Maternal health crisis worsening in U.S.

Yesterday the Lancet released a major study highlighting maternal morbidity and mortality in 181 countries from 1990-2008.

The United States ranks 39th with 16.7 deaths per 100,000. We're behind most of the OECD -- behind Canada, tiny Malta, Croatia, Serbia, and the United Arab Emirates. Instead of declining is accordance with Millennium Development Goal 5 -- the target is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015 -- the U.S. saw a 2% increase in MMR from 1990-2008.

I want you to gaze upon these picture for a few minutes:

I know this is hard to read but bear with me: Countries in blue, from very dark to light, have seen a decline in maternal mortality. Notice that the U.S. is in red. That's because instead of declining, our rate has increased. Our company in seeing at least a 1% increase, in descending order: Zimbabwe, Lesotho, Botswana, Swaziland, South Africa, Namibia, Côte d'Ivoire, Mozambique, Malawi, [United States], Cameroon, Denmark, Singapore, Georgia, Nigeria, Afghanistan, Slovenia and Chad.

Again, hard to read, I know. But I wanted to show you the U.S. with its nearest neighbors, statistically speaking.

Considering that the U.S. spends more than $7200 for every man, woman and child on health care -- 16% of our GDP in 2007 -- shouldn't we be seeing a decline? Unfortunately, no. The U.S. does wonderfully on acute, emergency care, and on cutting edge care but we are merely middling when it comes to primary and preventive medicine, including pre- and post-natal care.

Yes, the State Children's Health Insurance Program lets pregnant women enroll but only very low income pregnant women. And only in states that obtained a Section 1115 waiver. In 2007, that amounted to a whopping 6400 pregnant women. Pregnant women with incomes at or below 133% of the federal poverty line ($29,326 for a family of four) are Medicaid eligible as part of the "categorically needy" eligibility group.

If you're wondering what the heck can be done to lower our MMR, some good news: health reform included home visitation for low-income pregnant women and covers tobacco cessation services for Medicaid and Medicare eligible pregnant women. But for the most part, we still don't know enough preeclampsia and HELLP, we mostly don't know what drugs are safe(st) for pregnant women, we don't know why women of color -- even when you control for income, education, and insurance status -- have higher rates of maternal morbidity and mortality.

We need some well-funded research post-haste. As the FY 2011 appropriations cycle starts up, check back here for information on advocacy efforts around safe motherhood including funding for the Maternal Child Health Block Grant (Title V),  Population Research and Voluntary Family Planning Programs (Title X, and NICHD.

And let us all repeat the following to anyone in earshot: A safe pregnancy is a human right for every woman regardless of race or income.

A giant, enormous thank-you to the folks at the Institute for Health Metrics and Evaluation for their incredibly useful data set tools. 

Comments

[Julie Pippert]

I have to hope that disallowing excluding pregnancy from insurance will help even in some small way. I was luckily able to access COBRA for my care when insurance excluded covering *any* part of my second pregnancy, otherwise my younger daughter and I would be one of those horrifying numbers.

I also wonder about infection rates and how those play a part. I contracted atypical antibiotic resistant pneumonia in the L&D and it took me months to recover. Another lady contracted H1N1 and died. A baby got chicken pox. Just a few example from people I know.

I totally agree with your analysis that we don't do enough of preventive care, and don't know enough about potentially fatal conditions.