WASHINGTON (WOMENSENEWS)—Maternal mortality is mainly associated with the developing world, but it’s also a growing threat to women in parts of the U.S. where living conditions are just as harsh.
“There’s been a huge collapse of the health system in rural areas and many people lack transportation to access care,” Dr. Keisha Callins, an OB-GYN working in rural Georgia, told attendees of a congressional briefing this week. “I still have patients that don’t have a car or live so far out that they don’t have access to a bus system.”
Callins, the subject of a Women’s eNews article in 2015, works at the Mirian Worthy Women’s Health Center and is assistant medical director for Albany Area Primary Health Care in rural Albany, Georgia.
On April 13 she and two other experts on U.S. maternal mortality told a room of over 100 congressional staffers, federal employees and women’s health advocates about the problems they are seeing and the kinds of solutions they think can work.
Callins shared the social inequities besetting her patients: provider shortages; lack of physical access to care; and social factors such as low educational attainment, poverty, poor access to healthy foods, neighborhood violence and stress.
“It’s OK for me to tell my patient to eat better but if the only thing that’s around is McDonald’s, that’s an issue,” Callins said.
Each year over 600 women in the U.S. die from pregnancy-related causes and over 65,000 experience life-threatening complications or severe maternal morbidity. The average national rate of maternal mortality has increased from 12 per 100,000 live births in 1998 to 15.9 in 2012, after peaking at 17.8 in 2011.
Racial, Rural Disparities
The maternal health crisis in the U.S. is marked by racial disparities. Nationally, black women are three to four times more likely than white women to die from pregnancy-related causes. The data are even more shocking in certain parts of the U.S. where there are pockets of neglect.
According to health officials in Georgia, the state has the highest rate of maternal deaths overall with significant racial disparities. In 2011, Georgia’s maternal mortality rate was nearly double the national rate at 28.7 per 100,000 live births. Black women in the state are four times more likely than white women to die from pregnancy-related causes.
Cindy Hall is president of Women’s Policy Inc., a nonprofit, nonpartisan public policy organization based in Washington, D.C., that organized the briefing and often works with the Congressional Caucus for Women’s Issues, a bipartisan group of legislators seeking to address issues affecting women and families. The Caucus was established in 1977 and is currently co-chaired by Reps. Kristi Noem, R-S.D., and Doris Matsui, D-Calif.
“It is critical that policymakers realize the importance of investments in preventive health services and hear from speakers who are working directly with women at the highest risk [of maternal mortality] so that there is a better understanding of the factors driving the high rates in the U.S.,” Hall told Women’s eNews in a recent email ahead of the briefing.
The briefing represents the latest sign of rising attention to the problem on Capitol Hill.
Last fall, Rep. Jaime Herrera Beutler, R-Wash., and Rep. Lucille Roybal-Allard, D-Calif., created the Congressional Caucus on Maternity Care to address the problem of birth outcomes in the U.S. lagging behind other developed nations.
“The U.S. is the only nation in the developed world with a rising maternal mortality rate,” said Rep. Lois Capps, D-Calif., at the briefing. “It’s shocking, but it is true.”
One thing is certain, said Callins, the OB-GYN working in rural Georgia. “We can’t keep doing what we’re doing, where we’re doing it, because it’s not working.”
Potential Solutions
Speakers at the April 13 briefing also shared solutions. Callins noted the important role of community health centers that provide care to people who can’t get it elsewhere. “We don’t turn patients away. We will see whoever comes through our doors,” she said.
To begin to address growing maternal mortality and racial disparities in maternal outcomes, the Alliance for Innovation on Maternal Health, or AIM, a national partnership of organizations committed to reducing maternal mortality and morbidity, has developed maternity safety bundles that include best practices, guidelines and protocols to improve maternal health care quality and safety.
Dr. Michael Lu, associate administrator of the Maternal and Child Health Bureau at the Health Resources and Services Administration, said one of the strategies of HRSA’s Maternal Health Initiative is to get maternity safety bundles into every birthing hospital in the United States.
These “bundles” include equipping hospital labor units with a fully stocked cart for immediate hemorrhage treatment, establishing a hospital-level emergency management protocol, conducting regular staff drills and reviewing all cases to learn from past mistakes, among other things.
The initiative also calls for a reduction in the rate of elective C-sections and C-sections among low-risk pregnancies. One in three babies in the United States are delivered via C-section, well above the rate of 10-15 percent that the World Health Organization recommends. The rate of C-sections, particularly for pregnancies that carry low health risks, is important to consider, especially as maternal death is on the rise in the United States. C-sections are one factor associated with increased maternal mortality.
Another strategy is to boost women’s health before and between pregnancies by improving access to preventive services and addressing social factors that affect health. One way to do this, for example, is to provide transportation and facilitate conversations with providers via telemedicine.
Dr. Elliott Main is medical director of the California Maternal Quality Care Collaborative. Main told briefing attendees that any progress on maternal health in the United States will require collaboration between policy, public health and clinical medicine.
“[It] is the only way to make progress on these issues,” he said.
