Why Are U.S. Maternal Death Risks So High for Latinx Women?
Kristyn Brandi, MD, discusses what can be done to keep more women, but especially Hispanic women, alive — before, during, and after childbirth.
It’s 2022 and absolutely no one should be dying while pregnant, during childbirth, or immediately afterward.
And yet, in the United States, that is happening at an alarming rate. According to statistics compiled in 2018 by the Centers for Disease Control and Prevention (CDC) (the latest figures available), more than?17 out of every 100,000 U.S. women who delivered a live baby died during pregnancy or died up to a year after giving birth to a live baby because of an issue caused by or made worse by the pregnancy. Broken down by race, there were 41.4 deaths of Black women per 100,000 Black live births; the rate was 13.7 per 100,000 for non-Hispanic white women and 11.2 per 100,000 for Hispanic women.
Women in Other Developed Countries Are Less Likely to Die of Pregnancy or Childbirth-Related Deaths Than Women in the U.S.
By comparison, women living around the world in similar developed countries are less likely to die of pregnancy or childbirth-related complications: a report published in November 2020 by the?Commonwealth Fund found that the “maternal mortality ratio” of women in the Netherlands, Norway, and New Zealand who died in pregnancy or due to childbirth was fewer than 3 deaths per 100,000 live births. Those in Australia, Switzerland, Sweden, and Germany experienced 5 or fewer maternal deaths per 100,000 live births.
The COVID-19 pandemic worsened outcomes for U.S. women. According to a research letter published June 28, 2022, in JAMA Network Open, the number of Hispanic women who died during or after March 2020 during pregnancy or within 42 days of pregnancy jumped by more than 74 percent.
U.S. Maternal Health May Be Even More Problematic Post-Roe
The recent Supreme Court decision that overturned?Roe v. Wade, making abortion access a state-by-state decision rather than a federally protected medical procedure, doesn’t help. America’s maternal mortality rates aren’t likely to improve — particularly as more people attempt to end pregnancies on their own without a healthcare provider’s oversight, or continue with pregnancies while also living with potential life-threatening illnesses or conditions that develop or worsen as the pregnancy advances.
Everyday Health spoke with Kristyn Brandi,?MD, MPH, the board chair of Physicians for Reproductive Health, about how to reduce rising maternal mortality rates in the United States.
U.S. Mortality Rates Are Too High, Especially for BIPOC Women?
“While we have overall low rates of pregnant people dying in childbirth, the United States has one of the highest mortality rates in the world, and this disproportionately impacts the Black and brown communities,” says Dr. Brandi.
Why Is Pregnancy or Childbirth-Related Death Such a Problem in the U.S.?
“Pregnant Latine [Latinx] women are not a monolith, but many face barriers to accessing reproductive healthcare due a variety of reasons,” says Brandi. These can cover issues related to money and communication, including:
- It may be difficult to take time off from work to get care.
- The costs of childcare and transportation to make it to medical appointments may be a burden.
- Many patients who do not speak English have trouble navigating the healthcare system: making appointments, finding their way to providers’ offices, and understanding instructions that are printed solely in English. “This may be complicated for those that are undocumented, who may have to face additional hurdles to getting care,” says Brandi. This includes “things like navigating state checkpoints to get to care and worries about being reported to ICE [U.S. Immigration and Customs Enforcement] when seeking care.”
How to Keep More Women Alive
The problems are systemic, but “the first steps from a public health perspective within the Latine community is to address some of the root causes,” including racism, says Brandi. “We need to address systemic racism within our healthcare systems that disproportionately impact communities of color. People who are Black and brown frankly are not listened to in medicine, and that includes concerns during pregnancy. We need to trust people and build trust within communities.”
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Diagnose and Treat Diabetes and High Blood Pressure
Focusing on underlying health issues before, during, and after pregnancy would significantly reduce maternal mortality rates, says Brandi. According to the?American Heart Association, heart disease is the top killer of new moms. To counteract this, their campaign “Stay Fuerte for All,” conveys the importance of lowering blood pressure, which leads to lower risk of stroke and heart problems. “Additional resources to identify and manage diseases like hypertension and diabetes during pregnancy would help, since these diagnoses are disproportionally seen in the Latine community,” says Brandi.
Increase Access to Doula Care
More culturally relevant support during and after pregnancy would help, too. “One way is to have doulas and midwives, which have been shown to improve delivery outcomes,” she says. A doula is “a trained professional who provides continuous physical, emotional, and informational support to their client [a pregnant woman] before, during, and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible,” according to DONA International, the leading source of doula training and education.
Doula care has been linked to better health for babies and parents, according to research published in the?Journal of Perinatal Education. Doulas are typically hired by an expecting parent before delivery and can be part of a typical hospital birth experience. Midwives are trained and certified to deliver babies as well as care for women before, during and after pregnancy; some are credentialed nurses. They typically oversee uncomplicated pregnancies and are more likely to deliver babies outside a typical hospital setting, such as at home or at a birth center.
Give More Information in Spanish, Supply More Spanish-Speaking Providers
“Particularly in Spanish-speaking populations, having information and, even better, providers who speak Spanish would be helpful both to improve communication and improve trust. You cannot imagine how scary it would be to give birth in a room full of people shouting things you don’t understand. We need to make pregnancy care accessible for everyone.”
Without Abortion, Healthcare Demands Will Increase — Which Can Harm Everyone
With abortion access restricted across the country, healthcare for all women is affected in a negative way.
Demand for Prenatal, Postnatal, and Complication Care Is Growing
“If people are unable to choose abortion, which is how about one in four pregnancies end in the United States, forced birth will dramatically increase the number of people seeking prenatal and postnatal care,” says Brandi. “This will crowd out a healthcare system that has already been struggling to maintain staff, like labor and delivery nurses, since the COVID pandemic.”
There are many maternal health problems a woman may experience during pregnancy. According to the U.S. Department of Health and Human Services, common pregnancy complications include
- Depression and postpartum depression
- Ectopic pregnancy
- Fetal problems
- Gestational diabetes
- High blood pressure
- Hyperemesis gravidarum?(extreme and persistent nausea and vomiting)
- Infections that threaten fetal health, including urinary tract infections (UTIs)
- Miscarriage (pregnancy loss)
- Problems with the placenta, such as placenta previa or placental abruption
- Preterm labor and delivery
Without unfettered access to abortions for those who choose them, women are “forced to continue pregnancies that put them at higher risk of complications,” she says. “We need to be clear that abortion access impacts all of us, people continuing pregnancies included.”