Every day around the world 1,500 women die in child birth. In 2005 more than 500,000 women died giving birth. This is, of course, a double tragedy – a woman dying early from something that should be a joyful event and a baby left without a mother.
There is a big difference in the rate of maternal mortality based on country. The reason appears to be primarily economic: those who are more disadvantaged and do not have access to a skilled birthing attendant or life saving medications to stop bleeding or halt an infection die from what is preventable in a full-staffed hospital. In addition, extreme poverty affects nutritional status, another co-factor in mortality.
The goal is obviously to have the lowest maternal mortality, fewer than 10 deaths per 100,000 live births. This rate has been achieved in Canada, Northern Europe and the United Kingdom, Australia, New Zealand, and Japan. But not here in the United States. A study published in 2010 in Obstetrics and Gynecology by Berg et. al. evaluated maternal mortality during the eight-year period from 1998-2005. The rate was 14.5/100,000 live births (it was at an all time high of 16.8 in 2003, the year I delivered my babies).
There is a lot of talk that this high rate is due to problems with obstetrical care, when in fact the exact opposite is true. This same study looked at demographics and social factors. We know in third world countries these factors affect maternal mortality, so why not in the United States as well?
The results? If you have any prenatal care in the United States the pregnancy related mortality is 7.6/100,000, which is in the target range. However, for women with no prenatal care at all, the rate sky rockets to 39.1/100,000. In the United States, as everywhere else, poverty and lack of prenatal care are killers.
When the data are teased apart even more we see sad racial inequities. A white woman with prenatal care has a maternal mortality rate of 5.4/100,000 and for an African-American woman it is 18.9/100,000. Among other non-white women the mortality rate is 7.6/100,000, so African-American mothers are dying disproportionately in this country. Among those with no prenatal care the maternal mortality is on par with Eastern Europe (or worse): white women with no prenatal care in the U.S. have a mortality rate of 30.9/100,000 and African-American women, a staggering 56.1/100,000.
Why are African-American women dying at disproportionately higher rates? Many experts cite high rates of obesity and high-blood pressure (conditions more common among African-American), but there also appears to evidence of disparities in care.
So the United States is a microcosm of the world. Women in better health with access to the best prenatal care have the best outcomes. The low rates of maternal mortality among white and other racial groups with prenatal care show us it can be done, but we still have a lot of barriers to overcome. We also need to re-bouble our efforts with African-American women to address the higher rates of mortality for these women.
And as an aside to all those pro-life politicians who disparage universal medical care? Access to prenatal care clearly saves the lives of women, regardless of race. Universal prenatal care doesn’t address the racial inequities in this country, but it would reduce the risk of women of every racial and ethic background dying in childbirth. That’s pretty pro-life, don’t you think?