Authors

  1. Killion, Molly M. MS, RN, CNS

Article Content

The American Heart Association (AHA) recently released a policy statement endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) encouraging a call to action to reduce maternal morbidity and mortality (Mehta et al., 2021). They list seven areas for policy recommendations to improve maternal outcomes: improve access to and education about the importance of preconception care; achieve cultural competence and bias reduction; lessen the gap of social and structural determinants of health; reform health care to provide value-based care; modernize health care to allow for increased access through telehealth visits and remote monitoring to ensure equitable access to care; improve public health infrastructure and digitize more health care to allow for ease in access and sharing of information; and, to improve quality reporting and data capture of maternal outcomes and health metrics (Mehta et al.).

 

Although maternal mortality has decreased globally, it has increased in the United States. The maternal mortality ratio in the United States is more than double the ratio of 10 other high-income, highly resourced countries (World Health Organization, 2019). Worldwide, major complications that lead to death include severe bleeding (usually postpartum hemorrhage), infections, hypertensive disorders of pregnancy, birth complications, and unsafe abortion (World Health Organization). In the United States, major causes differ with cardiovascular disease (including cardiomyopathy, cerebrovascular disease, or other cardiovascular disease) the most common and have increased over the past 2 decades, whereas hemorrhage, hypertensive disorders, and anesthesia-related deaths have decreased (Mehta et al., 2021). Women living in the southeast part of the United States, including rural areas in Appalachia and the Mississippi Delta, have the highest morbidity and mortality (Mehta et al.). Black and Native American women are two to three times more likely to die in childbirth than White women and these disparities exist at all socioeconomic levels (Mehta et al.). In certain areas of the United States, rate of maternal mortality for Black women is similar to some developing countries (U.S. Commission on Civil Rights, 2021). Much of this disparity is contributed to access to safe and equitable health care. Research has shown that Black women and other minoritized women are not treated with respect they deserve during the childbirth process (U.S. Commission on Civil Rights).

 

It is estimated that nearly two-thirds of maternal deaths are preventable (U.S. Commission on Civil Rights, 2021). Rising rates of maternal morbidity and mortality in the United States, especially when compared with other well-resourced countries, is not new information yet does not seem to be at the forefront of policy changes or public outcry. Until there is priority placed on women, mothers, and all childbearing people, many of these issues will not be rectified. Equitable access to high-quality, evidence-based, culturally competent (with training in implicit bias) care should be the bare minimum available to all people, especially those who are pregnant. The only way to truly prevent morbidity and mortality from childbirth is to not get pregnant. As certain areas attempt to limit access to reproductive rights, including access to contraception and safe abortion, childbearing people continue to be placed at risk of severe complications or death which is particularly unfortunate when the person may not have wanted to become (or remain) pregnant, but did not have the resources to afford to travel for safe and comprehensive reproductive counseling and care. It is time to prioritize maternal mortality as a health care crisis and provide the expectation that all who present for prenatal, labor, birth, and postpartum care will receive the best and safest care possible, no matter race, ethnicity, economic status, or location.

 

References

 

Mehta L. S., Sharma G., Creanga A. A., Hameed A. B., Hollier L. M., Johnson J. C., Leffert L., McCullough L. D., Mujahid M. S., Watson K., White C. J. (2021). Call to action: Maternal health and saving mothers: A policy statement from the American Heart Association. Circulation, 144(15), e251-e269. https://doi.org/10.1161/cir.0000000000001000[Context Link]

 

U.S. Commission on Civil Rights. (2021). Racial disparities in maternal health (2021 Statutory Enforcement Report). Washington, DC: Author. https://www.usccr.gov/reports/2021/racial-disparities-maternal-health[Context Link]

 

World Health Organization. (2019, September 19). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality[Context Link]