The Rise of Maternal Mortality in the United States

By: Leah Howard

​Some of the best indicators of global health are infant mortality, life expectancy, and maternal mortality. The World Health Organization (WHO) recently released a report that from 2000-2013 found 157 of 183 countries had reductions in maternal mortality. The United States was not one of them. Instead, 48 states had a 27% increase in maternal mortality. This rate is highest amongst minorities. According to Dr. Barbara Levy,  the American Congress of Obstetricians and Gynecologists (ACOG) Vice President of Health Policy and Advocacy, African American women in some areas of the United States are at a higher risk of maternal mortality that some in Sub-Saharan Africa and South Asia. In addition, risk for African-American women living in Washington D.C. is over 70 times that of a Caucasian woman. Morbidity rates, or the incidence of disease in a certain area, are also on the rise. For every 1 maternal death, 100 women face morbidity or a life-threatening experience. This means 60,000 women every year face this issue. This may due in part to discrepancy in data reporting in the 1980’s and 1990’s as standardized questioning on the death certificate was not implemented until 2003.[1]
 
The maternal mortality rate in Texas is higher than any other state. In 2010, the rate was 18.6 per 100,000 live births. In 2012, it was 38.6 per 100,000. This increase over the span of 2 years is very uncommon and there is very little evidence as for why this change happened. However, the increase corresponds with cuts in women’s health programs and the shutting down of clinics in the state. California, on the other hand, was the exception, as this state's rate decreased from 21.5 per 100,000 live births in 2003 to 15.1 per 100,000 in 2014.[1] California has actively sought after improvements in maternal mortality by creating review committees to identify areas that need improvement and developing toolkits to reduce disparities in morbidity and mortality in what are called “bundles boxes,” which are binders that outline strategies to address leading causes of maternal mortality, including hemorrhage, hypertension, and venous thromboembolism (VTE)

Retrieved From: https://commons.wikimedia.org/wiki/File:Pregnant_woman2.jpg

​The increased rates of maternal mortality have been determined to be due to deaths such as hemorrhage, blood clots, and hypertension disease. In addition, substance use and abuse, mental illnesses, and partner violence may also play a role, as they are known to have detrimental effects on pregnancy. In a study on pregnant women in Philadelphia, about half of pregnancy related deaths were due to homicide, suicide, or unintentional injury. Mental illness and substance use was present in many non-overdose related deaths, and nearly half of the cases had unscheduled hospital visits within the month of their death, revealing that there were many opportunities to intervene.
 
Many of the current medical and public health efforts to alleviate the medical causes of maternal mortality, such as excessive bleeding and heart disease, fails to focus on the societal pregnancy-associated deaths which are just as , if not more, important in the causes of U.S. maternal mortality. There are many who believe that there is opportunity for intervention by using “out-of-the-box” strategies such as screening and support for those are deemed to be a part of the at-risk pregnant population which may have poor health outcomes. This is a strategy that could use more attention. 

Works Cited
1. Macdorman, Marian F., Eugene Declercq, Howard Cabral, and Christine Morton. "Recent Increases in the U.S. Maternal Mortality Rate." Obstetrics & Gynecology128.3 (2016): 447-55. Web. 29 Oct. 2016.