths, nearly 29 percent while only representing 11 percent of births in the state. The top three causes of those deaths were cardiac events, drug abuse, and hypertensive disorders. It’s common knowledge, at this point, that minorities are the most likely to suffer and die from treatable, and often preventable, chronic health conditions. African-American women, in particular, have higher rates of being diagnosed with heart disease, high blood pressure, diabetes, and obesity. Many of these conditions go untreated because they are less likely to receive care or they get it far too late. Minorities represent half of all births in this country. So, how can we hope to reduce the U.S. maternal mortality rate when have yet to eliminate racial health disparities?

When addressing this issue and why we are doing so poorly compared to other countries, we are forced to look at what we are actively doing to solve it. Since 2014, ACOG has been working directly with clinicians and hospital networks in several states through an initiative called The Alliance for Innovation on Maternal Health (AIM) to put real strategies in place. AIM is a collaborative partnership among physicians, nurses, midwives, hospitals, states and others that provides open access resources such as safety bundles for conditions including hemorrhage, high blood pressure, and reduction of peripartum racial disparities, which will be released soon. This latest bundle will address factors that directly impact patient care such as race, religion, education, and socioeconomic status. There is also a focus on continuity of care, care fragmentation and hospital quality. Providers will be given the support and tools to put systems in place that will establish coordination to ensure women receive the appropriate follow-up care.

In addition to working to expand the initiative in other states, ACOG’s Office of Global Women’s Health has been collaborating with various partners to implement AIM in Malawi where, last year, the maternal mortality rate was 634 deaths per 100,000 live births, according to the World Health Organization. That is a far cry from the U.S. rate of 23.9 per 100,000 but, frankly, solving this problem both locally and abroad involves dealing with some of the same issues, including providing better care for the marginalized members of our societies. Through AIM, we have put data tracking in place and, within the next 12 months, we will be able to assess our progress in the United States. Our goal is to reduce maternal mortality by 1,000 deaths and reduce severe maternal morbidity by 100,000 instances by 2018. I believe we can do it.

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About Tom Gellhaus, MD

Tom Gellhaus, MD is ACOG President through 2017. He is a Clinical Associate Professor in the Department of Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Dr. Gellhaus graduated from Yankton High School in Yankton, South Dakota, received his Bachelor of Arts Degree in Chemistry from Augustana College in Sioux Falls, South Dakota and his Doctor of Medicine Degree from the University of Oklahoma in Oklahoma City, Oklahoma. He completed his residency in Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. Following residency, he entered private practice in Davenport, Iowa and after 20 years in private practice, he returned to academic medicine at the University of Iowa. Over the past 20 years, Dr. Gellhaus has served in many ACOG positions at the local, regional, national and international levels. Dr. Gellhaus’ interests are in the areas of health care advocacy and policy. He has also been very involved and active in global healthcare. He has completed the McCain Fellowship, a month long in-depth experience in advocacy, at ACOG in Washington, D.C. in 1999. In 2001, he was a Primary Care Policy Fellow with the U.S. Department of Health and Human Services. He has remained active in Advocacy and Policy as a member of ACOG’s Government Affairs Committee and the Ob/Gyn PAC. Dr. Gellhaus has also been very active in leading groups on short-term medical and surgical mission projects for the last 20 years. He has done numerous presentations about these short-term medical and surgical mission projects throughout the United States.

4 thoughts on ““AIM”ing to Reduce U.S. Maternal Mortality

  1. This is not only eye-opening but also compels us to take action and address this issue head on. It’s encouraging to see organizations like ACOG partnering with others to expand their reach. I look forward to seeing how big of a difference we’re all able to make working together. I would challenge all of us as health care providers and other professionals who care deeply about our health care system and its patients to think about the health disparities that make issues like this possible. I challenge us to address the issue at its root instead of just treating its symptoms.

  2. In Kentucky there is a Maternal Mortality Committee that meets regularly to review maternal deaths from all causes. This involves gathering information from physician and hospital records based on death certificates that are sent to us from local government agencies. This involves a considerable amount of work. We have discussed what is the best and most effective way to promulgate this information to our physicians so that it can be meaningful in preventing maternal deaths where physician intervention can be effective. Unfortunately may deaths result from causes that are difficult to control: drugs and guns and automobiles often are the causes. Our challenge is to make our findings meaningful for our physicians and nurses, while protecting everyone’s legal rights. Our work continues. This information needs to be used effectively.

  3. It was very sad to see the dramatic increase in maternal mortality that occurred in Texas in recent years. I hope we will be able to understand more specifically why this occurred. I applaud ACOG for turning their attention to this issue and I will be following your efforts!

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