A woman in America in 1990 had a better chance of surviving childbirth than her own daughter does today. Ranked 46th among nations, the United States. is the only high-income country in the world where pregnancy- and childbirth-related deaths in women are rising.
Reversing the trend requires collaboration and support from all of us: women and their families, doctors, nurses and other health care providers, community health workers, advocates, policymakers and researchers, professional societies, government agencies and the private sector.
Critical efforts are already under way to tackle the leading contributors to maternal mortality and morbidity in the United States: the lack of data; inconsistent obstetric care; an increase in chronic conditions; and limited awareness of the problem. Many are working across sectors to design and test innovations, scale promising solutions and elevate women’s voices in policy and practice to ensure every woman has access to quality care, no matter where she gives birth.
A groundbreaking report
Every year in the United States, there are close to 60,000 near-deaths from pregnancy and childbirth-related causes. Roughly two women die every day. In its first-ever multi-state report on maternal deaths, the CDC found that up to 60 percent of them were preventable.
“A decade ago, we didn’t understand the problem, because we did not have the data — most states were not regularly tracking maternal deaths,” says Dr. Etiebet, lead and executive director of Merck for Mothers, a partner in the CDC’s Review to Action. Another partner, the Association for Maternal and Child Health Programs (AMCHP), reviewed maternal death cases in 12 states to identify the root problem and implement solutions. “Now, we know what to do to saves lives and help women thrive.”
The impact of maternal mortality is felt widely, but it does discriminate. In the United States, a Black woman is 3-4 times more likely to die from childbirth-related causes than a White woman. “We need to investigate why these racial disparities exist and what can we do to fix them,” Dr. Etiebet says.
Researchers from Averting Maternal Death and Disability (AMDD) at Columbia University are studying the experiences of women from underserved communities to shed light on factors contributing to the disparities, and to inform strategies for promoting respectful maternity care. “There is a huge opportunity to be more human and aware of how you talk to women,” says AMDD associate director Shanon McNab. “Powerful individual stories bring awareness.”
Building on its first citywide analysis of severe maternal morbidity — the “near misses” — New York City has begun interviewing individual women who survived a life-threatening complication about their interactions with maternity care providers to identify opportunities for systemic change.
Building a better future of care for mothers
Hospitals around the country are working to implement evidence-based, standardized approaches, called safety bundles, to improve how care teams manage obstetric emergencies, through programs such as the California Maternal Quality Care Collaborative, the New York State Safe Motherhood Initiative and the national Alliance for Innovation on Maternal Health (AIM). The Institute for Healthcare Improvement is also complementing efforts by AIM to scale these tools nationally.
Given that most deaths occur in the days and weeks that follow childbirth, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has been working to raise awareness of postpartum health risks by developing a checklist of warning signs and training nurses to educate new mothers before they are discharged from the hospital. “We need to start with education of practitioners and providers, and encourage doctors, nurses and even pediatricians to talk to women more about dangerous postpartum signs and symptoms,” says Dr. Trish Suplee, an associate professor at the Rutgers School of Nursing-Camden.
Community-based organizations are pioneering new integrated care models in which community health workers and doulas support high-risk women throughout and after pregnancy. The Camden Coalition, an association of health care providers, community partners and advocates in Camden, NJ, helps connect women with prenatal care, housing, counseling and treatment for addiction if needed. “The women we serve are stigmatized in all kinds of ways,” says Natasha Dravid, director of the agency’s clinical redesign initiatives. “We stand with them to help break some of that stigma.”
To advance the fight to end preventable maternal mortality in the United States, Merck for Mothers is launching Safer Childbirth Cities, a new multi-city initiative to improve outcomes and reduce disparities in maternal health.
Merck for Mothers is Merck’s 10-year, $500 million global maternal health initiative dedicated to creating a world where no woman has to die giving life. Learn more at merckformothers.com or find out how to become an advocate to #EndMaternalMortality through a coalition of patient organizations led by the Preeclampsia Foundation the Preeclampsia Foundation.
Kristen Castillo, [email protected]