Hundreds of mothers die of preventable pregnancy-related complications up to a year after delivering their babies, with black and native women experiencing notably high maternal morality risks.
The needless deaths of around 700 women nationwide each year due to cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies underscores the importance of improving maternal care, especially in increasing its access and quality, the federal Centers for Disease Control reported in a new study.
The Washington Post quoted Anne Schuchat, the CDC’s principal deputy director, commenting on the agency data:
“The bottom line is that too many women are dying largely preventable deaths associated with their pregnancies. We have the means to identify and close gaps in the care they receive. We can’t prevent every one of these tragedies, but we can and should do more.”
Racial disparities were stark in the government findings, the New York Times reported:
The agency found that black women were 3.3 times more likely than white women to suffer a pregnancy-related death; Native American and Alaska Native women were 2.5 times more likely to die than white women.
The newspaper also said the complications that killed moms were familiar — and medical science can treat them:
Obstetric emergencies involving complications like severe bleeding caused most of the deaths at delivery. Disorders related to high blood pressure accounted for most deaths from the day of delivery through the sixth day postpartum. A leading cause of pregnancy-related deaths was cardiovascular disease, which is not typically associated with young pregnant women. Heart disease and strokes caused more than one-third of pregnancy-related deaths, the CDC found. Cerebrovascular events, such as strokes, were the most common cause of death during the first 42 days after the delivery. Cardiac disease, which disproportionately affects black women, may be present in a woman before pregnancy, but it also may appear during pregnancy. If heart disease goes undetected, it may become acute after the baby is born. Indeed, a greater proportion of the deaths among black women occurred in the later postpartum period, between seven weeks and a year after the delivery, compared with white women, the CDC found.
Anger over the nation’s dismal and lagging maternal care has grown, and it has become a 2020 political issue, with news media investigations reporting how American moms die and suffer huge and sustained damage due to problem pregnancies. The U.S. shares with developing nations like Afghanistan, Lesotho, and Swaziland the unhappy distinction of having a climbing maternal mortality rate.
Public health officials, working with doctors and hospitals, have waged successful campaigns to slash pregnancy-related complications and deaths with California a proven model for how this can work.
In my practice, I see not only the harms that patients suffer while seeking medical care, but also the sustained and unacceptable injury that can be inflicted on mothers and their babies and children due to poor maternal care. It is part of what, sadly, is a growing catalog of the ways modern medicine persists in mistreating women. It would be a positive turn in the nation’s bitter, divisive politics if equal measure were paid not only to protecting the unborn but also to their mothers, their health, and the well-being of families that are crucial to raising outstanding generations to follow.
The unhappy component of race in maternal care needs to be dealt with head on, including here in the nation’s capital, where mothers’ mortality rates are among the highest in the nation and issues of access and quality plague poor mothers of color in significant areas of the District of Columbia. Cost, bad management, and politics have led hospitals to shut down maternal care and nurseries that served mostly minority communities. The medical community here, so far, also hasn’t stepped up to fill voids in medical services that burden mothers with increased logistics for care.
Separate and unequal medical facilities and services? Unacceptable in our pluralistic democracy. And harmful. We can and must do better in eliminating racial and economic disparities in health care — including in how we treat the opioid epidemic.
Opioid treatment prescribed for whites but not blacks
Although death rates are spiking for blacks due to opioid overdoses, African Americans are not getting an uptick in treatment with buprenorphine, a drug that curbs the craving for opioids and reduces the chance of a fatal overdose, new research shows.
As the Kaiser Health News service reported of the study, published in JAMA Psychiatry:
Researchers reviewed two national surveys of physician-reported prescriptions. From 2012 to 2015, as overdose deaths surged in many states so did the number of visits during which a doctor or nurse practitioner prescribed buprenorphine, often referred to by the brand name Suboxone. The researchers assessed 13.4 million medical encounters involving the drug but found no increase in prescriptions written for African Americans. ‘White populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans,’ said Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School and the study’s lead author. The dominant use of buprenorphine to treat whites occurred while opioid overdose deaths were rising faster for blacks than for whites.
Researchers said that differences in how patients pay for addiction care may be a leading cause in the prescribing disparity. White patients, more than their black counterparts, paid in cash or carried private insurance that would cover their buprenorphine prescription, with only a slice of them relying on Medicaid or Medicare. Doctors, who can make choices because too few of them are specially trained to prescribe the addiction treating drug, also may lean toward treating the more affluent and privately insured patients.
We’ve got more work to do in yet another medical area to deal with apparent and problematic racial inequity.