Maternal mortality is an issue that isn’t often widely acknowledged, but that’s changing with the 2020 race for president.
Several candidates have staked out positions on how to address the issue, and many of the senators have already sponsored or co-sponsored bills in the Senate.
According to the CDC, about 700 women die every year because of complications with the pregnancy or delivery. The death could also happen during the post-partum period. Statistics from 2015 shows about 17 women died for every 100,000 births in the United States.
Black women in the United States face even greater risks. A report done by the CDC showed that maternal mortality was three-to-four times more likely for black women than for white women.
Data also shows that the number of deaths has increased, but researchers attribute some of that to increased reporting and recognition of deaths being related to complications from giving birth.
Candidates’ Proposed Solutions
The candidates with the most specific plans to address these issues are the senators who have supported legislation that tackles them from a variety of angles.
Sen. Kamala Harris has the Maternal CARE Act, introduced in the Senate in August 2018. The bill is designed to reduce the racial disparity in mortality.
Simply put, it would create implicit bias training grants that trains physicians to recognize and move beyond biases and establish pregnancy medical home programs, which reduce adverse outcomes for a mother’s health and prioritize Medicaid recipients.
The bill is currently in the finance committee. Sens. Kirsten Gillibrand, Cory Booker and Bernie Sanders are co-sponsors. Sen. Elizabeth Warren has expressed support for it.
Sen. Gillibrand also has legislation pending in the Senate. In August 2018, Gillibrand introduced the MOMS Act.
The legislation would target maternal safety standards and best practices for hospitals, create a grant program to help states implement the best practices, include information from state Maternal Mortality Review Committees in the CDC’s Pregnancy Mortality Surveillance System and direct the CDC to assist those state committees.
So far, Harris and Booker are the only co-sponsors on the bill.
Booker’s bill, the MOMMIES Act, was introduced to the Senate in September 2018, and both Harris and Gillibrand are cosponsors.
The bill is in committee right now, but it would extend Medicaid coverage for women to a full year after birth and give those women full coverage, create a program to study the benefits of Maternity Care Homes, increase access to doula care for pregnant women and study how telemedicine can increase access to maternity care.
In April, Warren announced a plan to address the mortality rate for black women. In it, she suggests offering bonus funds to health care providers that make an effort to drive down rates. Providers who don’t fix the problem would lose money. Warren’s plan is an effort to address the disparity in health care between women of color and white women.
The other candidates have expressed support for combinations of research, expanded funding, telemedicine, expanded access to care and insurance, increased training and changes to existing health care coverage.
Conditions In Iowa
Data in the 2017 Vital Statistics report from the Iowa Department of Public Health show that the rate of maternal deaths per 100,000 live births was 31.2. This number is up from the 22.8 reported in 2015.
Stephanie Trusty, a maternal health coordinator for the IDPH said no one really knows how to explain the increase because it could be caused by a variety of factors.
Another thing to consider, she said, is that a third of deaths happen in each stage of the process — before, during and after delivery.
One factor is the increasing number of older women, who have already developed chronic medical conditions like hypertension and diabetes, giving birth.
The CDC lists cardiovascular conditions as the leading cause of maternal mortality.
Trusty said providing access to care and getting control over those chronic diseases is a key way to solve that problem.
Two other common causes of death are hemorrhage and infection.
Trusty said risk factors for hemorrhage increase with C-sections, so reducing those would be a step toward fixing the problem.
“Not every hospital or provider has the capacity to allow women to labor when they’ve had a prior C-section,” she said. “If we could get more hospitals and doctors to allow that trial of labor, that could help.”
She also said California hospitals have a good policy of making tools readily available and standardizing care so all providers know how to handle hemorrhage.
Infection can have multiple causes, and they can be missed or misdiagnosed by providers and patients.
The problem of maternal mortality often lies outside of the mother’s health, too. Trusty said poverty and a lack of support or reliable transportation can also lead to maternal mortality.
“I think everybody has a part,” she said. “Patients have to better recognize warning signs, physicians have to do a better job educating women during the pregnancy, during labor and delivery about the warning signs, hospitals have to do a better job, the community has a role, so I think we all have to work together.”
by Nikoel Hytrek
Photo via U.S. Air Force