5 Things to Know About The Maternal Health Crisis In America

The statistics surrounding maternal health in America are bleak. Maternal mortality is high. Pregnant women are suffering life-altering complications at an alarming rate. And, the risks are amplified for women of color. As part of our ongoing Answer This interview series dedicated to women’s health issues, we’re taking a deeper look at the maternal health emergency in America.

We spoke with Dr. Elizabeth Howell, Chair of the Department of Obstetrics and Gynecology at the University of Pennsylvania’s Perelman School of Medicine, about the causes of this crisis — and what can be done to help mothers. Below are five key takeaways from our interview. You can watch the full episode of Answer This with NowThis correspondent Zinhle Essamuah and Dr. Howell here.

The U.S. has the worst rate of maternal death among high-income countries: 26.4 out of 100,000. For comparison, Norway’s maternal death rate is 2. But for Black women, those statistics are even more dire: Black women are three times more likely than white women to die from pregnancy and childbirth. So-called “social determinants of health,” such as access to high-quality health care, good nutrition, and stable housing, in addition to patients’ pre-existing conditions, all contribute to these somber statistics. Still, Dr. Howell maintained that “there's a growing understanding of the role of structural racism” in these maternal morbidity rates.

And the data doesn’t lie; a college-educated Black woman is more than five times more likely to die in labor as a white woman with a college education. A Black woman over 30 is five times more likely than her peers to suffer complications. “Folks... often think these [statistics] are rooted in socioeconomic differences,” Dr. Howell said, “but these go far beyond that.”

Severe Maternal Morbidity (SMM) — the unexpected complications that can occur up to a year after pregnancy — steadily increased between 1993 and 2014,according to the CDC. The rate of women needing blood transfusions (hemorrhage is the fourth leading cause of maternal death) rose200% since the early 1990s. Hysterectomy increased 55% from 1993-2014. “We're talking about more than 50,000 women every year in the United States experiencing one of these types of significant complications,” said Dr. Howell.

And among underserved communities, inequities along racial lines are evident in Severe Maternal Morbidity (SMM). According to the CDC, “Among deliveries insured by Medicaid, the odds of SMM among Black women are about 1.7 times more likely than white women.”

An increasing number of pregnant women have hypertension, diabetes, or chronic heart disease — all ailments that can lead to complications. In fact, the CDC reports that cardiovascular episodes and strokes among pregnant women are increasing.

However, Dr. Howell points out that these chronic conditions are, largely, very common, and manageable with consistent medical care. If these conditions were managed “pre-conceptionally,” she said, “We could lower their risk during pregnancy and help them optimize not only their own health, but the health of their unborn child.”

Implicit bias — an unconscious prejudice against a group of people — can have profound implications in medical settings. A 2005 study from the National Academy of Medicine found medical professionals held “negative attitudes toward people of color.” As Dr. Howell cautioned, “We also have to think about the ways in which bias might be playing out within our hospital doors.”

Confronting implicit bias head-on, via training, is one measure Dr. Howell suggested, but added, “We have to have a multi-pronged approach.” Community outreach is key, she said, specifically for “understanding their perspective about what were the things that worked and didn't work. [It] can only help us improve the care that we deliver.”

Dr. Howell championed the idea of patient advocates — such as doulas, who are trained labor coaches, or patient navigators — to help underserved women through their pregnancy. Dr. Howell said this is especially true “if you have a significant chronic illness, your care can become very complex.” She continued, “They could provide education around not only the maternal health and maternal health risks, but the risks for the fetus and then the child.”

Expanding access to doulas — who often aren’t fully covered under insurance — can improve the odds for a successful labor. After all, doulas have a proven track record of success: A 2013 study of underserved mothers found that participants assisted by doulas were four times less likely to have a baby with a low birth weight, and two times less likely to have complications.

See our first installment of Answer This here, where we explore CMV, a common virus you've probably never heard of that can affect people of all ages, but can have long-term negative health effects for some newborn infants. We spoke to Dr. Gail Demmler-Harrison, an infectious disease doctor and professor at Texas Children's Hospital. Additional resources on CMV can be found here and here.