The maternal mortality rate in the U.S. is nearly three times higher than in any other peer nation. And, while other countries around the world are reducing maternal mortality, more mothers in the U.S. are dying during pregnancy or shortly thereafter. What's going on, and what can we do collectively to address this public health crisis?
On December 13, JHF's WHAMglobal network hosted an event at Contemporary Craft designed to explore the root causes of maternal mortality in the U.S., as well as the innovative programs and research under way locally to reduce maternal mortality. The event—featuring leading experts in maternal health from Magee-Womens Research Institute (MWRI)—put a spotlight on national trends in maternal mortality, the implications of maternal health policy and data collection, and the mothers and communities affected by the crisis in western Pennsylvania.
"Maternal mortality is a U.S. tragedy, and it's starting to be recognized as such," Dr. Feinstein said while welcoming more than 75 maternal health experts and advocates braved a winter snowstorm to attend the December 13 event. "The status quo is simply unacceptable. We're a fortunate community, as a center for innovation for women's health. Our goal tonight is to start a conversation, and to explore the research and data that helps us to be informed activists."
WHAMglobal is committed to uncovering and advancing creative, scalable ideas that tackle urgent women's health issues. WHAMglobal is working to reduce maternal mortality through a multi-pronged approach that includes unlocking the potential of community health workers to help mothers navigate complex medical and social services; and forming a network of experts in maternal health care, research, policy, and advocacy. The focus on maternal mortality is the result of WHAMglobal's "Big Idea Challenge" in the summer of 2017, which crowd sourced the Pittsburgh community for women's health priorities and action plans.
Karen Feinstein moderated a panel discussion on maternal mortality causes and potential solutions featuring Stacy Beck, MD, Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal Fetal Medicine, MageeWomens Hospital of UPMC; Richard Beigi, MD, MSc, VP of Medical Affairs and Chief Medical Officer, Magee-Womens Hospital of UPMC, Primary Investigator, MWRI; and Francesca L. Facco, MD, Assistant Professor, Department of Obstetrics, Gynecology & Reproductive Science Division of Maternal Fetal Medicine, Magee-Womens Hospital of UPMC, Primary Investigator, MWRI.
Nearly 60% of maternal deaths in the U.S. could be prevented through "reasonable changes to patient, community, provider, facility, and/or systems factors," according to the CDC Foundation. The panelists highlighted some of the critical research topics as well as policy and delivery changes that could lead to healthier mothers in western PA and beyond.
Dr. Beck said that about half of the states in the U.S., including Pennsylvania, have not developed maternal mortality review committees. Such state-level, multidisciplinary groups review all maternal deaths, identify trends and disparities, and develop recommendations and processes that can prevent avoidable maternal deaths in the future. "
Pennsylvania is lagging behind. We need to have a more systematic approach," said Dr. Beck, who noted that there is pending legislation in Pennsylvania to establish a maternal mortality review committee.
Dr. Beigi said that in order to understand the scope of the maternal mortality problem, there must be a more robust system for collecting, analyzing and acting upon data. He provided a high-level overview of maternal mortality trends, observing that the crisis disproportionately affects African-American women. Dr. Beigi also noted that the average age of pregnancy in the U.S. has climbed, and that more women are entering pregnancy with co-morbid health conditions. While the complexity of pregnancy may be increasing, insurance coverage hasn't kept pace and women may lack access to critical, ongoing health services. He's hopeful that will change, however.
"The payment and delivery systems [for maternal care] are going to change—it's just a question of when and how," Dr. Beigi said. "The current system is not delivering the outcomes that we want."
Dr. Facco advocated for an expanded concept of pregnancy that better supports at-risk women and links them with quality postpartum care. She said that young doctors, many of whom have an activist mindset, will lead the way.
"We need to empower doctors and nurses, to ensure they have a voice," Dr. Facco said. "You can be an activist for one patient. Activism can happen in those little moments—ones that organizations like WHAM can turn into big moments."
