In the United States, women are dying from complications related to pregnancy and childbirth at a higher rate than other industrialized nations, and the rate is increasing.
Understanding this issue is complex; even just understanding the terminology describing deaths and complications related to pregnancy and childbirth is quite an undertaking. It’s important to understand it though, so we’re going to begin here.
Non-Hispanic black women are dying at a rate three to four times that of non-Hispanic white women.
Approximately 700 women die each year in the U.S., and thousands more experience complications.[1] Non-Hispanic black women are dying at a rate three to four times that of non-Hispanic white women.[2] The most recent data available shows that between 2008 and 2014, there were 408 pregnancy-associated deaths in Ohio.[3] More recent data will be released this year, so it is not currently clear what the rates look like in Ohio.
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The term maternal mortality broadly describes maternal deaths associated with pregnancy and childbirth, but there are related terms that have specific definitions. These terms are measured as a ratio i.e. the number of deaths per 100,000 live births.
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Source: Review to Action: Working Together to Prevent Maternal
Mortality https://reviewtoaction.org/learn/definitions
Beyond the definitions associated with deaths, the term severe maternal morbidity (SMM) captures the complications experienced by pregnant and postpartum women. Severe maternal morbidity is defined as “a physical or psychological condition that either results from, or is aggravated by, pregnancy and has an adverse effect on a woman’s health.”[4] There has been an increase in SMM of 75 percent, nationally, over the last decade.[5] In 2014, more than 50,000 women were affected by SMM.[6] Incidences of SMM are often viewed as a “near miss” of a maternal death.[7] In Ohio, the SMM rate per 10,000 deliveries in 2013 was 143.[8] There is a similar racial disparity for SMM, with the incidence in Ohio for Non-Hispanic black women at 210 per 10,000 deliveries and 215 per 10,000 deliveries for Hispanic women. Rates for black and Hispanic women are around 50 percent higher than the overall rate and around 70 percent higher than the rate for non-Hispanic white women.
There has been an increase in severe maternal mortality of 75 percent, nationally, over the last decade. In 2014, more than 50,000 women were affected by severe maternal morbidity.
Over the last several years, Ohio has committed to broad-based efforts and has dedicated resources to addressing the state’s high rate of infant mortality, which in 2016 was 7.7 infant deaths per 1,000 live births (a total of 1,024 deaths).[9] Ohio is still working toward reducing this rate. While many strategies employed to reduce this rate could also make an impact on maternal health, a dedicated effort to address maternal mortality and morbidity is also required to wholly address maternal and infant health. Improvements have been made across the world and in the United States, so there are certainly lessons to learn. Ohio has a Pregnancy-Associated Mortality Review Committee that reviews deaths on a quarterly basis. Having access to this information is significant in learning from past deaths and preventing future ones. There are states that do not have a review committee. Ohio’s committee has also contributed data and learnings to a national effort, Review to Action that views these review committees as “the best way to understand why maternal mortality in the U.S. is increasing and prioritize interventions that improve health.”[10]
Community Solutions will continue to bring attention to this issue and work with stakeholders and policymakers on ways to focus on and improve health for and outcomes of women and mothers.
[1] Review to Action: Working Together to Prevent Maternal Mortality. Report from Nine Maternal Mortality Review Committees.
[2] Ibid.
[3] Snapshot of Ohio Pregnancy-Associated Death, 2008-2014. https://www.odh.ohio.gov/odhprograms/cfhs/pamr/Pregnancy-Associated%20Mortality%20Review.aspx
[4] Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5)
[5] Severe Maternal Mortality (SMM). Ohio Department of Health. https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/pamr/2017/SMM-Factsheet.pdf
[6] U.S. Centers for Disease Control and Prevention. Severe Maternal Morbidity in the United States. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
[7] American College of Obstetrics and Gynecology. Severe Maternal Morbidity: Screening and Review. https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Severe-Maternal-Morbidity-Screening-and-Review
[8] Severe Maternal Mortality (SMM). Ohio Department of Health. https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/pamr/2017/SMM-Factsheet.pdf
[9] Ohio Department of Health. 2016 Ohio Infant Mortality Data: General Findings. https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/OEI/2016-Ohio-Infant-Mortality-Report-FINAL.pdf?la=en
[10] Review to Action: Working Together to Prevent Maternal Mortality. https://reviewtoaction.org/
