The US surgeon general and Department of Health and Human Services (HHS) are calling on healthcare professionals, hospitals, employers, insurers, women, and the nation to work together to reduce maternal morbidity and mortality — and the disparities that make the risks higher for women of color.
The maternal mortality rate in the United States is the highest among developed countries of the world and continues to rise. In 2018, for every 100,000 live births, approximately 17 women died while pregnant or within 42 days of the end of pregnancy from causes related to pregnancy or delivery — that’s a substantial increase from 7 deaths per 100,000 live births in 1987, according to the surgeon general’s new call to action.
“Our mothers had much lower rates of dying related to pregnancy compared to women today,” said Dorothy Fink, MD, HHS deputy assistant secretary for women’s health, at a briefing held Thursday to mark the call to action.
Cardiovascular conditions were the most common cause of pregnancy-related deaths between 2011 and 2015, accounting for more than 1 in 3 of the deaths. HHS’s related action plan sets a target of achieving blood pressure control in 80% of women of reproductive age with hypertension by 2025.
The plan also seeks to reduce the maternal mortality rate by 50% and decrease low-risk cesarean deliveries by 25% within 5 years.
“A woman dies every 12 hours in this country from pregnancy-related complications,” said Surgeon General Jerome Adams, MD, at the briefing. “This is not just unacceptable, it is just something that we need to understand is not inevitable,” he said, adding that the Centers for Disease Control and Prevention (CDC) has determined that two thirds of the deaths are preventable.
Adams also noted that it was important to address maternal health now, especially with COVID-19 raging. “Without attention and action, maternal health could actually worsen because of this pandemic,” he said.
“We cannot discuss maternal health, much less improve it, unless we acknowledge women of color are at a much greater risk of harm related to childbirth,” Adams said. “Black women are two to three times more likely to die of pregnancy-related causes compared to many other racial and ethnic groups,” he said. The disparity increases with age, according to the CDC.
Studies have shown that education does not eliminate those disparities. Black women with a college degree are twice as likely to die than White or Asian American women who did not finish high school, Adams said.
He held up a photo of a colleague, Shalone Irving, who he said was a PhD-educated epidemiologist who “died not long ago from pregnancy-related complications.”
Income is also not a factor, said Adams, noting that pop singer Beyonce had a near-death experience with preeclampsia. He also noted that Serena Williams, a top athlete, also struggled with pregnancy complications.
Recommendations Not All Funded
The HHS action plan is not explicitly funded, although Fink and Adams said that President Donald J. Trump’s fiscal 2021 budget includes some specific requests for improving maternal health. It will be up to Congress to grant the requests.
The budget seeks $80 million for the Health Resources and Services Administration to improve access to and quality of care. It also includes money to expand Medicaid coverage for 1 year after birth for women with substance use disorders. The American Medical Association in 2019 adopted a policy urging Medicaid coverage to be expanded to include all women for a year after childbirth. The American College of Obstetricians and Gynecologists has also encouraged this extension.
“We are encouraged that the HHS action plan includes support for policies to close coverage and care gaps for all postpartum women after pregnancy-related Medicaid coverage expires,” Maureen G. Phipps, MD, MPH, CEO of the American College of Obstetricians and Gynecologists, told Medscape Medical News.
HHS could act immediately by approving Medicaid waivers to extend such coverage, Phipps said.
The budget also requests $24 million to expand maternal mortality review programs to every state, said Fink. Currently, 43 states and Washington, DC, have such committees, which are charged with reviewing deaths of women within a year of pregnancy or birth.
HHS will also join with the March of Dimes to address the disparities in Black women by implementing evidence-based best practices to improve quality in hospital settings.
It is not the first time the Trump administration has taken aim at reducing maternal morbidity and mortality. In 2018, the president signed the Preventing Maternal Deaths Act, which authorized the CDC to award $50 million over 5 years so that every state could form maternal mortality review committees.
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