Since 2018, maternal mortality in the United States has been on the rise, especially among black people, especially during the pandemic, and new data released this week reinforces an alarming and largely preventable trend.
In 2021, there were 1,205 maternal deaths reported to the CDC, compared with 861 in 2020 and 754 in 2019. An overall increase of about 60%.
(These figures do not include homicide, the leading cause of death among pregnant women. Pregnant women are 16% more likely to die from homicide than others their age. Become.
Maternal mortality – defined as death of persons within 42 days of gestation due to prenatal or pregnancy-related causes – increases with age in all races, with mortality in women aged 40 years and older being 6.8 that of women under 25 years of age Double. , according to the CDC.
However, the maternal mortality rate for black pregnant women was found to be 2.6 times higher than for white pregnant women. This is a well-known statistic and not at all shocking to doctors treating pregnant women. The mortality rate for black women was 69.9 per 100,000 live births compared to 26.6 per 100,000 for her whites.
“I’m not surprised,” said an obstetrician-gynecologist in Stamford, Connecticut. Tribe named V“Black women do not have equal access to care and do not feel safe. do It’s accessible because it feels like you’re in a hospital or clinic where very explicit or unconscious biases are in play. ”
When asked why such gross racial inequality among pregnant people persists, even though it’s been known for years, Goffranny said, “The system has There have been so many accidents that it only leads to more problems and I don’t think this is a problem.It will be resolved soon.”
“The plain reality is that America’s healthcare system is so broken,” Goffranny said, adding that he doesn’t need data to understand how black pregnant people are treated. rice field. She hears about it in a discussion with her patient.
In fact, in the United States Worst maternal mortality rate Among high-income countries; more than twice as many as the second and third worst countries (France and Canada) and about 16 times as many as New Zealand and Norway, according to the Commonwealth Fund.
Goffranny says the United States may report maternal deaths more accurately (or incorrectly) and more frequently than other similar countries, but that’s wishful thinking. There is no denying that there are diverse populations, including those who are fatter, those who become pregnant at an older age, and those who use assisted reproductive technology. All of these are associated with an increased risk of maternal mortality. Countries share similar characteristics and that argument only explains so much, he said.
a Lack of maternity care providers The United States, which includes both obstetricians and midwives, has shown that it may also explain the country’s high maternal mortality rate compared to the number of births. Many maternal care providers choose to stop performing births because of how exhausting, unpredictable, and risky (in terms of the high cost of malpractice) the work is, according to That’s it. More tired, more underrated, more attacked by the public. ”
“Let’s face it, we lie in America saying we really care about mothers, motherhood, and women.” We see this every day about reproductive rights. It’s illegal.”
In the United States, there is a great deal of pressure on pregnant women to work until delivery and then quickly return. Not to mention, the United States, despite having the highest number of pregnancy-related deaths after childbirth, is the only country that does not guarantee access to paid parental leave or home visits by health care providers.
especially because of that Roe v. Wade case With the depravity that last summer disenfranchised abortion in many states, more and more people are experiencing unintended pregnancies, becoming pregnant, and being forced to continue to term. people of color. (Some states are trying to push it further. For example, South Carolina has allow the death penalty For those who have abortions. )
“States that claim to value lives need to start putting money out of their mouths to defend and invest in fully realized lives that are alive now,” Goffrani said. rice field. “Women and mothers who need their help.”
US black experience high rate of unwanted pregnancies They also have more limited access to abortion than members of all other racial groups for a variety of reasons, including barriers to quality health care, family planning services, and mental health counseling. All of these factors increase the risk of depression, high blood pressure (pre-eclampsia), heart disease, physical violence during pregnancy, and maternal death among black pregnant women. It also affects babies, increasing the chances of low birth weight, premature birth, birth defects and death.
The pandemic certainly left its mark, too. With fewer appointments and telemedicine testing, many maternal medical conditions, such as high blood pressure and depression, may have gone unnoticed, increasing the risk of complications during or after childbirth, Goffrani said. .
These factors may have played at least some role in the increasing rate of sudden infant death (SUID) in the United States. According to a CDC study published this week in Pediatrics, SUID prevalence increased by 15% from 2019 to 2020, has become the third leading cause of infant death in the country. The proportion of black and Native American or Alaska Native infants was about three times higher than that of white infants.
Black infants saw the greatest increase in SUID rates, reaching the highest levels between 2017 and 2019. The researchers say that pandemic-related parenting losses or changes “may be due to unfamiliar infant sleeping positions and other unsafe sleeping habits.” ”
In an attempt to bridge racial disparities in health care, patients are often encouraged to seek help and advice from their health care providers more often, but “that’s not really possible today,” Goffrani said. rice field.
“We don’t have enough mental health providers to see our patients. Many of them don’t have insurance because they don’t get anything reimbursed,” Goffrani said. “In the end, the patient loses out because we are also making obstetricians responsible for their mental health.”
In theory, pregnant women could take steps to reduce their risk of dying during pregnancy, such as staying under recommended weight, quitting smoking and drinking alcohol, and addressing mental health issues. increase Before get pregnant. However, according to Goffrani, the advice is “full of privilege.”
“That means you have to have the financial means and the time in your life to recognize these problems, to know that these problems are not good, and to have the psychological capacity to make a change,” Goffrani said. “Even privileged people don’t take time off work to access this.”
That’s why “it’s most important to find a doctor, nurse, or midwife who you really feel you can work with and who listens, listens, and directs you in an authentic way,” Goffrani said.
But even that seemingly simple advice, she said, can’t be implemented without a certain degree of privilege. Poor quality of care and high incidence of maternal complications More than any other facility, the data shows. Yet, Black people still prefer to receive treatment from people who are similar and empathetic to them in hopes of receiving better care.
“When people talk about how they can advocate for themselves, it assumes they have options to choose from,” Goffranny said. We have a lot.”
