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Maternal mortality in the United States is at an unacceptable rate. We believe health care is a right to all Americans not only to those who can afford it. The consequences of denying maternal health care to women has a devastating effect on many underserved women and their families.

Below are a few organizations that are challenging the status quo on how our country administers health to those who need it the most.

 

Please join us in fighting maternal mortality in the United States

 

Innovators Working for Real Changes to Maternal Health in America.

Maternal mortality rates continue to soar across the nation, but these leaders and organizations are paving the way to improve access to quality care for our highest-risk mothers and families.

 

While bringing a baby into the world should be a joyous occasion, it can turn tragic when the needs of a mother aren't met. And that's the sad reality for many in the United States, a country where more women are dying from pregnancy-related complications than in any other developed nation.

Since the Centers for Disease Control and Prevention (CDC) began recording data on pregnancy-related deaths in 1987, there has been a significant rise in maternal deaths within the U.S.—especially among mothers of color. From about seven deaths for every 100,000 live births that year, the rate of maternal mortality now hovers around 17 deaths per 100,000. Black, Native American, and Alaska Native women are "two to three times more likely to die from pregnancy-related causes than white women," reports the CDC.

These statistics have motivated individuals and organizations across the country to fight to reduce maternal mortality. Meet some of the innovators who are leading the way to change.

A State-by-State Review of Maternal Health Care Black Mamas Matter Alliance.

 

 

Courtesy of the black mamas matter alliance

The Black women-led group, Black Mamas Matter Alliance (BMMA), aims to change the narrative around maternal health in the community. Its approach involves introducing more holistic approaches to the health care of Black mothers, creating policies that improve their care, and conducting research to support these efforts. In partnership with the global legal advocacy organization Center for Reproductive Rights, BMMA has also created a comprehensive toolkit that compiles research about advancing maternal health as a human rights issue, dives into the statistics of maternal mortality and morbidity, and gives actionable steps toward, among other things, improving quality and access to health care for Black mothers. Anyone interested can also view BMMA's webinars showcasing a closer look at its work.

 

National Birth Equity Collaborative

Dr. Joia Crear-Perry, photographed at the Community of Hope Family Health and Birth Center in Washington, D.C., on March 2, 2020. SCOTT SUCHMAN FOR PARENTS.COM

The National Birth Equity Collaborative works with a variety of organizations and communities looking to ensure the well-being of Black mothers and babies by way of research, training, and advocacy. At the helm is Joia Adele Crear-Perry, M.D., FACOG, the founder and president, who has committed her life's work to health equity, and maternal and child health. Dr. Crear-Perry, an OB-GYN based in New Orleans, is bringing awareness to the way racism leads to health inequities like premature birth. Praised for her efforts to improve affordable health care for New Orleans residents after Hurricane Katrina in 2005, Dr. Crear-Perry has also received the Congressional Black Caucus "Health Care Heroes" award and the Global Visionary award for commitment to advancing women's health from the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health. She's also on the Steering Committee of the aforementioned Black Mamas Matter Alliance, and is running to become president-elect of the National Medical Association, a national organization representing African American physicians and their patients.

Dr. Joia Crear-Perry with Ebony Marcelle, Director of Midwifery at the Community of Hope Family Health and Birth Center, Washington, D.C., on March 2, 2020. SCOTT SUCHMAN FOR PARENTS.COM

'A Better Birth Experience Could Have Saved My Son': How One Mom is Changing the Conversation Around Infant Loss Every Mother Counts

 

COURTESY OF CHRISTY TURLINGTON BURNS

Every Mother Counts (EMC) is on a mission "to make pregnancy and childbirth safe for everyone, everywhere." The organization is raising awareness on issues relating to maternal health around the globe and working to implement strategies with policymakers and individuals in highly-affected communities. Founded in 2010 by model-turned-activist and filmmaker Christy Turlington Burns, EMC notably provides grants to community-based programs helping underserved populations obtain quality maternal health care. It has raised more than $5 million to combat maternal mortality by way of funding indigenous midwives in Guatemala, mobile clinics in Haiti, birth attendants in Bangladesh, and addressing public policy in India, while also increasing birth education here in the United States.

 

Mississippi Perinatal Quality Collaborative

Mississippi has long been among the states with the highest rate of maternal mortality. Between 2013 and 2016, the state had about 22 deaths per 100,000 live births (1.2 percent higher than the national average), with the ratio increasing to an alarming 51.9 to 64.1 per 100,000 for Black births. As such, the Mississippi Perinatal Quality Collaborative, established in 2014, has been working on hospital and community-based initiatives to reduce maternal and infant morbidity and mortality and protect mothers across the state—especially Black mothers. Some projects it focuses on include the Obstetric Hemorrhage Initiative (aimed at standardizing hospital care using evidence-based methods that can reduce this common form of maternal injury), as well as the development of a toolkit to assist in managing severe maternal hypertension.

