Ma­ter­nal deaths ris­ing at alarm­ing rate

The Register Citizen (Torrington, CT) - - HAVE YOUR SAY - Su­san Camp­bell is a dis­tin­guished lec­turer at the Univer­sity of New Haven. She can be reached at slcamp­bell417@gmail.com. This col­umn was re­ported un­der a part­ner­ship with the Con­necti­cut Health I-Team (www.c-hit.org).

Why do so many preg­nant women and young moth­ers die?

Your guess is as good as our gov­ern­ment’s. We sim­ply don’t know. Even the sta­tis­tics we have aren’t cur­rent, though from all in­di­ca­tions the Unites States’ mor­tal­ity rate is ris­ing, as it is in Afghanistan and Su­dan.

But in the United States, the rate has risen by 136 per­cent between 1990 and 2013.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion rec­og­nized gaps in the data all the way back in 1986, dur­ing the Rea­gan ad­min­is­tra­tion. Since then, the CDC has re­quested that states share the death cer­tifi­cates of ev­ery woman who died dur­ing preg­nancy or within a year of giv­ing birth.

But it wasn’t un­til 2017 that all states al­lowed a check box on their death cer­tifi­cates to mark preg­nancy-re­lated deaths. The CDC re­ports sig­nif­i­cant dis­par­ity among races, with a far higher fig­ure for African-Amer­i­can moth­ers (43.5 deaths per 100,000 live births, com­pared with 12.7 deaths among white moth­ers). Ac­cord­ing to a 2014 study from, among other or­ga­ni­za­tions, the Na­tional Latina In­sti­tute for Re­pro­duc­tive Health, in some parts of Mis­sis­sippi the rate of ma­ter­nal death for women of color ex­ceeds that of sub-Sa­ha­ran Africa.

The most fre­quent cause of death (at 15.5 per­cent of all ma­ter­nal deaths) was car­dio­vas­cu­lar dis­ease. Other causes in­clude preeclamp­sia, a com­pli­ca­tion that can in­clude high blood pres­sure and dam­age to or­gans such as the liver and kid­neys. Doc­tors say that at least half of these deaths are pre­ventable.

This much we know: At 26.4 per 100,000 live births, the United States has the worst rate of ma­ter­nal death in the de­vel­oped world by sev­eral times over. The rate has risen by 136 per­cent between 1990 and 2013.

In Canada, the rate is 7.3 ma­ter­nal deaths per 100,000 live births. In Western Europe — Italy, Nor­way, Swe­den — the num­ber is 7.2. Since the United Na­tions set a goal in the 1990s to re­duce ma­ter­nal mor­tal­ity by 75 per­cent, the uni­ver­sal ma­ter­nal mor­tal­ity ra­tio was cut by 45 per­cent by 2013. But not in the U.S.

In ad­di­tion to the deaths of moth­ers, ac­cord­ing to a 2017 Quartz re­port, an­other 50,000 U.S. women nar­rowly es­cape death dur­ing preg­nancy or child­birth, and ev­ery year, an­other 100,000 women be­come se­ri­ously ill dur­ing or af­ter a preg­nancy. Here’s an­other per­spec­tive: A joint NPR/ProPublica re­port said that for ev­ery woman who dies from child­birth, 70 more come close.

In a time of big data, how is this an area where we fall trag­i­cally short? Data isn’t every­thing, but with­out know­ing the is­sue, there’s no chance we can ad­dress it.

In Con­necti­cut, eight women died between 2011 and 2014 — prob­a­bly. No more re­cent fig­ures are pub­licly avail­able. This past leg­isla­tive ses­sion, Gov. Dan­nel P. Mal­loy signed a bill that es­tab­lishes a ma­ter­nal mor­tal­ity re­view pro­gram as part of the state De­part­ment of Pub­lic Health. A pre­vi­ous it­er­a­tion of the pro­gram was de­funded in the state’s re­cent bud­get cri­sis.

But this pro­gram isn’t state-funded, ei­ther.

Compiling data takes time and it takes money. So how does a re­view of the roots of ma­ter­nal mor­tal­ity hap­pen with­out (cur­rent) data? And how does data get col­lected with­out fund­ing? Go to United Health Foun­da­tion’s Amer­ica’s Health Rank­ings and try to find cur­rent data on Con­necti­cut’s ma­ter­nal mor­tal­ity rate. It’s sparse.

This work is too im­por­tant to hand to doc­tors to try to work that into their al­ready-busy sched­ules. A high ma­ter­nal mor­tal­ity rate is a blight on the na­tion and the state. It’s pos­si­ble to share ma­ter­nal mor­tal­ity data and still pro­tect al­limpor­tant pa­tient con­fi­den­tial­ity. This im­por­tant work needs more than lip ser­vice. It needs fund­ing, and ded­i­cated per­son­nel.

Even the sta­tis­tics we have aren’t cur­rent, though from all in­di­ca­tions the United States’ mor­tal­ity rate is ris­ing.

Ro­drigo Abd / AP file photo

An Afghan women holds her daugh­ter, who is suf­fer­ing from mal­nu­tri­tion at the Indira Ghandi chil­dren’s hos­pi­tal, in Kabul. In­fant and ma­ter­nal mor­tal­ity, along with chronic child mal­nu­tri­tion, are among Afghanistan’s most dire health chal­lenges.

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