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Thursday Nov 12, 2020

U.S. Must Work to Improve Maternal Mortality Rate

The United States has the worst maternal mortality rate among industrialized nations. In fact, a 2016 investigation found that of more than a dozen countries studied, ours was the only nation with an increasing rate, at 26.4 maternal deaths per 100,000 live births.(www.thelancet.com) The United Kingdom had the second-highest rate at 9.2 maternal deaths per 100,000 live births, while Ireland, Sweden, Italy, Denmark and Finland had the best marks at less than five deaths per 100,000 live births.

[young child touching mother's belly]

And while white American mothers have substandard outcomes by international standards at 12.4 deaths per 100,000, consider that Black American mothers suffer 40 deaths per 100,000 live births. Differences in education and income don’t explain the incredible inequity. In fact, a 2016 study found that college-educated Black women are more likely to suffer complications and death from pregnancy compared to white women who lack a high school diploma. And according to the CDC, Black women with college degrees are more than five times as likely to die due to pregnancy complications(www.cdc.gov) than their white counterparts.

We were reminded of this stark disparity by the recent death of Chaniece Wallace, M.D.,(www.medpagetoday.com) a 30-year-old chief pediatric resident at the Indiana University of Medicine in Indianapolis, who died from complications four days after the birth of her daughter. Wallace developed symptoms of preeclampsia, and her baby girl was delivered early via C-section. Wallace endued a ruptured liver, decreased kidney function, hypertension and multiple surgeries before she died.

That young physician is just one of an estimated 700 U.S. women who will die from pregnancy-related complications this year. According to the CDC, roughly 60% of those deaths are preventable.(www.cdc.gov) 

So how do we reduce maternal mortality and close the gap on associated health disparities? The AAFP has put an emphasis on addressing this crisis during the past two years based on resolutions passed during the 2018 Congress of Delegates. The work includes an Academy task force that issued recommendations in a report during the 2019 COD.(307 KB PDF) 

The AAFP has supported events and initiatives aimed at addressing the issue. For example, the Academy is a member of the March of Dimes Equitable Maternal Health Coalition,(www.equitablemhc.org) is a partner and sponsor of March for Moms,(marchformoms.org) works with the National Birth Equity Collaborative(birthequity.org) and participates in the CDC’s Hear Her Campaign.(www.cdc.gov) 

The AAFP also has worked to inform legislators and advocated for bills with potential to address the problem.

During our recent Family Medicine Experience, I was honored to share the virtual stage with Uché Blackstock, M.D., an emergency physician who left academic medicine last year(www.statnews.com) because of challenges related to racism and sexism. Blackstock, the founder of Advancing Health Equity,(advancinghealthequity.com) said people of color fare worse than white individuals at every age and income level with regard to societal outcomes such as health, education, economic stability and incarceration rates.

Blackstock also said that in some instances the health gap between Black and white outcomes is widening. 

“Black babies are more than twice as likely as white babies to die within their first year of life, which actually is a wider disparity than in 1850, 15 years before the end of slavery,” she said.

Blackstock pointed out that the United States was one of only 13 countries that had worse maternal mortality rates in 2015 than in 1990,(www.reuters.com) joining a not-so-select group that included North Korea.

So what can family physicians do about it?

The AAFP’s new position paper on overcoming disparities in maternal morbidity and mortality outlines steps family physicians can take:

  • Learn about the effects of implicit bias and develop an action plan for addressing personal biases.
  • Work in a rural community to provide obstetrical services or partner with other clinicians providing obstetrical services in rural communities.
  • Identify and encourage CME and other training opportunities on topics like patient safety bundles, implicit bias and health/birth equity.
  • Participate in a local maternal health review committee.
  • Advocate for policies to increase birth equity. 
  • Advocate for Medicaid expansion, payment parity and post-partum coverage to increase access to care.

The position paper recommends that educators also learn about and address implicit bias, and that they

  • develop best practice guides to help family physicians retrain and gain privileges to provide obstetrical care,
  • support family medicine preceptorship programs for medical students and advocate for funding to expand opportunities into rural communities, and
  • advocate for funding of additional graduate medical education opportunities for family physicians and obstetricians to train in rural communities.

I am so proud of the work our Academy and members are doing to address this issue, but I also recognize that we still have significant work to do. To meet this challenge, we must keep our foot on the gas pedal and not let up.

Ada Stewart, M.D., is president of the AAFP.

Posted at 07:00AM Nov 12, 2020 by Ada Stewart, M.D.

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