A Policy Brief On Maternal Deaths Within the United States
Note: Having written this in Microsoft Word, the formatting is a bit off, my apologies.
According to the World Health Organization, maternal death is, “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. The United States has the highest rate of maternal mortality in the developed world, as written about in Nina Martin and Renee Montagne’s articles, “U.S. Has The Worst Rate Of Maternal Deaths In The Developed World” and “The Last Person You’d Expect to Die in Childbirth”, at a staggering 26.4 deaths per 100,000 live births, as of 2015. What is even more troubling is that that number continues to rise as other developed nations continue to lower their maternal mortality rates. According to Martin and Montagne, there are four key reasons for this: lack of hospital preparedness in the case of maternal emergencies, less than 10% of federal “maternal and child health” grants goes to funding for mothers’ heath, overly complicated hospital protocols can lead to treatable complications becoming lethal, and improperly vetted doctors being allowed to complete maternal-fetal training without spending any time within a labor-delivery unit.
Should the United States want to address its maternal mortality rates, the two most effective strategies that could be employed would be the passage of the Preventing Maternal Deaths Act of 2017 and the widespread implementation of the California Maternal Quality Care Collaborative’s (CMQCC) various toolkits for dealing with maternal deaths.Should the United States government pass the Preventing Maternal Deaths Act of 2017, it would be a turning point for the maternal death crisis currently plaguing the U.S healthcare system. The bill is intended to:
Support States in their work to save and sustain the health of mothers during pregnancy, childbirth, and in the postpartum period, to eliminate disparities in maternal health outcomes for pregnancy-related and pregnancy-associated deaths, to identify solutions to improve health care quality and health outcomes for mothers, and for other purposes. (Beutler)
If the bill were to fulfill its intended goal, the federal government would facilitate in the development of maternal death review panels, whom would then take steps to address the given failure(s) that led to a maternal death. In other words, treating maternal deaths like a failure of the current system. By addressing the problem in a holistic manner and reviewing all the failures that lead to any given maternal death, this bill could give panels the autonomy to reform statewide hospital procedures and significantly reduce the wide ranging disparities within maternal deaths. From a political perspective, this bill could also help to stimulate interest and funding for a myriad of women’s health related issues and the disparities of those issues amongst different socio-economic groups of women. As Nina Martin and Renee Montagne write in their article, “Black Mothers Keep Dying After Giving Birth. Shalon Irving's Story Explains Why”, the gap between maternal deaths amongst women of different races is staggering, with black women being, “243 percent more likely to die from pregnancy- or childbirth-related causes”, than white women; a gap that, while substantial enough in and of itself, is potentially exacerbated depending on where one lives within the United States. However, while the state review boards this bill hopes to sponsor will undoubtedly alleviate the maternal death crisis, it fails to hold hospitals, healthcare providers and individuals accountable, as the current review boards present in 26 states, “‘de-identifies’ the records — strips them of any information that might point to an individual hospital or a particular woman. Otherwise, the medical community and lawmakers would refuse to go along” (Martin Propublica). This lack of accountability may lead to a lack of incentive for hospitals and hospital staff to familiarize themselves with any new form of protocol recommended by a state’s given maternal death review board. If hospitals and health care providers prioritize their own economic incentives, the bill may prove to just be another form of gathering data on maternal deaths, rather than an effective tool in combating it.
The California Maternal Quality Care Collaborative is an organization devoted to the reduction and prevention of life threatening complications during childbirth, along with the reduction of racial disparities faced by women in obstetric care. They are devoted to the reduction of maternal deaths through studying the most common complications in maternal deaths and creating toolkits to prevent those deaths. Through their toolkits, they aim to create simpler protocols and solutions to address very common and specific forms of childbirth complications. The specialization of their work is why it can be so effective, “Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year”, with the difference being so powerful that by 2013-- six years after the CMQCC’s founding--, “maternal deaths in California fell to around 7 per 100,000 births, similar to the numbers in Canada, France and the Netherlands — a dramatic counter to the trends in other parts of the U.S.” (Martin Propublica). However, one can draw the same conclusion that Michelle Murphy draws in her book, The Economization of Life, about the relationship between oral rehydration therapy (ORT) and its relationship to cholera, “as a technology of not dying, [ORT] does not do away with the experience…ORT prevented mortality but not morbidity…cholera was now preventable by a cheap emergency measure that did not demand changed conditions to world order” (Murphy 101). One can imagine a world wherein the CMQCC’s toolkits are ubiquitous in hospitals throughout the United States, but glaring racial disparities amongst women’s healthcare persists, including disparities in obstetric care. CMQCC’s toolkits address the issue of maternal deaths without addressing the underlying inequalities in women’s health, while also failing to account for the mental, and potential bodily, trauma faced by a near death experience due to complications from childbirth.
It is undeniable that the maternal death rate in the United States is one of the many glaring problems with the current healthcare system. It is a complete failure of the system, from healthcare providers to hospitals, preventable deaths are occurring at an alarming rate and that rate is rising. To tackle this issue in a comprehensive manner, my view is that it is imperative for acts like that Preventing Maternal Deaths Act of 2017 gain the political support to be passed. While initiatives like the CMQCC’s toolkits are great deterrents to maternal deaths, they are plagued with institutional bottlenecks, “it takes an average of 17 years for a new medical protocol to be widely adopted”, and it does not address the societal and cultural forces that maternal deaths symbolize and statistically prove, in particular the disparities faced among varying groups of women in healthcare (Martin Propublica). If it were to pass, the act could serve as a catalyst to address various issues regarding women’s health, as is the case with New Jersey’s review board which, “publishes a report, focusing on things like the race and age of the mothers who died, the causes of death, and other demographic and health data… the findings have been used to promote policies to reduce postpartum depression” (Martin Propublica).
Beutler, Herrera. “H.R.1318 - 115th Congress (2017-2018): Preventing Maternal Deaths Act of 2017.” Congress.gov, House - Energy and Commerce, 17 Mar. 2017, www.congress.gov/bill/115th-congress/house-bill/1318/text.
“Dying, Not Dying, Not Being Born.” The Economization of Life, by Michelle Murphy, Duke University Press, 2017, pp. 101
Martin, Nina, and Renee Montagne. “The Last Person You'd Expect to Die in Childbirth.” ProPublica, ProPublica and NPR, 12 May 2017, www.propublica.org/article/die-in childbirth-maternal-death-rate-health-care-system.
Martin, Nina, and Renee Montagne. “U.S. Has The Worst Rate Of Maternal Deaths In The Developed World.” NPR, NPR, 12 May 2017, www.npr.org/2017/05/12/528098789/u-s has-the-worst-rate-of-maternal-deaths-in-the-developed-world.
Montagne, Renee, and Nina Martin. “Black Mothers Keep Dying After Giving Birth. Shalon Irving's Story Explains Why.” NPR, NPR, 7 Dec. 2017, www.npr.org/2017/12/07/568948782/black mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why.
WHO. “Maternal Mortality Ratio (per 100 000 Live Births).” WHO, World Health Organization, www.who.int/healthinfo/statistics/indmaternalmortality/en/.
