At a time when maternal mortality rates are dropping worldwide, the United States is an unfortunate outlier.
According to the World Health Organization, maternal mortality declined more than 40%(www.who.int) worldwide from 1990 to 2015. During roughly the same period, the United States saw a 26.6% increase.(www.ncbi.nlm.nih.gov)
AAFP President John Cullen, M.D., of Valdez, Alaska, told AAFP News that one of the problems is the closure of rural hospitals and obstetrics programs.
"This is causing obstetrical deserts, which leads to bad outcomes," said Cullen, who added that access also is an issue in underserved urban communities. "When there is loss of access to prenatal and perinatal services, women and babies die."
Maternal mortality rates are as much as four times higher for women who do not receive prenatal care compared with those who do, and access to early prenatal care has been shown to reduce the incidence of infants born with low birthweight.
- The AAFP is taking several steps to build a coalition to address the nation's maternal mortality crisis.
- President John Cullen, M.D., will be a featured speaker May 11 during the March for Moms rally in Washington, D.C.; the Academy is a partner in the event.
- The AAFP's maternal mortality task force had its first meeting in April and is expected to report to the Congress of Delegates in September.
Cullen said family physicians can play a key role in reversing the trend, and the AAFP is working with partners to address the problem. He will be a featured speaker May 11 during the March for Moms rally(www.marchformoms.org) on the National Mall in Washington, D.C. The AAFP is a partner in the event, which aims to raise awareness.
The United States has the worst maternal mortality rate(www.npr.org) -- by far -- of any industrialized nation. In addition to access, health disparities and lack of education about family planning also play a role. American Indian/Alaska Native and non-Hispanic black women are up to four times more likely to suffer a pregnancy-related death in this country than white women.
It also is estimated that as many as 21% of pregnant U.S. women experience moderate to severe depression or anxiety, which can have long-term adverse implications for mothers, children and their families.
The March for Moms rally will follow an advocacy day May 10 on Capitol Hill. Legislation introduced in Congress(www.congress.gov) would address issues such as family leave and health disparities.
The March for Moms event is just one piece of the Academy's strategy on this issue. Cullen said the AAFP aims to build a coalition of partners to address maternal mortality. Academy representatives met March 26 in Washington with representatives from the American College of Obstetricians and Gynecologists and the National Rural Health Association.
Both organizations are participating in the AAFP's maternal mortality task force, which was created at the direction of a substitute resolution adopted during last year's Congress of Delegates meeting. The task force, which had its first meeting in April and is scheduled to meet again June 29, is expected to report back to the COD when it meets Sept. 23-25 in Philadelphia.
AAFP Director and task force chair Tochi Iroku-Malize, M.D., M.P.H., M.B.A., told AAFP News that the group has four primary objectives:
- Evaluate evidence-based methods to decrease maternal mortality.
- Review methods to increase recognition of implicit bias and reduce disparities in maternal morbidity and mortality.
- Develop strategies to help improve resident education and support practicing family physicians providing full-scope reproductive and maternity care.
- Address the growing loss of rural maternity services nationwide.
"What we realized was that whatever recommendations we come up with will need to be actionable, with policy changes to support them," Iroku-Malize said. "Also, recommendations will need be twofold -- steps that we as an Academy should take and those that our collective task force organizations should embark upon as a collaborative."
The task force includes AAFP members and also has representation from other family medicine organizations -- namely, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the Society of Teachers of Family Medicine. In addition to these groups, the American Hospital Association is participating, and the task force may expand further to broaden its reach.
Iroku-Malize said removing barriers and ensuring that family physicians are able to practice full-scope family medicine -- including maternity care -- is a critical part of addressing the problem.
"My hope for this task force is that we will be able to align stakeholders and create a pathway for family physicians to be recognized as equal members of a maternal health care team capable of providing services anywhere, any time to care for our patients," she said.
Cullen will have multiple opportunities to talk with representatives from health care groups outside family medicine in the coming weeks. He is scheduled to speak during a May 5 maternal safety meeting hosted by the CDC's Division of Reproductive Health and ACOG during ACOG's annual meeting in Nashville, Tenn., and he also will participate in a CMS forum on rural maternal health June 12 in Washington.
The ACOG event, which will focus on racial disparities and rural maternal health, is expected to draw hundreds of cross-disciplinary practitioners, public health advocates and other stakeholders, as well as reporters.
The CMS forum, which also will be attended by representatives from ACOG, the American Association of Birth Centers, the Kaiser Family Foundation and the NRHA, among others, is expected to lay the groundwork for an action plan to improve access to maternal health services in rural communities and reduce disparities.
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