Data review shows pregnancy is fatal far more often for women of color
The disparity is shocking.
“In Georgia, in 2010, 2011 and 2012, the rate of maternal mortality for white women was 14 per 100,000 live births,” Michael K. Lindsay, M.D. said. “For African-American women, it was 49 per 100,000.”
These are some of the first details from the Georgia Maternal Mortality Review Committee, created by state lawmakers in 2014 to review health data in Georgia, which Amnesty International ranks highest in the nation in maternal deaths.
After a year of investigation, Dr. Lindsay, who chairs the committee, presented the first findings to state health authorities on June 9 at a meeting of the State Board of Public Health.
Dr. Lindsay, Seema Csukas, M.D., and others on the review committee examined the deaths of 85 women in the state in 2012.
Twenty-five of these deaths were described as “pregnancy related,” from causes topped by hemorrhage, hypertension, cardiac, embolism and seizure. Sixty were described as “pregnancy associated,” which is defined as “the death of a woman while pregnant or within one year of end of pregnancy, irrespective of cause.”
Many of the 60 pregnancy-associated deaths resulted from homicide, suicide, drug toxicity and a host of chronic medical conditions—from obesity and diabetes to mental health issues—that are widespread in underserved communities.
The committee will work with the Georgia Bureau of Investigation to dive deeper into homicide cases. They will also investigate if some of the suicide cases are related to postpartum depression.
“It’s one thing to just state, we’re the worst in the country,” said Dr. Lindsay, a board certified obstetrics-gynecologist and associate professor of medicine at Emory University School of Medicine. “It’s another thing to immediately start taking small steps to turn this around.”
“We are already looking at 2013,” said Dr. Csukas, director of the Maternal and Child Health Section for the state Department of Public Health. “We’re committed to looking at hemorrhage incidents, and sharing that information throughout the state.”
About 125,000 women giving birth in the U.S. will bleed too much; that’s nearly 3 percent of all births. And at least 500 will die, though precise maternal mortality statistics are hard to come by. The Atlanta-based Centers for Disease Control and Prevention (CDC) must piece together voluntary annual reports that differ from state to state.
Despite the U.S. having an advanced medical system, the majority of those postpartum hemorrhage deaths—somewhere between 54 percent and 93 percent—are preventable, estimates AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Still without answers, there’s also a huge void in trying to understand why African-American women on average are three- to four-times more likely to die from birthing complications than other racial and ethnic groups.
In Georgia, being poor is also almost certainly a factor in a state where, according to the Kaiser Family Foundation, 50 percent of all births are covered by Medicaid, the public health insurance plan for low-income Americans. Georgia, like many red states, chose not to expand Medicaid eligibility under the Affordable Care Act. That means 26 percent of Georgia women between 18 and 64 have no insurance; one of the highest risk factors for maternal mortality.
Whether in maternal or other health issues—such as access to care or an organ transplant—the disparities are deep and wide.
Here’s the conclusion of a 2013 report on national health-care disparities by the U.S. Department of Health and Human Services: “Among all measures of health-care quality and access that are tracked, blacks had worse care than whites in the most recent year for 78 measures. Most of these measures showed no significant change in disparities over time.”
Numerous studies show the stark differences in treatment between African Americans and whites at all levels of medical care. The Institute of Medicine reports that even when insurance and income are the same, minorities receive fewer tests and less sophisticated care for everything from HIV to heart disease to diabetes.
The CDC says health disparities between African Americans and other racial and ethnic populations “are striking and apparent in life expectancy, death rates, infant mortality and other measures of health status and risk conditions and behaviors.”
William Callaghan, M.D., is a senior scientist for the maternal and infant health branch of the CDC’s Division of Reproductive Health. He said racial disparities transcend maternal care. “It is all clinical care. It is hard not to find a disparity in care,” he said in a recent phone interview. “We talk a lot here about trying to understand social determinants of health … and the biggest predictor of health is wealth.”
Midwife Sondra Abdullah-Zaimah has delivered thousands of babies, everywhere from Ghana to Grady Hospital in Atlanta. “It’s really hard to be black in white America,” said Abdullah-Zaimah. “And it’s across the board. It doesn’t matter education level, income level. It just doesn’t matter.”
She said that when women are blamed for not taking proper care of themselves, not eating well, it’s a form of victim blaming. “There’s a lot more to it than that,” she said, referring to how poor pregnancy outcomes go beyond women’s personal choices and behavior.
From Women’s eNews