ATLANTA (WOMENSENEWS)–The Safe Motherhood Quilt tells of real women who should not have died in their childbearing years: Shanna Sacchetti of Syracuse, N.Y., was just 20. Julie Crowley of Mountain Home, Ark., was 28; she was survived by 6-week-old quadruplets. Nancy Lim, 42, of Oakland, Calif., left behind her husband and their infant Max.
A hand-stitched art work, its patches crudely tacked together, starkly tells the story of a silent national scourge–the preventable deaths of U.S. women from pregnancy and childbirth-related causes.
It is a complicated tale of the interplay of economics, poverty and the marketplace model of health care that means artificial hearts for the few who can pay and inadequate or absent health care and pre- and post-natal visits for those less financially fortunate, experts say.
However, these same health experts say specific reasons for the relatively high maternal mortality rate in the United States are elusive because the problem has not been carefully studied on a national level, and each victim’s story is different.
The evolving quilt–it starts with just 21 tales–calls attention to the problem of hundreds of thousands of U.S. women who suffer serious pregnancy complications, such as hemorrhage, infection or pregnancy-induced hypertension.
Nearly 1,000 of those women die a pregnancy-related death every year, and rates are higher for women of color, young women, older women and women with many children.
“We see it as a measure not only of what is happening during pregnancy, but as a measure of women’s health before and after pregnancy,” says Lynne Wilcox, director of the Centers for Disease Control’s Division of Reproductive Health.
The quilt project was conceived by Ina May Gaskin, president of the Midwives Alliances in North America and author of “Spiritual Midwifery,” and it is sponsored by the Safe Motherhood Initiatives, USA, dedicated to improving the country’s maternal mortality rates. Gaskin, who founded The Farm communal living center in Tennessee, began sewing the quilt in February after her research into maternal deaths filled her with sadness and frustration.
“I’d been told of so many women who have died, and I began to feel haunted by their stories,” she says.
Gaskin has stitched about half of the 12-by-16-inch patches herself and welcomes contributions. She hopes to eventually cull the names of all women who have died from pregnancy-related complications since 1982, the last year the U.S. maternal mortality ratio improved.
Nancy Lim in Oakland, for example, contracted a devastating infection after a Caesarian section, required a colostomy and died after eight months of illness, hospitalizations and surgeries.
Maternal Mortality a Measure of Women’s Health in General
“Maternal mortality and maternal health is really an indicator of what’s going on in women’s lives during their reproductive years,” says Lynne Wilcox, director of the Centers for Disease Control’s Division of Reproductive Health.
“When a woman dies in childbirth, sometimes it’s something that nobody could have foreseen,” adds Eugene Leclercq, professor and assistant chair of the Maternal and Child Health Department at Boston University School of Public Health.
“In other cases, it is about nobody paying attention to her.”
Experts are starting to pay more attention to the U.S. maternal mortality rate, which has stagnated even as the infant mortality rate has dropped. The current rate, about 7.7 maternal deaths per 100,000 live births, ranks 21st among developed countries. It places the U.S. among countries such as Slovenia and Portugal. The countries with the best rates include Spain, Norway and Canada–they have a lifetime risk of maternal death that is less than half the U.S. risk, according to the World Health Organization.
Recent Centers for Disease Control studies have revealed startling disparities in maternal death ratios in the United States, based on factors such as geography, race, ethnicity, marital status and age.
- Women in urban areas and in a swath of southern states that extends from North Carolina to New Mexico are far more likely to suffer a pregnancy-related death than women in other areas.
- Black women are four times more likely to die than white women from childbirth, pregnancy and their complications.
- Hispanic women in the United States are about 1.6 times as likely to die as white women, and those born outside the United States fare much worse than those born here.
- Unmarried women, women over age 35, and women who already have many children have a higher than average risk of death.
Disparities Caused by Poverty, Lack of Facilities, Transport, Lack of Education
“We see these disparities, but we don’t know why they exist,” says Wilcox, adding that more research and data are needed to help explain the differences. But many experts believe that they have a lot to do with access to health care.
“Lack of facilities, lack of transport, poverty, women who don’t know that they have choices–these are the challenges we face in our work,” says Theresa Shaver, a safe motherhood and child survival advisor for a partnership of nongovernmental organizations that deals with the global problem of maternal mortality.
“It’s a measure of the quality of our health care delivery system,” adds Sherri Marts, scientific director at the Society for Women’s Health Research. “And it’s one of the ironies of our system. We’ve chosen to stay with a health system based on the marketplace model. This is what you get: You get people walking around with artificial hearts, and you get a higher than expected maternal mortality rate.”
The marketplace model may help explain why the United States has not been able to match the lower maternal mortality rates in countries that provide universal health care.
“In many of those countries, there are not any financial barriers to care, so the likelihood of people being completely excluded from the system is low,” says Leclercq, the maternal health professor at Boston University School of Public Health.
Prenatal Care Isn’t Enough, Often Focuses on Babies, Not Women
“In the U.S. just a few percent of women get no prenatal care, but that’s a major risk factor for maternal death,” he says. Women who get delayed or no prenatal care often cite “no insurance or money” or “inability to get an appointment” as the reason, according to Centers for Disease Control studies.
But even ensuring prenatal care isn’t enough.
“States decide to provide prenatal care to make sure mother and baby are healthy, as if that resolves all the lack of care she had before and will continue to have afterwards,” says Leclercq. “It may also say something about how we value women–it seems to say that her main role here is just to deliver the baby. That’s shortsighted.”
U.S. hospitals must admit women once they are in labor, but even her care while in the hospital can depend on gritty financial calculations. “Decisions are driven, not necessarily by optimal patient care, but by economic and coverage concerns,” says Marts. “If there were any way to divorce these decisions from who’s paying for this and how, if it were really left up to mom and baby, that might be the direction to go in.”
A growing number of women’s health professionals feel that women should be constantly attended during labor and birth, so that problems are noticed immediately. Studies of attended deliveries show a marked decrease in complications and improved outcomes for both mother and baby.
Other initiatives discussed at the recent National Summit for Safe Motherhood include better definition and measure of the problem, better health education for women of reproductive age, and more public funding earmarked for women’s health research.
“We as a nation must do all we can to ensure that all mothers are safe and healthy before, during and after pregnancy,” says Dr. Wanda K. Jones, director of the U.S. Public Health Service Office on Women’s Health. She adds, “Death and serious illnesses due to pregnancy and childbirth should not be part of the picture in the United States.”
Rebecca Webber is a free-lance writer in Allentown, Penn. She has written on health topics for CBS HealthWatch and worked as a reporter for Glamour magazine. She has a master’s degree in journalism from Columbia University.
For more information:
Centers for Disease Control, Spotlight on Safe Motherhood:
Maternal Mortality Quilt:
International Safe Motherhood Inititative:
International Safe Motherhood:
World Health Organization, Country-by-Country Lifetime Maternal Death Risk: