September 9, 2015

NYC Reports Black Moms’ Risks 12 Times Above Whites

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(WOMENSENEWS)–Black women in New York City died 12 times as often as white women during pregnancy, labor or from complications of labor during the years 2006 to 2010, finds a newly available report by city health authorities.

That disparity is much wider than five years ago, when a similar study found black women were dying seven times as often from the same causes.

The new ratio reflects a dramatic drop in the deaths of the city’s pregnant white women and new mothers, when compared with a previous five-year study, authors find. The report did not provide an explanation for the growing disparity.

The reported also finds that Asian and Pacific Islander women were four times as likely to die as the result of being pregnant than white women; the city’s Latinas faced a nearly identical heightened risk of death related to being pregnant.

The report, Pregnancy-Associated Maternal Mortality, NYC 2006-2010, is posted on the city’s health department website, but is undated and not publicized.

A spokesperson for the city’s health department said Tuesday that the city is working in communities and with partners to reduce these rates in the report. “Much still has to be done,” she said.

Dr. Lorraine Boyd, medical director of the city’s Bureau of Maternal, Infant and Reproductive Health, in an interview with WNYC, emphasized the health of residents in certain communities and not differences in quality of care.

However, hemorrhage is widely considered to be one of the most preventable causes of maternal death, said Nan Strauss, director of policy and research at Choices in Childbirth, a New York City advocacy organization.

“The new report indicates that hemorrhage was responsible for more maternal deaths than any other cause for all groups of women of color,” Strauss said; 25 percent of maternal deaths for black non-Hispanic women, 31 percent for Hispanic women and 40 percent for Asian/Pacific Islander women. By comparison, hemorrhage caused just 11 percent of maternal deaths for white women. This gap suggests that women of color may experience a lower quality of health care than that available to white women.

139 Deaths

The new data are the result of the city’s maternal mortality review team’s in-depth look into the 139 pregnancy-related deaths between 2006 and 2010. The relationship of a woman’s pregnancy to her death could not be determined in five cases. A previous maternal mortality report reviewed the maternal deaths in the city during the years 2001 to 2005.

“Black, non-Hispanic women were 12 times more likely than white, non-Hispanic women to die from pregnancy-related causes between 2006 and 2010,” the report said. “This represents a widening of the pregnancy-related mortality gap since the period from 2001 to 2005, when mortality risk was seven times greater among black, non-Hispanic women. The increasing gap was largely driven by a 45 percent decrease in the pregnancy-related mortality among white, non-Hispanic women.”

The leading causes of deaths among the city’s pregnant women and new mothers were hemorrhage (28 women or 20.1 percent of deaths); blood clots (26 women or 18.7 percent of the deaths); pregnancy-induced high blood pressure (19 women or 13.7 percent); and cardiovascular conditions (18 women or 13 percent), again according to the report.

Dr. Priya Agrawal, the head of a 16-state program–including New York–to reduce maternal mortality, has been calling in recent months for the U.S. to “immediately” address maternal deaths, estimated to be avoidable in at least half the cases.

For each maternal death in New York City, 100 women suffer severe health problems as a result of being pregnant, twice the national rate, according to testimony provided to the New York City Council by the city’s health department.

A Centers for Disease Control and Prevention study reported that the risk of severe maternal complications is three times greater following a Cesarean section and may include maternal death, cardiac arrest, hysterectomy, blood clots and major infections, as well as result in longer hospital stays and a greater chance of hospital readmission

This recent report did not include data on the percentage of Caesarian section births in New York City hospitals. Data from the New York State health department indicate that overall a third of births in the city involve the surgery and several hospitals had rates above 40 percent; one teaching hospital’s rates were above 50 percent.

Deaths from ectopic pregnancies rose in New York in the two sets of data that were studied, up to 11 percent in the latest period from 2.5 percent between 2001 and 2005. However, no explanation for the increase was included. Ectopic pregnancies develop when a fertilized egg fails to attach to the uterus and attaches elsewhere, such as in a fallopian tube. They occur in 1-in-50 pregnancies nationally.

Shortcomings in Care

Agrawal was not reached for comment for this story, but as executive director of Merck for Mothers in the U.S., she has pointed to two major shortcomings in the nation’s care of pregnant women in recent forums.

“There’s no standard protocol for health professionals regarding pregnancy issues,” Agrawal said during a BlogHer conference in New York City. “And maternal deaths aren’t being counted in a reliable way.”

Merck and Co., the giant drug company based in Kenilworth, N.J., has pledged to spend $500 million worldwide to reduce maternal mortality. Its U.S. project includes a focus on establishing better clinical routines for managing obstetric emergencies.

A similar criticism of the quality of care provided to pregnant women is included in the New York Academy of Medicine’s 2011 public report. “Many patients – even those at high risk – are not screened appropriately for surgery” the document said, “nor do they meet with anesthesiology staff prior to entry to the operating room.”

It added that post-C-section patients are cared for in labor rooms rather than rooms dedicated to recovery from surgery.

The city’s maternal mortality rate varies from borough to borough: Manhattan’s total of eight maternal deaths from 2010 to 2012 produced a rate of 13.7 deaths per 100,000 births. In contrast, 36 Brooklyn women died during the same time period, for a rate of 29 deaths per 100,000 births, according to data published by the New York State Department of Health.



Within boroughs, rates of Cesarean births–recommended by the World Health Organization this year to be no higher than 10 percent–also vary substantially. For example, at the University Hospital of Brooklyn, 53 percent of all births are by C-section. Two other Brooklyn hospitals–Kings County Hospital Center and Maimonides Medical Center–perform half as many, again according to the data available on the New York State health department website. Kings County is a city-managed public hospital and Maimonides is private.

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