A recent report from the Centers for Disease Control and Prevention contains the alarming news that maternal deaths associated with pregnancy, childbirth and its aftermath up to one year later have been rising over the past decade in the United States. They are now among the highest in the developed world. That comes after USA Today reported last year that South Carolina has the ninth-worst record in the nation. All of this is unacceptable.
Nationally, the CDC has estimated that 700 women die each year from complications of pregnancy, and over 400 of these deaths are preventable. But, it added, there is a major need for better reporting from the states, only a few of which have given focused professional attention to the problem. More precise figures would give the medical community a better idea of the scope of the challenge.
Similar data were reported this spring but, sadly, that got little attention. What makes the new report of particular interest here is that South Carolina’s Maternal Mortality and Morbidity Commission, created by the state Legislature in 2016, played a major role in preparing the CDC report as one of the pioneering efforts in the nation to measure and understand the causes of maternal deaths.
Last year, the commission reported to the Legislature that from 2014 through 2018, South Carolinians experienced pregnancy-related deaths at a startling rate of 25.5 per 100,000 live births. To put this in perspective, the recent CDC report estimated that the national rate has risen from 7.2 deaths per 100,000 live births in 1987 to 16.7 in 2016. That means South Carolina has been losing young mothers to complications of pregnancy at a much higher rate than the national rate, which is already alarmingly high.
Of particular concern in South Carolina and the nation is the even higher rate of pregnancy-related mortality among African-Americans. Those maternal mortality rates have been as high as 3 times greater than for whites over the past decade.
For every woman who dies from complications of pregnancy, “exponentially” more suffer major health problems, according to a recent paper from the Medical University of South Carolina. Data on Severe Maternal Morbidity show that the nationwide incidence of serious short- or long-term health consequences, including near-fatal complications, associated with pregnancy and delivery increased 45 percent between 2006 and 2014, and now affect 52,000 women a year. Black women are roughly twice as likely to suffer from these “near misses.”
Thankfully, there are several efforts underway to find answers to these problems. The causes of the rise in maternal mortality in South Carolina and elsewhere are being intensively studied by the Maternal Mortality and Morbidity Commission and similar state-level medical bodies, as well as the CDC. They include complications from cesarean deliveries, more women deferring childbirth into their late 20s and 30s, and a rising number of women with chronic health conditions. A recent University of Michigan study found that in 2014, compared with 10 years earlier, there were nearly 40 percent more pregnant mothers with dangerous chronic conditions posing a risk to the mother and child.
The aim of the studies is to identify preventable deaths and educate physicians on better protocols. Improving access to adequate prenatal care is a critical component.
Nationally, the American College of Obstetrics and Gynecology has launched the Alliance for Innovation on Maternal Health program, which distributes “bundles” of guidelines for improving maternal health based in part on the detailed research being done by state maternal morbidity commissions. South Carolina participates in the AIM program under a federal grant.
Much thought is being given to improving maternal health, which should lead to a reduction in the unacceptably high rates of maternal mortality and morbidity. That’s a good start. But we must do more to save mothers.