Merck funds effort to find solutions for maternal mortality

Giving birth is more hazardous today than in the 1980s.

In the United States, women giving birth in the 21st century are 2.5 times more likely to die of a complication of pregnancy or labor than women who gave birth three decades ago.

The trend, largely overshadowed by the much higher rate of infant deaths, has been getting a closer look in recent years.

In one of the newest initiatives, the Merck pharmaceutical company announced Oct. 1 the “Safer Childbirth Cities” program, which seeks to fund local efforts aimed at bringing those numbers down.

It’s part of the $500 million Merck for Mothers effort, which was formed in 2011 to reduce maternal mortality rates worldwide.

“What we want to do is really catalyze bottoms-up solutions,” said Dr. MaryAnn Etiebet, executive director of Merck for Mothers, which “thinks the best solutions are the ones that come from women themselves and from working with women in communities.”

Ohio was one of the first states involved in Merck for Mothers, with the Ohio Department of Health and Ohio State University participating in a Merck-funded federal program to collect data and recommendations from nine state committees investigating maternal deaths.

A report on that effort released this year found that more than 60 percent of maternal deaths were preventable. Contributing factors included lack of patient knowledge about warning signs, misdiagnosis or ineffective treatment by healthcare professionals and lack of coordination between providers.

The report came from Review to Action, a partnership of the Association of Maternal and Child Health Programs, the Division of Reproductive Health at the federal Centers for Diseases Control and Prevention and the CDC Foundation. The group promotes state-based maternal mortality reviews as the best way to understand why maternal deaths are increasing and to prioritize interventions.

Nationwide, 18 women died for every 100,000 births in 2014, the most recent data available from the CDC. That amounts to more than 700 women, and compares with just 7.2 deaths per 100,000 births (fewer than 300 women) in 1986.

In Ohio, women are faring better, with fatalities trending downward, based on reviews by the state maternal-mortality review committee, formed in 2010. In 2014, the most current year available, there were 10.8 maternal-related deaths per 100,000 births.

The numbers, however, should be viewed with caution, said Dr. Cynthia Shellhaas, a maternal and fetal specialist at Ohio State’s Wexner Medical Center who is an Ohio Department of Health Department consultant.

She said data has been collected for only a handful of years and that the numbers tend to “bounce around,” hitting as high as 24.9 per 100,000 births in 2009.

Chronic conditions, which can impact overall health, especially during pregnancy, may be part of the explanation for maternal deaths, said Sandy Oxley, who oversees the Bureau of Maternal, Child and Family Health at the state Health Department. Managing such issues before, during and after pregnancy, she said, is critically important.

Among such conditions, obesity, diabetes and high blood pressure all have been trending upward.

In Ohio, about 35 percent of adults had high blood pressure in 2017, compared with about 20 percent in 1990; about 11 percent had diabetes in 2017, compared with about 5 percent in 1990; and about 34 percent were obese in 2017, compared with about 11 percent in 1990, according to a recent report from the Trust for America’s Health and the Robert Wood Johnson Foundation, the nation’s largest public-health philanthropy.

Maternal mortality has gained recognition nationally, and the state committee has received queries from county and city entities, Shellhaas said. Many city–level efforts are aimed at infant mortality, which claims thousands more lives each year.

In 2016, more than 23,000 infants died in the U.S., a rate of 587 babies for every 100,000 births, according to the CDC.

Etiebet said the Safer Childbirth Cities initiative seeks to encourage organizations to submit “women-centered, community-centered” proposals that describe why they need funding and offer possible solutions to reduce pregnancy-related deaths. It also aims to foster partnerships between organizations and key community investors.

Etiebet said maternal mortality rates have grown in part because there was an assumption that there was no problem. She attributed that to the fact that data weren’t being tracked and healthcare advocates didn’t recognize the trend.

“We really aren’t listening to women when they are telling us what’s happening to them and what’s happening to their bodies,” she said. “And unless we do, we are going to miss those signs and symptoms and it’s going to be too late to address them.”

Maternal deaths, Etiebet said, impact entire families, including children, to an extent that they are less likely to graduate from high school.

“Each number is a life, and these deaths are preventable. And we shouldn’t be living today, in 2018, where we are not doing everything we can to save each of these lives,” she said.