Recently the U.S. Department of Health and Human Services (HHS) announced a landmark The initiative incorporates a comprehensive to significantly reduce maternal deaths and disparities that put women at risk before, during and after pregnancy. In addition the U.S. Surgeon General issued a corresponding , which puts forth the critical roles healthcare providers can do to improve maternal health.
Remarkable as it may seem, though the United States has one of the most technologically advanced healthcare systems in the world, we have a maternal mortality rate that is higher than comparable countries. The barriers placed on racial and ethnic groups, geographic location, and age disparities are particularly alarming. For instance pregnancy-related mortality for African American, Native American and Alaska Native women is alarming at nearly triple that of white, Hispanic, and Asian/Pacific Islander women. Since 2010 hospital obstetric services in rural counties decreased significantly, leaving pregnant women in these areas with few options for care. Plus women over 35 years of age are one and a half times more likely to experience complications during pregnancy than a decade ago. Every year thousands of women experience severe maternal morbidity with unexpected difficulties in labor and delivery that ultimately have a significant effect on their short- or long-term health. These disparities and outcomes are unacceptable anywhere, but most particularly in an otherwise advanced country such as ours. The impact of these disparities can create lasting problems which make it extremely difficult for many mothers to deliver healthy babies and live healthy lives themselves.
According to the National Center for Biotechnology Information “almost one fourth of stillbirths are potentially preventable. Given the predominance of placental insufficiency among stillbirths, identification and management of placental insufficiency may have the most immediate effect on stillbirth reduction.” With far too many preventable still births and miscarriages, and the dangers of postpartum emotional and physical health issues this new call to action by the HHS is committed to reducing disparities and improving care for all of our nation’s mothers. And we can accomplish even more if Congress acts on the maternal health proposals contained in the 2021 Fiscal Year Budget. With public and private sector partners working together these actions can once again make the United States one of the safest places in the world for women to give birth. HHS Action Plan provides a clear roadmap to address the risk factors before, during and after pregnancy by improving the quality of services and providing more access to maternity and postpartum care.
Maternal Mortality and Morbidity in the United States
According to the World Health Organization (WHO) maternal morbidity is defined as “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman's wellbeing”. This includes the death of a woman while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy. Approximately 700 women die each year in the United States from pregnancy-related causes. The U.S. experiences rates of morbidity and mortality that are significantly higher than in other countries of similar income and population size. Though thousands of women experience and survive severe maternal morbidity (SMM) each year, many still have significant short or long term consequences to their health. In 2017, there were over 25,000 hospital deliveries with an SMM which does not include those who only received a blood transfusion. The results of these SMMs included bleeding disorders, infection, and emergency hysterectomies. And when we include those that required blood transfusions there where over 50,000 hospital deliveries with an SMM. And as suggested above there are considerable ethnic, racial, and geographic disparities in the rates of severe maternal morbidity and pregnancy-related mortality.
Approximately two thirds of pregnancy related deaths in the United States are preventable. We can dramatically reduce this number and improve birth outcomes by addressing risk factors before pregnancy, and improve the quality of health during maternity and address postpartum care early.
What’s the Plan?
There are three primary goals contained in the HHS Action Plan to help the nation improve maternal mortality outcomes:
- Cut the maternal mortality rate in half by 2025. (from the current 17.4 deaths per 100,000 live births to 8.7)
- Decrease low-risk cesarean delivery rate 25% by 2025. (from the current 25.9% to 19.4%)*
- Improve blood pressure control in 80% of the women of reproductive age who experience hypertension by 2025. (from the current 55.5% to 80.0%)
* A cesarean delivery is considered low-risk if a single infant is delivered head-first at full term to a mother who has not given birth before. Low-risk cesarean sections are considered inappropriate care. (Peterson-KFF)
The Health Resources & Service Administration (HRSA) has a number of resources that support Maternal and Child Health, including:
- The Title V Maternal and Child Health Services Block Grant Program which is one of the largest federal block grant programs for promoting and improving the health and well-being of the mothers, children (including those with special needs), and their families. In 2019, this grant program funded 59 states and jurisdictions to provide healthcare and public health services for an approximately 60 million people. The program’s services reached 92% of pregnant women, 98% of infants, and 60% of children throughout the U.S.
- Healthy Start Initiative: Eliminating Disparities in Prenatal Health expanded its efforts in 2019 by supporting clinical service professionals within program sites in the U.S. to provide direct access to well-woman and maternity care.
- Women’s Preventive Services Initiative works to enhance women’s health across their lifespan by identifying useful preventive services and screenings.
- Alliance for Innovation on Maternal Health (AIM) and AIM Community Care Initiative (AIM-CCI) has instituted programs to improve the quality and safety of maternity care by addressing preventable maternal mortality and severe maternal morbidity among pregnant and postpartum women in hospitals, outpatient clinics, community-based organizations and other birthing facilities.
- Screening and Treatment for Maternal Depression and Related Behavioral Disorders Program: The program’s seven state grantees expand health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum women for depression and related behavioral health disorders.
- The Maternal and Child Health Bureau instituted a challenge to develop innovative, technology-based solutions for the improvement of mothers and children’s health across the U.S. A total prize of $1.5 million was awarded in four challenges:
- Preventing Childhood Obesity
- Care Coordination for Children with Special Health Care Needs (CSHCN)
- Remote Pregnancy Monitoring
- Addressing Opioid Use Disorder in Pregnant Women and New Moms (a vital issue that unfortunately continues to grow in every sector of the population)
There are many opportunities to improve maternal health. Because of our advance technologies and healthcare infrastructure, the United States should be one of the safest places in the world for women to give birth, have healthy children and lead a thriving life.
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