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.