A Framework to Address Maternal Mortality: Global and US Context

Why maternal mortality is so importnat in poublic jealth?

A powerful warning sign about how well a society protects pregnant people and families, how strong its healthcare system is, and how much it values human rights—and it’s now recognized as a top U.S. public health priority.

• not in HP2020 but in HP2030

Maternal Death – definition

the death of a woman while pregnant or within 42 days of the end of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Maternal mortality ratio (MMR)

MMR = (# of maternal deaths)/(# of live births)

• represents the risk associated with each pregnancy

Maternal death - direct cause

• Deaths resulting from obstetric complications of the pregnant state (pregnancy, labor and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

Maternal death - indirect cause

• Deaths resulting from previous existing disease or disease that developed during pregnancy and which was NOT due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.

leading causes of maternal death (globally) [direct causes]

• HOUSE

  • H - Hemorrhage (28%)

  • O - Obstructed labor (8%)

  • U – Unsafe abortion (13%)

  • S – Sepsis (15%)

  • E – Eclampsia / hypertensive disorders (14%)

Hemorrhage

Massive bleeding during pregnancy/after birth due to uterine or placental issues,

trauma, or blood clotting issue. Leads to shock or death

Obstructed labor

Malpresentation (breech, transverse); cephalopelvic disproportion (inability of

head to fit through pelvic canal). Can lead to fetal death and maternal death.

Unsafe abortion

Can lead to uterine perforation, other trauma, hemorrhage, and infection.

Sepsis

AKA puerperal infection or fever (temperature ≥38°C during pregnancy, labor, or after childbirth.

Eclampsia / hypertensive disorders

High blood pressure, protein in urine, and other symptoms During late pregnancy or postpartum. Can lead to liver rupture, stroke, seizure or death

leading causes of maternal death (globally) [indirect causes]

Anemia, Malaria, HIV, heart disease

hemorrage - direct or indirect?

direct

Anemia - direct or indirect?

indirect

Pregannt mom not knowing she has pre-eclampsia symptoms - delay?

delay in recognizing

Long distance to provide - delay?

delay in reaching services

Shortage of equipment and supplies - delay?

delay in receiving quality care

Proportion of maternal deaths considered preventable

80-85%

MMR in low-income countries vs. developed countries vs. sub-saharan africa

• MMR in low-income countries: 240

• MMR in developed countries: 16

• MMR in Sub-Saharan Africa: 500

Maternal Mortality [1990 vs 2015] [globally]

fell by almost half btwn 1990 and 2015

what prevents maternal mortality

access

access - community levels and rural areas for maternal mortality

• Community levels: someone who has 2 or 3 jobs and don't get pto they have less access

• Rural Areas: federal cuts impact state levels too and rural areas are impacted the most

Investments in infant health vs maternal health

• Investments in infant health, may not always improve maternal health

• Investments in maternal health WILL improve infant health

causes of death in mothers and infants …

overlap

Rates since 2015 [globally]

• Stagnating

  • This means improvements in maternal mortality have slowed or stopped.

  • After years of decline, progress plateaued around 2015 instead of continuing to improve.

  • COVID-19 - possible contributing factor

Maternal mortality in U.S versus globally

• rising in the U.S while it declines everywhere else

Maternal mortality post COVID [globally]

• increased in most countries during COVID but began to decline since then

racial/ethnic disparities in maternal mortality rates

• higher pregnancy-related mortality ratios among Black and American Indian/Alaskan Native women.

• These gaps DID NOT CHANGE OVER TIME

US maternal mortality rate

highest maternal death rate, with the rate for black women being the highest of any group

when do most U.S pregnancy related deaths occur (what period of pregnancy)

2/3 occur during post partum period

when is a death considered preventable

if there was at least some chance

of the death being prevented by

one or more reasonable changes

to patient, family, provider,

facility, system, and/or

community factors.