A woman’s maternity should not be a one-way ticket to eternity
Globally, maternal mortality is on its way to becoming a public health victory with decreased deaths for many countries in recent years. However, the U.S. has not followed that trend. In fact, we’ve gotten worse. Between 2000 and 2013, when the most recent data is available, the number of women who have died from pregnancy has risen. Our rates are above Iran, Vietnam, Russia and Romania, countries that all saw a decrease in the past decade, and we are last among all high-income countries.
Maternal Mortality Ratio (MMR) is the number of maternal deaths per 100,000 live births. The U.S. had a MMR of 28 in 2013, which is about a 27% increase since the year 2000. The Institute of Metrics and Evaluation, which released the MMR data in September, has projected that the U.S. MMR likely dipped to 25 in 2015, but data is not yet available to confirm this projection. While deaths are still relatively rare, we have a lot of work to do.
The reason for the increase in mortality can’t be pinpointed to one issue, but likely a complex set of reasons such as access to health care, insurance coverage and pre-existing chronic conditions like diabetes, hypertension and obesity. A little over 40% of American women are obese and at least 1 in 10 adult women have diagnosed diabetes. Diabetes can cause harm to the unborn child, including miscarriage or birth defects. Between 1988 and 2012, the prevalence of diabetes increased significantly in every age group, in both sexes, in every racial/ethnic group, by all education levels, and in all poverty income ratio tertiles, a 2015 study of American adults found. However, we know that these chronic conditions (and maternal mortality) do not affect everyone equally. Socioeconomic factors and geographic location are tied closely to the risk of maternal mortality. American Indians are more than twice as likely as non-Hispanic Whites to have diabetes and African Americans have almost double the rate of Whites. Diabetes rates are also greater for people with less than a high school graduation. Geographically, Texas, a state known for its limited women’s reproductive health services, has seen its MMR double in a two-year period while California saw a decrease. MMR disparities exist and need to be addressed using targeted resources and interventions.
The health of a woman during and after pregnancy begins long before she may even be considering getting pregnant. Therefore as part of a multi-prong strategy, public health practitioners need to focus resources on preventing chronic conditions throughout the life course. For example, a multi-component school-based obesity program implemented in elementary school has been shown to decrease obesity in childhood and adulthood. Universal preschool, another early childhood program, has been shown to reduce smoking and smoking-related health risks later in life. Other programs implemented during pregnancy, such as a nurse-family partnership program where trained nurses visit low-income first-time mothers before birth and up to the baby’s second birthday, leads to reductions in mortality among mothers and their children. A program like this that targets at-risk women also helps to address the inequities of MMR.
Other programs that improve women’s health throughout the life course and especially target those most at-risk will be necessary in order to decrease inequities and reverse this troubling trend.