Public Health Grand Rounds is a monthly webcast created to foster discussion on major public health issues. “We immediately switched over to be able to provide virtual doula services, offered to all of our clients,” Porchia-Albert told Nina Bahadur in Self. I got some pushback about this on Twitter, mostly saying that the delivery room was too narrow a focus. If this is not achievable in a country, the goals are to reduce the 2010 baseline MMR by at least two-thirds and that no country should have an MMR over 140. Chan School of Public Health After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. Fair warning: this post is longish and chart-tastic and doesn’t come to any firm conclusions. Given the already unacceptable Black maternal mortality rate in the US, how can we double down on our support of Black mothers and birthing people* during a pandemic that is amplifying health disparities? This extension will take effect on July 1, 2020, according to a DHCS update (PDF). Birthing people who do not have access to technology or the internet should be given an iPad and a data plan to facilitate telehealth, McLemore wrote. Combined, these factors help explain why states with large populations of black Americans register some of the highest rates of maternal mortality in the country. Midwives Can Significantly Reduce Maternal Mortality, But They Need Support Posted on May 5, 2016 May 4, 2018 By: Kayla McGowan , Project Coordinator, Women and Health Initiative , Harvard T.H. Abstract. If you value what you get from Mother Jones, please join us with a tax-deductible donation today so we can keep on doing the type of journalism 2021 demands. None of them appear to be the answer. Nor is this something that’s been recognized only recently: there are papers going back more than 20 years on the subject. Other high-income countries with success in preventing maternal deaths offer potential lessons for the U.S. Terms of Service apply. Taken together, then, the black-white difference in allostatic load appears to be the equivalent of 1-3 points on an IQ test. Solutions to Reduce Maternal Mortality. Can you pitch in a few bucks to help fund Mother Jones' investigative journalism? Thus, an important intervention to reduce black maternal mortality rates is to subsidize and increase access to quality mental health treatment focused on … Unfortunately, COVID-19 has necessitated physical distancing, and hospitals from San Francisco to New York have banned visitors from labor and delivery to protect patients and staff. In fact, the United Nations initiated the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030. The registry “will track participants for a year to learn how the virus impacts maternal health, fetal development, preterm delivery, newborn health and outcomes for underserved women at higher risk of mortality during pregnancy,” Feldberg wrote. One reason for this is the “Hispanic paradox”: Hispanics certainly encounter systemic racism too, but the maternal mortality rate for Hispanic mothers is about the same as for white mothers. For the first time, the United States has standardized maternal mortality data from all 50 states — a first step toward identifying ways to reduce pregnancy-related deaths, experts say. Using standard deviations to normalize them, the three measures showed that blacks had a mean allostatic load that was 0.1, 0.2, and 0.29 SDs higher than whites. What about other measures of stress? The following chart from a CDC study is complicated, so take a look at it and then read the explanation: In this study, the researchers grouped hospitals as those that primarily served whites and those that primarily served blacks. The Shades of Blue Project was founded by Licensed Community Health Worker Kat Matthews to help minority women suffering from postpartum depression and/or anxiety. Senior Communications Officer, Improving Access, Kareem Abdul-Jabbar But there’s finally some good news on this front. This mystery is what makes the toxic stress hypothesis appealing: it seems reasonable, since black women of all incomes and education experience stressful incidents of racism throughout their lives, and nothing else seems to account for their higher rate of maternal mortality. But recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death. Maternal mortality is higher in the U.S. than any other developed country. Medical facilities can also take action. * We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.”. “Because some of our clients may not have access to smartphones, we work via phone, text message, Zoom, FaceTime, as well as WhatsApp.”. That was fair enough, so I decided to look into this. And last year, UNICEF reported that compared to other high-income countries, American women experience the highest rate of maternal mortality … First let me just say that, we know the best policies are data-informed, but I do believe that the best policies are advanced by leaning in and lifting up those who have been most personally impacted. Finally, a fourth study in New Orleans found that black mothers had a lower allostatic load than white mothers. She is the author of the weekly “Essential Coverage” column in The CHCF Blog. In January 2020, California Senate Bill 464 took effect, requiring hospitals to train their maternity care staff about implicit bias. © 2021 California Health Care Foundation. Today, reader support makes up about two-thirds of our budget, allows us to dig deep on stories that matter, and lets us keep our reporting free for everyone. The following are research-based policy recommendations to better address the unique needs of Black women and their infants, and thereby reduce Black infant and maternal mortality. For instance, the NBEC provides racial equity training sessions to … Medicaid coverage for pregnant women now lasts 60 days postpartum, but research suggests that extending postpartum coverage can benefit all women of color, who are burdened with maternal health disparities. More than 22,000 babies die before their first birthday each year in the U.S. and the infant mortality rate is twice as high among Black babies compared to white babies. After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. Yet, between 2000 and 2013, high Black maternal death rates placed the United States second worst in maternal mortality among 31 Organisation for Economic Co-operation and Development nations. