By William Fisher
Despite the U.S. spending more on maternal health than any other country in the world, deaths in childbirth among American women are on the rise and already surpass the morbidity rates in most developed countries.
That’s the principal conclusion reached in a new study by Amnesty International and data from the Organization for Cooperation and Development (OECD) and the UN’s World Health Organization (WHO).
The Amnesty study, entitled “Deadly Delivery,” reports that deaths from pregnancy and childbirth in the United States have doubled in the past 20 years -- from 6.6 per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006.
That would mean that, of the four million women who give birth each year, two to three women die each day in the U.S. from complications related to pregnancy.
While better reporting may account for some of the increase, the study speculates that it’s more likely that the figures may actually understate the problem because there are no federal requirements to report maternal deaths.
The OECD is an organization that brings together the governments of countries committed to democracy and the market economy from around the world. It provides a setting where governments compare policy experiences, seek answers to common problems, identify good practice and coordinate domestic and international policies. Its members consist mostly of the developed nations of Europe.
Other findings from the study:
American women are now at greater risk of dying from pregnancy-related causes than women in 40 other countries -- five times greater than Greek women, for example, and four times greater than German women.
And another 1.7 million American women -- a third of all women who become pregnant in the United States -- experience some kind of pregnancy-related complication that adversely affects their health. Severe pregnancy-related complications (known as “near misses” because the woman comes close to death) have increased 25 percent since 1998, the study reports.
"No American woman should die from childbirth in 2009, we can definitely do a lot better," says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).
Why are women in America more likely to die during childbirth than their peers in other developed nations?
The answer is complex and a number of factors may be at play. The study says about half of American women are entering pregnancy overweight. And a spokesperson for the U.S. Centers for Disease Control (CDC) says the latest maternal mortality data suggests one in four to one in five women who die have heart disease or diseased blood vessels. Other factors include financial and physical barriers to accessing care, including a lack of physicians in rural areas, and an overuse of risky interventions, such as inducing labor and delivering via cesarean section.
According to the Centers for Disease Control and Prevention (CDC), about half of all maternal deaths in the U.S. are preventable. Pregnant women and new mothers are dying because of “systemic failures” in our current health system, the Amnesty report says.
The alarming data on maternal mortality are even more shocking for African-American women. They are three to four times more likely to die during childbirth than white American women. And even wealthy black American women have a higher rate of mortality during childbirth than wealthy white women.
One factor may be high blood pressure; African-American women tend to have higher blood pressure than the rest of the population. But poverty and racism may also be factors.
JoAnne Fischer, Executive Director of the Maternity Care Coalition, which works with low income women to help them stay healthy during their pregnancies, says: "We do know that there is extraordinary stress involved in racism and in being poor. "And we know that sometimes this creates hypertension. "Hypertension, obesity and diabetes are all linked, so we have to make sure women start their pregnancies healthy."
The increase in maternal deaths is viewed against a history of steady decreases during the 20th century. Mortality rates reached very high levels in maternity institutions in the 1800s, sometimes climbing to 40 percent of birthgiving women. At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. The number in 2005 in the United States was 11 in 100,000, a decline by two orders of magnitude. However, that figure has begun to rise in recent years, having nearly tripled over the past decade in California.
The decline in maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care.
Recommendations for reducing maternal mortality include access to health care and emergency obstetric care, funding and intrapartum care. Moreover, political will and support play a major role and without it reforms to reduce maternal mortality cannot be made.
The risk of dying as a result of pregnancy or childbirth differs significantly by economic status from about 1 in 26 in Africa, to 1 in 7,300 in developed countries. Even within countries there is a marked difference in access to skilled birth attendants, a key intervention to improve maternal health, by a magnitude of six times between the lowest wealth quintile and the upper quintile. The proportion of women whose family planning desires are satisfied is distinctly linked to wealth, with the poorest lagging behind the richest in each region.
On a global basis, one woman dies every minute during childbirth, yet almost all of these deaths are preventable. In 2001, the UN set a goal of slashing maternal mortality by 75% by 2015, but it is still very far from meeting that target.