Solving Maternal Health Problems in the United States: Signs of Hope?


December 14, 2021 – In the United States, nearly 4 million women prepare for childbirth each year, looking forward to the joy that is coming. But for some, dream it becomes tragic. About 700 women die each year either during pregnancy or in the weeks after giving birth. And there are 60,000 more related to pregnancy or childbirth-connected health questions.

The causes of death vary greatly, including bleeding during pregnancy or during childbirth, heart conditions and mental health problems such as substance abuse and suicide after birth.

In 2019, the maternal mortality rate in the U.S. was 20.1 per 100,000 women, according to the CDC, significantly higher than the 17.4 per 100,000 recorded in 2019. 2018. For black women, the maternal mortality rate was more than twice the total – 44 per 100,000 in 2019.

“We need to address our terrible maternal health care system and we also need to address inequalities,” says Laurie Zephyrin, MD, vice president of health equality for the Commonwealth Fund, a foundation that supports independent research on health care issues. “This is an issue that has long demanded national attention time. “

“Overall, our maternal mortality rate is more than twice that of more than 10 other high-income countries,” she says.

As sobering as the problem has been, recent developments have raised hopes that a reversal of course is possible. Between them:

  • US News & World Report, long known for its hospital rankings, it released its first ever “Best Maternity Hospitals” rankings on December 7, highlighting facilities that perform well on key quality indicators. It plans to update the report annually.
  • On the first Day of Maternal Health Action at the White House on December 7, Vice President Kamala Harris called for a call to action to reduce maternal mortality and pregnancy-related health problems, while expanding postpartum coverage through Medicaid programs, among others actions.
  • The Centers for Medicare and Medicaid Services will establish a new hospital label called “Pleasant to Birth”. The label will be awarded to institutions participating in a program aimed at improving maternal outcomes and using patient safety practice.
  • President Joe Biden’s proposed Build Back Better plan includes provisions for maternal health, including $ 3 billion in new funding for maternal health. The money will be used to increase and diversify the workforce caring for pregnant women, better coordinate care and strengthen maternal health research, among other projects.
  • Ongoing efforts in Congress are focused on correcting large differences in maternal health affecting black women. Regardless of income level or education, black women are at higher risk of maternal death and other health problems than white women. A black woman with a college education is at 60 percent higher risk of maternal death than a white or Latin American woman who did not finish high school, according to the Commonwealth Fund.

The best maternity hospitals

For your ranking, US News and World Report came to 2,700 U.S. hospitals offering maternity services, says Ben Harder, head of health analysis and editor-in-chief publication.

To receive recognition, the hospital had to submit data from 2019 and meet the publication’s maternity care standards. The publication received responses from only 571 hospitals, representing approximately 2 out of every 5 births in the country.

Of these, 237 were identified as the best for motherhood.

As to why the response rate was not higher, Harder cites the burden of reporting and says it is understandable. Some hospitals may not have staff, especially during a pandemic, to collect data to assess US News and World Report.

According to their other estimates, the scales are based on Medicare data, “so hospitals don’t have to move a finger.” He expects more hospitals to respond to their future maternity care assessments.

The evaluators focused on five quality measures, giving a rating based on Caesarean section birth rate among first mothers, early elective birth, unexpected newborns complication rates breast-feeding rates and possibility of vaginal delivery after caesarean section (VBAC).

Call to action: expand coverage

Speaking on Mother’s Day at the White House, Harris told attendees, “The challenge is urgent, it’s important, and it’s going to take us all.”

Pregnancy and childbirth, she said, should not carry such great risks. She focused on systemic inequalities in the way women are treated and the dramatic impact of maternal death and health problems on the economy.

“A healthy economy requires healthy mothers and healthy babies,” Harris said He said.

“Before, during and after childbirth, women in our nation die at a higher rate than any other developed nation in our world,” she said, noting that research shows that black women, Indians and women in rural America are more likely to suffer.

The main call-to-action strategy, according to Harris, encourages states to extend postpartum coverage to pregnant women enrolled in the Medicaid or Child Health Insurance Program (CHIP) from the existing 60 days to the full year. Together, these two programs cover over 42% of births in the country, so expanding coverage is expected to have a big impact.

60 days of coverage is not enough, because many deaths and complications occur more than 60 days after birth, Harris said. Logistics for states to expand coverage was established by the U.S. Rescue Plan and will be available by April 2022, she said. Some states have already extended the postpartum coverage.

According to the Centers for Medicare and Medicaid Services, if each state passed the extension, as proposed by the Build Back Better Act, the number of Americans receiving full-year coverage after childbirth would roughly double, increasing coverage by about 720,000 each year.

Congress actions

Congress is also working on that issue. Black Mother Health Act Momnibus of 2021, for example, proposes several measures, including improving maternal nutrition, expanding affordable housing and expanding maternal workforce to include more doulas and midwives.

“And for so many women, let’s keep in mind that doulas are literally salvation,” Harris said at a White House event.

Doules are trained to provide women with physical, emotional and informational support before, during and after childbirth. There are no reliable statistics on their number in the U.S., but a March of Dimes report estimates that about 9,000 were included in the 2018 registration database.

Explaining and correcting inequalities

No one can explain with certainty why black women are at greater risk of death from pregnancy-related complications. Systemic inequality is one of the probable reasons, Harris said, noting that there are differences in the way people are treated depending on who they are.

Innate and unconscious bias in providing treatment to women plays an important role, experts say. Training could reverse or reduce that bias. Some skin colors may also have less access to care, as can women in some rural areas.

According to Harris, more than 20 companies and nonprofits have pledged more than $ 20 million in maternal health efforts in the U.S. and more than $ 150 million worldwide. Among the proposed programs are: remote care monitors in rural areas, better models of postpartum care, and improved education programs for maternal health care providers.

When statistics hit the homepage

Many who work to improve the health of their mothers have gone through problems themselves or have had loved ones.

Jill Arnold, founder of the Bentonville Maternal Safety Foundation, AR, became a consumer advocate after giving birth to her two daughters, now teenagers. With her first childbirth, Arnold says she was under a lot of pressure at the last minute to have a caesarean section. She endured, resisted and gave birth healthy child vaginally.

For her second childbirth, she chose an accredited maternity center that provided her with a doula and midwife.

“The care I received was night and day,” she says. “There was no huge pressure to agree to a caesarean section.”

She welcomes the information provided by the new one US News and World Report scales as well as upcoming “Birthing Friendly” tags.

“The burden should not be on patients, on individuals, on pregnant women to conduct research,” says Arnold.

Instead, women and their partners need information at their fingertips to be able to make an informed decision about how to give birth and where.

U.S. MP Lauren Underwood (D-IL), who co-founded Black Maternal Health Caucus with Alma Adams (D-NC) in April 2019, wrote a touching blog in the magazine Health jobs to explain her passion in improving maternal health.

Her former classmate, Shalon Irving, who later became a CDC epidemiologist, died in February 2017 at the age of 36, just 3 weeks after giving birth, when complications developed from high blood pressure.

The Underwood blog provides statistics and details of the Black Mother’s Health Act of 2021, and then concludes the blog, published in 2020, with an update on how Shalona’s then three-year-old daughter, raised by her grandmother,. While Soleil is ‘curious, joyful and brilliant’, Grandma told Underwood that she also walked into the room and found the little girl holding a framed photo of her mother.

The child’s question is understandable and heartbreaking: She wants to know where her mom is.

“Soleil’s question is my motivation,” Underwood writes. “In honor of Shalon and all the women like her that we have lost, let us take the serious and urgent action needed to save our Mom. “


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