Maternal deaths have decreased worldwide between 2000 and 2017, but lower-income communities and countries are still at higher risk. In 2015, the World Health Organization recorded more than 300,000 maternal deaths, translating to 830 women per day.
The U.S. has a particular problem with maternal mortality, even in developed cities, due to closing Planned Parenthood clinics, abortion restrictions, and racism.
As of 2015, the countries with the highest maternal death rates include Nigeria, India, the Democratic Republic of Congo, Ethiopia, and Pakistan. Nigeria estimated 58,000 maternal deaths in 2015. However, women are most likely to die from pregnancy in Sierra Leone, and with each pregnancy she is “300 to 400 times more likely to die.”
There is a strong correlation between the average income of a country and the maternal death rate, while “healthcare and nutrition also play a big role” in maternal death rates.
In terms of the U.S., according to 2015 data, only 14 women out of every 100,000 die from live births. These numbers increase for Washington D.C., with 33 deaths per 100,000 live births. For just African American women in the area, the count changes drastically to 59.7 deaths. The death rate of pregnant women in D.C. is nearly four times the rate of the United Kingdom or France.
Between 2014 and 2016, African Americans composed 75 percent of the high maternal mortality rate. These inequities are further highlighted as “D.C. has the second-highest insured population in the country behind Massachusetts, according to U.S. Census Bureau data.”
Even compared to other large cities in the U.S., D.C.’s rate is incredibly high. New York City (“NYC”) records 23 and L.A. 18 per 100,000 live births. Both Maryland and Virginia have significantly lower rates of 24 and 12.
NPR reported that the maternal mortality rate for D.C. in 2018 was 40.07 deaths per 100,000 live births.
The Centers for Disease Control and Prevention found ways of preventing these high mortality rates through “access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs.”
D.C. is strategizing on how to curtail the rising maternal death rate. In 2018, the Maternal Mortality Review Committee Establishment Act was unanimously passed by the D.C. Council to create a committee charged with investigating ways to prevent maternal deaths.
NBC research found that introducing gestational limits for abortion and closing the Planned Parenthood clinic results in an increase in maternal deaths. Gestational limits are restrictions on during what months of pregnancy women may receive abortions. They found “a 20 percent reduction in Planned Parenthood clinics increased mortality by 8 percent on average.”
The Maternal Mortality Review Committee Establishment Act of 2018 established a committee to “evaluate maternal mortalities.” It also “identifies and characterizes the scope and nature of maternal mortalities.”
The law goes on to require the committee to “[recommend] systemic improvements to promote improved and integrated public and private systems serving pregnant women in the District.” It also lists who should compose the committee, allowing the mayor to choose a person who holds one of a specified list of occupations. The work of the committee is confidential, and they have the power to subpoena witnesses.
D.C. Mayor Muriel Bowser’s administration introduced the Investigating Maternal Mortalities Amendment Act of 2019, which requires the “chief medical examiner to investigate all instances of maternal mortality.”
The legislation comes after 2018’s maternal mortality was recorded at 36.1 maternal deaths per 100,000 births. Introduced on September 16, 2019, the act is still under council review. The mayor submits a project for council review, who then has 30 days to review the individual project and analyze impacts before they may “may approve, conditionally approve, or disapprove.”
D.C. is not the only place attempting to deal with high mortality rates and race disparity.
While NYC has a significantly lower maternal mortality rate than D.C., the number of deaths is on the rise in New York State (NYS). The disparity is more shocking in NYS: from 2014 to 2016, black women’s maternal mortality rate was 51.6 deaths, while white women were 15.9 deaths per 100,000 births.
Similar to Bowser’s actions, Governor Andrew M. Cuomo established a task force for all of NYS in 2018. This organization’s plan is clear from its name: Taskforce on Maternal Mortality and Disparate Racial Outcomes, clearly identifying and targeting the group with the most maternal deaths. Governor Cuomo also “committed eight million dollars over two years” for the work. In 2019, as a result of the task force’s findings, Governor Cuomo created the “Maternal Mortality Review Board,” which will not only collect data but prompt “implicit racial bias training and education program for hospitals.”
These are not the worst areas for maternal mortality: in 2010, Georgia was named the worst in terms of “maternal health care.”
Georgia reacted similarly to D.C. and NYS: lawmakers passed legislation, created a review committee, and developed projects. Yet, Georgia remains near the top of the list of U.S. states with the highest maternal mortality rates with 46.2 deaths per 100,000 births from 2011 to 2015.
In 2018, research showed that the incredible disparity continues in Georgia: white women died at a rate of 12.7 deaths per 100,000 births while black women died at a rate of 43.5 deaths per 100,000 births. While rates for Non-Hispanic black women have been the highest and fastest-growing because of centuries-long misconceptions about their lack of pain in childbirth, there are also elevated maternal mortality rates for “Native Americans/Native Alaskans, Asians/Pacific Islanders, and for certain subgroups of Hispanic women.”
Not only are states and cities moving to rectify this disparity, but organizations like the one founded by Dr. Joia Crear-Perry, who is a national expert on maternal mortality disparity. She founded the National Birth Equity Collaborative to work to eliminate these disparities between white and black mothers.
Research shows that it is not just race that impacts the care mothers receive, but also the hospitals women go to for childbirth. The assumption that black women do not have as much childbirth pian leads to doctors not taking pain complaints seriously, especially in low-income areas without enough resources or education. Data reveals that if black and white women went to the same hospitals, “there could be a possible reduction of severe maternal morbidity rates by 47.7% for black women.”
Severe maternal morbidity (SMM) describes the “unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman’s health,” according to the CDC. SMM is also on the rise.
The rate of maternity mortality is a strong descriptor for the health and strength of a society. The closure of Planned Parenthoods, abortion restrictions, and lack of understanding about black women and childbirth lead to high maternal mortality rates within the developed U.S. Therefore, D.C. must continue working to improve and lower the death rate in the capital of the U.S.