The maternal mortality rate in the United States.



Pregnancy is supposed to be a beautiful experience and a magical time for the mother to be, her partner, and their family. However, despite the current developments in Medicine, maternal death is still a sad reality and a dangerous threat facing pregnant women in the USA.


According to the CDC and the World Health Organization, maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. [1]. 

The Maternal Mortality Ratio or Rate (MMR) corresponds to the number of maternal deaths per 100,000 live births [2]. 

The maternal mortality rate in the US:


According to the Pregnancy Mortality Surveillance System, the Maternal Mortality Rate in the United States has increased from 7.2 in 1987 to 16.9 deaths per 100,000 live births in 2016 [3]. The most recent data available are the numbers from 2018, which have just been published in the CDC’s National Vital Statistics Reports in January. According to that data, the MMR for 2018 is reported to have increased to 17.4 deaths per 100,000 live births [1]. 


This situation is alarming because, in spite of the various scientific and technological breakthroughs that the field of Medicine has known in the past decades, the Maternal Mortality rate continues to grow.

The maternal mortality rate in the world:

The situation is even more alarming because the United States has the highest Maternal Mortality Rate in a developed country. According to the WHO, Canada was reported to have an MMR of 10 per 100,000 live births in 2017, while the UK and Germany had reported an MMR of 7.

 

The United States, on the other hand, had a reported MMR of 19 per 100,000 live births [4], making maternal mortality in the United States the highest in comparison to other countries in the developed world.

Why such a high mortality rate in the US?


The exact reasons are unclear, according to the CDC [3]. However, many efforts are currently being made in an attempt to track and further understand these numbers efficiently.

Among these efforts the creation of the Maternal Mortality Review Committee, which specializes in reviewing death certificates to identify pregnancy-related deaths in an attempt to determine the preventability of maternal deaths and to make recommendations to prevent future deaths and to reduce disparities in maternal mortality [3]. 


However, as reported by the WHO, the majority of these deaths are preventable by improving medical care and by paying close attention to the women who are at risk [2].

Who is at a higher risk?


In the CDC’s last report on Maternal Mortality [1], two main risk factors have been reported: age over 40 and non-Hispanic black ethnicity.


The MMR of pregnant women older than 40 years old was found to be 7.7 times higher than that of women under age 25 [1].  
The MMR of non-Hispanic black women was 2.5 times that of non-Hispanic white women and 3.1 the rate for Hispanic women [1].


How many deaths could be prevented?


While these numbers are scary, these deaths are avoidable and preventable, just like the state of California has proven.

The California Pregnancy-Associated Mortality Review (CA-PAMR) is a statewide examination of deaths while pregnant or within one year after termination of pregnancy, which aims to identify the cause and the factors that contributed to the death, in an effort to improve opportunities in maternity care with the ultimate goal to reduce preventable deaths and pregnancy-associated health disparities [5].


The CA-PAMR was launched in 2006, to investigate the rise in maternal mortality rates and to identify improvement opportunities. Between 2008 and 2013, the State of California was able to decrease maternal mortality rates by nearly 50%.  

The state of California has implemented many programs such as the California Maternal Quality Improvement Toolkits and the Regional Perinatal Programs of California, which aim to improve health care and support among pregnant and postpartum women.

The maternal mortality rate is a critical public health issue in the United States and a serious concern for the health of American women. The numbers reported are scary, but thankfully more and more efforts are being made to understand and therefore tackle the problem.


REFERENCES :

1 : https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69_02-508.pdf

2 : https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

3 : https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

4 : http://gamapserver.who.int/gho/interactive_charts/mdg5_mm/atlas.html

5 : https://www.cdph.ca.gov/Programs/CFH/DMCAH/Pages/PAMR.aspx

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