Black Maternal Health of New York City

Part: 2

NYC's High Maternal Deaths Defy Usual Explanations

By Rita Henley Jensen

WeNews editor in chief

Wednesday, March 16, 2011

New York's high rate of maternal mortality exposes glaring risks for black women. But a detailed 2010 city report eliminated many usual suspects for the maternal morality gap: poverty, obesity, pre-existing conditions. The first story of a series.

Page 2 of 2

Lack of Prenatal Care

The lack of prenatal care, even in a city with public hospitals and clinics, played a definitive role in the maternal mortality rate. The 2010 report indicates that 51 percent of those who died had "adequate or adequate plus" medical care while they were pregnant, however this data was not broken down further by race or ethnicity.

Of the mothers who died as a result of a pregnancy, the city's report found 58 percent were African American. That's an outsized statistic on its own, but even more glaring against the minority status of black women, who represented 24 percent of all births.

Ten percent of the pregnancy-related deaths were of white women, who represent 30 percent of all births.

Hispanic and Asian-Pacific Island pregnant women, who represent 45 percent of all who gave birth, died at twice the rate of white pregnant women but at significantly lower rates than black women.

Physicians, researchers, academicians, midwives and public health experts agree: Most of these deaths are preventable.

Obesity among those who died was emphasized in the city's official statements about the implications of the report. Pre-existing conditions have been the subject of significant research. Poverty and lack of maternal health care are often linked by maternal health activists to high maternal mortality rates.

However, the data in the city's 2010 report indicate that the medical community might have to look further than these usual suspects and ask themselves what more can be done by medical providers to save women's lives, particularly African American women.

Obesity Factor

Obesity was the maternal mortality factor focused on in the city's press release about the report, in line with Mayor Michael Bloomberg's health agenda. In the New York study, 44 percent of the white pregnant women who died were obese; 60 percent in the case of African American women--an imbalance but not sufficient to explain the vast difference between the percentage of white women and African American women who die.

At the same time, this data suggest obesity could be a bigger risk factor for black women, but the lack of information providing the percentage of C-sections among black women who died prevents a real finding.

The report also indicates that obese pregnant women with two or more previous births were at highest risk, responsible for 60 percent of deaths among women with two or more children. This data was also not broken down by race and ethnicity.

In fact, the report does not make clear the connection, if any, between C-sections and the mortality rates of obese women.

Carol Sakala, director of programs for Childbirth Connections, said during an interview about the report that she was concerned that obese women were "tracked" into having C-sections despite the risks.

She acknowledges that it might be more difficult for medical personnel to assist an obese woman giving birth, but given the alternative, she argues that more effort should be made. Childbirth Connections is a national nonprofit organization based in New York City dedicated to improving the quality of maternity care.

Poverty

While obesity proved an inconclusive factor in the maternal mortality disparities, poverty, which is often raised as a possible explanation, was apparently not a primary factor in the city's high maternal mortality rate or the high rates among African American women.

Pregnant women who had private insurance and those insured by Medicaid--government insurance for those with low incomes--had similar maternal mortality rates, the report found.

The Age Factor

A chart in the city report indicates that maternal mortality hit a low between the ages of 20 to 24, rose by 10 percentage points after age 30 and doubled after age 40.

Older age is a long-established medical risk factor in pregnancy but Sakala, from Childbirth Connections, pointed out a less-noted suspicion. She said that she was concerned that the high number of deaths among older mothers might reflect that many women underwent multiple Cesarean sections

"Each C-section a mother has is more dangerous," she said.

Pre-Existing Conditions

As for the final usual suspect, according to the New York City report, of the mothers with pre-existing conditions who died, 56 percent were white and 58 percent where African American. (Of the Hispanic women who died, 60 percent had pre-existing conditions; of the Asian women, 28.6 percent did.)

In other words, pre-existing conditions played a similar role in black and white women and didn't account for demographic differences in the rate of maternal deaths.

Which is exactly what keeps Dr. Callahan awake at night. If it is not pre-existing conditions, not obesity, not poverty, not age, then how to explain why African American women die at such higher rates?

"I have more questions about the why than answers," he said.