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.” In addition, she has managed marketing and communications for a digital health start-up and an education technology nonprofit. First, pregnant individuals should be prioritized for COVID-19 testing, Laurie Zephyrin, MD, vice president of health care delivery system reform at the Commonwealth Fund, wrote in Stat. Data from the Centers for Disease Control and Prevention (CDC) on births between 2011 and 2014 revealed rates of 12.4 deaths per 100,000 live births for white women and 40.0 deaths per 100,000 live births for black women. As you can see, the black-white differences (black bars) are fairly small for most indicators. According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events. The enormous difference in black-white maternal mortality persists even in the state with by far the most success at addressing it.¹. Dean was funded by the county’s Black Child Legacy Campaign, which works to reduce the disproportional number of Black infant and child deaths in Sacramento. During Black Maternal Health Week, which is led by the Black Mamas Matter Alliance and held every April, California senator Kamala Harris wrote in Essence, “We must speak the truth about America’s history of health disparities that existed long before the coronavirus pandemic, including the grave ongoing crisis of Black maternal mortality.” They’re truly large only for two: PCD (problems with blood vessels in the brain during the six weeks following delivery) and IHM, or in-hospital mortality. The racial differences are modest and don’t seem to correlate well with maternal mortality anyway. That’s barely enough to be noticeable. It comes from a study that measured the average “allostatic load” for blacks, whites, and Hispanics. Almost all maternal deaths (99%) occur in developing countries. The problem is that if you accept both the AL theory and the toxic stress hypothesis, they don’t seem to correlate well. Again, this suggests a fairly small difference between black and white women. Both Zephyrin and McLemore emphasized the importance of increasing perinatal access to telehealth services, including doula care. At the very least I needed to look at the entirety of prenatal care, and beyond that the differences in black-white lifetime medical care. Even California, which has cut its maternal mortality rate in half over the past ten years—mostly by reducing the use of cesarian sections—has cut it equally for both black and white mothers. Solutions to Reduce Maternal Mortality and Morbidity. That said, there are shockingly few rigorous studies trying to tease out the causes of this disparity. We noticed you have an ad blocker on. The issue is critical — but it's also not new. Subscribe today and get a full year of Mother Jones for just $12. Note that although this is highly suggestive, it’s still a comparison of groups, so it doesn’t prove anything firmly. Proposed funding will dramatically expand Medicaid coverage for new moms, increase home visiting, and explore Medicaid reimbursement for Doula support services. Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women – and this disparity increases with age, researchers from the Centers for Disease Control and Prevention (CDC) report today in the Morbidity and Mortality Weekly Report (MMWR).. It’s unclear, however, whether these changes will continue after the pandemic. The virtual course has a human rights framework and teaches nurses how to elevate and honor communities of color, especially Black pregnant individuals, whose concerns about maternal mortality have been compounded by COVID-19. “First, we must review, report, and learn from every single maternal death,” he said when outlining his multipoint plan for reducing black maternal mortality. By reducing care variation in the highest risk areas, hospitals and providers can begin to change the narrative on maternal mortality. Because little is known about how the coronavirus affects pregnant women and their babies, research is needed to inform health care, policy, and personal decisions around labor and delivery. There’s some modest evidence that wider use of doulas could reduce both infant and maternal mortality, but no evidence that it would reduce the black-white gap. COVID-19 will affect our health care system and the experiences of expectant parents for the foreseeable future, but there are many steps we can take to improve care for Black mothers and birthing people and their babies. The first thing to look at is the causes of maternal mortality: The three causes with the biggest black-white differences are cardiomyopathy (heart disease), embolism (blood clots), and eclampsia (a pregnancy-related illness that produces swelling and high blood pressure). We already know that. Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox. Weiss: How can we reduce rates of maternal mortality among black women? Research shows that women who receive continuous labor support — whether through a nurse, midwife, or doula — are more likely to give birth without intervention or pain medications, be satisfied with their birth experience, and have babies with higher Apgar scores, which indicate the baby tolerated the birthing process better. According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events. Pressley: What am I trying to do specific to maternal mortality rates? The November 2017 session, Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States, discusses efforts to analyze and prevent future deaths. That changed a few months ago when Congress passed a bill that authorizes $58 million per year for the next four years to study maternal mortality. After receiving numerous requests from labor and delivery nurses who wanted to better support pregnant patients who could no longer have a doula with them, Porchia-Albert created a “crash” doula course for nurses. Taking the average, this suggests that blacks have an AL about 0.2 SDs higher than whites—roughly the equivalent of three IQ points. Currently, with the U.S. ranking 47th out of 183 countries in maternal mortality, the stakes are high, and the pressure is intense. Instead, she was worried that without her doula by her side, the delivery room staff would not listen to her. Although the numbers are alarming, the disparity in mortality rates for minority women are even more devastating, with Black women being three to four times more likely to die from a pregnancy-related complication than their white counterparts. After all, “we have spent a lot of time convincing Black women their link to survival in the health care system is their doula,” Kathryn Hall-Trujillo, founder of Birthing Project USA, told Guo. How is COVID-19 affecting maternity care in your community? Using a back-of-the-envelope look at patterns of racial bias vs. racial differences in maternal mortality, I found little reason to think that racism among delivery doctors was the likely cause of this. Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. The new aim is to reduce the global MMR to less than 70 by 2030. Maternal Mortality in the U.S.: A Human Rights Crisis. To prevent maternal mental health from falling to the wayside during the pandemic, the Shades of Blue Project started an eight-week online support group for pregnant and postpartum individuals and a separate online support series for providers and community leaders. Another possibility is the timing of prenatal care, which differs moderately between black and white mothers, but studies suggest that it doesn’t explain the difference in maternal mortality either. They’re hard to come by, but Arline Geronimus, who originated the “weathering” theory to explain black-white differences, has studied the length of telomeres in black and white women. Dean drove them to the hospital only to discover that new restrictions on visitors in labor and delivery rooms meant that Young would have to labor alone, Eileen Guo reported in the New York Times. But in mid-March, when Young went into labor just as Governor Gavin Newsom ordered Californians to stay at home to avoid spreading the novel coronavirus, her plans went awry. Issue: Most maternal deaths are preventable, but they have been increasing in the United States. Fortunately, some organizations, like Ancient Song Doula Services in Brooklyn, NY, have been able to quickly pivot to virtual services. It will also investigate whether a mother can transmit the virus to her baby during pregnancy and birth or through breast milk. 14 In the United States, pregnancy-related mortality is three to four times higher among Black women than among White women. The issue is critical — but it's also not new. Researchers have looked at poverty, education, drinking, smoking, and genetic causes. According to the Centers for Disease Control (CDC), the maternal mortality rate for Black women in 2018 was more than 2.5 times higher than the maternal mortality rate of white women, and the infant mortality rate of babies born to Black women is more than 2.3 times higher than the infant mortality rate of babies born to white women. Geronimus found that in middle-aged women, the telomeres in black women suggested an “age” about 7.5 years higher than in white women. Alarmingly, maternal mortality rates for women living in the U.S. are the highest in the developed world with stark racial disparities. While many countries have made progress in reducing maternal mortality, progress has stagnated or been reversed in many of the countries with the highest burden of maternal mortality:12 Most parts of the world are off-track to meet the MDG target of reducing maternal mortality.13 This makes the toxic stress hypothesis intuitively appealing, but it has little rigorous evidence supporting it. - Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. But for all its length, the article provides no real evidence for it. Any pregnancy-related death within a year of delivery is counted as maternal mortality, and the difference in IHM rates suggests that in white hospitals black mothers die at high rates in the hospital, while in black hospitals they die at high rates after going home. Women in the United States are more likely to die from childbirth or pregnancy-related causes than other women … Inexpensive, too! By signing up, you agree to our privacy policy and terms of use, and to receive messages from Mother Jones and our partners. Despite high-tech medical advances of the last century, women around the world are still dying in pregnancy and childbirth from age-old scourges such as hemorrhage and pre-eclampsia and, increasingly, from complications related to chronic diseases, obesity, and advanced maternal age. As you can see, the delivery room staff would not listen to.. You can see, the maternal mortality in the developed world with stark racial disparities in morbidity! Today and get a full year of investigations, ideas, and how to reduce black maternal mortality Foundation for national Progress they were unfairly... 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