By Malena Amusa
Sunday, April 18, 2010
New York City statistics include the troubling finding that black women here are nearly eight times more likely to die from pregnancy-related complications than white mothers. Efforts to explain the trend appear nonexistent.
NEW YORK (WOMENSENEWS)--New York City is one of the most fatal cities in the United States for a woman to have a baby.
That's the indication from the most recent data on maternal mortality here, which show black women are nearly eight times more likely to die during pregnancy or right after childbirth than white mothers.
In 2008, black women in New York City experienced 79 maternal deaths per 100,000 live births compared to 10 white maternal deaths per 100,000 live births, and a national rate of 13 maternal deaths per 100,000 live births, according to the latest data available.
The rate of maternal deaths among black women in New York City has increased annually since 2004, when the city reached a low of 44 black maternal deaths per 100,000 live births. That's all according to vital statistics released by the city in January.
"If I were mayor I'd be saying, 'This is a priority,'" said Maureen P. Corry, the executive director of Childbirth Connection, a New York-based agency working to improve maternal health through research, advocacy and policy. "'This needs urgent attention. What is happening to women in our city?'"
New York City Mayor Michael Bloomberg started the year with the upbeat news that the average New Yorker's life span had increased by five months to 79.4 years, a historic high. At the same time, the city extolled the success of agencies in reducing smoking and infant mortality, helping to make the city one of the healthiest in the United States. While not specifically mentioning mothers, Bloomberg acknowledged that the need to reduce preventable deaths and health disparities in the city persists.
A spokesperson with Bloomberg's office declined to comment on the most recent maternal mortality statistics.
In the United States, more than two women die from pregnancy-related complications every day, according to an Amnesty International March report "Deadly Delivery." In addition to rising maternal mortality rates, the occurrence of a 'near-miss,' a term used to describe severe complications that nearly take the life of a pregnant woman, rose by 25 percent from 1998 to 2005, to nearly 70,000 women, Amnesty reported.
Only five states, including Vermont and Maine, have achieved the federal 2010 goal of cutting maternal deaths to 4.3 per 100,000 live births, according to the report.
The disturbing trend in black women's maternal health in New York City has been unfolding in apparent obscurity, with sparse major academic research found that analyses the trend.
Overall, New York City had 30 maternal deaths per 100,000 live births in 2008. That number is almost double the statewide rate in California, which has climbed to 17 maternal deaths per 100,000 live births in what some are tying to an increase in deliveries by Cesarean section.
"Hospitals doing a maternal mortality review are looking at how to respond to women," said Deborah Kaplan, assistant commissioner of New York City's Bureau of Maternal, Infant and Reproductive Health, which is helping hospitals assess the city's 141 maternal deaths that occurred between 2001 and 2005.
New York City and state health officials have not coordinated an effective action plan to target the myriad contributors to maternal mortality.
Hemorrhaging, embolism, a hypertensive disorder and heart disease are the leading causes of maternal deaths, according to the New York State Department of Health. Other experts cite C-section-related complications.
Hypertension and pre-existing medical conditions that distress mothers are more prevalent among black women and are compounded during pregnancy. A third of black women who gave birth in New York City in 2008 had pre-pregnancy obesity, which many consider to be a pregnancy complication. Nearly 70 percent were on Medicaid, the federal health program for low-income people.
"As a result of increased poverty and likelihood to face chronic stress and poor access to quality care, black women are likely to enter their pregnancy having health factors that put them at risk," Kaplan said.
Data indicate that black Caribbean and African women living in New York City in particular have negative maternity experiences. Mothers from Guyana, Haiti, Trinidad, Jamaica and Nigeria are more likely to lose an infant than African American women. The stress of working-class immigrant life contributes to poor maternal health, as do fears of encountering a complicated hospital system, say some health leaders in New York City.
An income-strapped woman can obtain low-cost insurance in New York State and apply for a special Medicaid package once she is pregnant. But eight weeks after her delivery, that insurance stops and this may contribute to a mother's health complications between pregnancies.
Setting aside the issues of limited access to medical care, low socio-economic status and inadequate-to-nonexistent health insurance, poor maternal health outcomes are still more common among black women, said Nereida Correa, medical director of MIC-Women's Health Services, a community health program of Public Health Solutions in New York City.
Correa works with six women's health centers in New York City that care for about 12,000 clients a year. Staff at these centers help women enroll in medical insurance, provide prenatal care and educate mothers before they go into labor about the symptoms of preeclampsia and high blood pressure.
"We have access to so much prenatal care and so many programs and we still have some of the biggest maternal health problems," Correa said.
Health leaders point to the rise of Cesarean sections to help explain the country's increase in maternal mortality.
One-third of births are now by C-sections. Ten years ago that figure was 20 percent, almost double the level the World Health Organization recommends industrialized countries should not exceed, lest they cause more harm to mothers than good. Among Manhattan hospitals, 22 to 40 percent of births in were by C-section in 2007.
A C-section can take anywhere from two to 30 minutes and carries the risk of causing deadly blood clots, said Dr. Aaron Caughey, a perinatologist and the medical director for the Diabetes and Pregnancy Program at the University of California, San Francisco. Caughey led a 2008 report about "labor arrest," which found that most C-sections can be avoided if doctors wait a few more hours for a stalled labor to turn around.
"The proportion of women who actually ask for a C-section is in the 3-to-5 percent range," he said. But many health institutions, fearing liabilities, train obstetricians that if a woman doesn't keep dilating after two hours of stalled labor, then it's best to do a C-section.
We need to be wide open about maternal mortality, said Correa of MIC-Women's Health Services, who also stressed the value of community-level health services that target women long before they enter a hospital.
"Most hospitals are worried that they would have to face liabilities. But we shouldn't be worried about liabilities when it comes to protecting our women against dying in childbirth," she said.
Malena Amusa is a New York-based reporter completing a book about her adventures in New Delhi.
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