 

'My Wife's Legacy Gives a Voice to the Voiceless': Charles Johnson's Loss Launched a Maternal Health Revolution Shades of Blue Project.

Kay Matthews hosting a Shades of Blue Project community group session using their INSPIRE Method to address solutions around black maternal mental health in our community.

COURTESY OF SHADES OF BLUE

Addressing the mental health aspect of maternal health (especially within the minority community) is the Shades of Blue Project. It aims to "break the stigma surrounding seeking treatment in the minority community when experiencing complications after childbirth." Founded by Kat Matthews, a licensed community health worker, the organization uses social media as well as training sessions to educate the public on how to provide better mental health care for women of color. Individuals can also sign up for its quarterly journal support group—an idea that spawned out of Matthews' own need for a diverse support group after experiencing a loss. This year, the Shades of Blue Project plans to host the Black Maternal Health Summit in July 2020 for health professionals to learn more about how they can provide compassionate care to pregnant people in marginalized communities.

Jennie Joseph

Jennie Johnson, founder, clinical director, and executive director for Commonsense Childbirth Incorporated, uses a vascular doppler on her patient to listen to the baby's heartbeat at her clinic for disadvantaged pregnant women in Orlando, Florida, on February 13, 2017. ZACK WITTMAN/THE NEW YORK TIMES/REDUX

Jennie Joseph is a licensed midwife doing grassroots work to reduce maternal mortality and ensure the safety and well-being of mothers and babies. Joseph has spearheaded a number of initiatives to address the struggles of low-income and uninsured women. In 1998, Joseph founded Commonsense Childbirth Inc., a non-profit that seeks to improve maternal-child health care and offers training programs (in-person and online) that teach individuals to become certified childbirth educators, community health workers, doulas, and midwives. Joseph has also developed an effective, proven model for patient-centered care known as the JJ Way, wherein pregnant people are given more freedom, tools, and support to improve their birth outcomes. Additionally, Joseph runs her own private birth center in Florida called The Birth Place, as well as an Easy Access Prenatal Clinic aiming to help support the needs of low-income patients.

Doulas Make a Difference for Culturally Competent Care and We Need Them in Delivery Rooms

Safer Childbirth Cities

(From left to right) Kim Boller, Chief Strategy and Evaluation Officer at The Nicholson Foundation; Lisa Asare, Assistant Commissioner at NJ Department of Health; Carmen Villar, VP Social Business Innovation at Merck; Mary-Ann Etiebet, Lead and Executive Director at Merck for Mothers; Keri Logosso-Misurell, Executive Director at The Greater Newark Healthcare Coalition; Kathleen Noonan, Chief Executive Officer at Camden Coalition of Healthcare Providers; Tammy Murphy, first lady of NJ; Aasta Mehta, Women's Health Policy Advisor at Philadelphia Department of Public Health; Atiya Weiss, Executive Director at the Burke Foundation; Jacquelyn Caglia, Director of Global Communications & U.S. Programs at Merck for Mothers.

 

COURTESY OF MERCK FOR MOTHERS

Merck for Mothers launched the Safer Childbirth Cities initiative in 2018 to support maternal health care in locations around the country with high maternal mortality rates. The initiative offers grants to community-based organizations in select cities to be used to increase health education, access to care, and ensure regular pre- and perinatal care for high-risk women who are expecting. In Jackson, Mississippi,for example, the organization is working with the Mississippi Public Health Institute to reduce unnecessary C-sections and provide community-based support to pregnant and postpartum individuals. While in Columbus, Ohio, it's partnered with Restoring Our Own Through Transformation (ROOTT) to develop community-based perinatal doula care to support Black women and others who may be under or uninsured.

 

 

Maternal mortality

22 February 2023

World Health Organizarion

 

Key facts

  • Every day in 2020, almost 800 women died from preventable causes related to pregnancy and childbirth.
  • A maternal death occurred almost every two minutes in 2020.
  • Between 2000 and 2020, the maternal mortality ratio (MMR, number of maternal deaths per 100 000 live births) dropped by about 34% worldwide.
  • Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020.
  • Care by skilled health professionals before, during and after childbirth can save the lives of women and newborns.

Overview

Maternal mortality is unacceptably high. About 287 000 women died during and following pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020, and most could have been prevented.

Sustainable Development Goal (SDG) regions and sub-regions are used here. Sub-Saharan Africa and Southern Asia accounted for around 87% (253 000) of the estimated global maternal deaths in 2020. Sub-Saharan Africa alone accounted for around 70% of maternal deaths (202 000), while Southern Asia accounted for around 16% (47 000).

At the same time, between 2000 and 2020, Eastern Europe and Southern Asia achieved the greatest overall reduction in maternal mortality ratio (MMR): a decline of 70% (from an MMR of 38 to 11) and 67% (from an MMR of 408 down to 134), respectively. Despite its very high MMR in 2020, Sub-Saharan Africa also achieved a substantial reduction in MMR of 33% between 2000 and 2020. Four SDG sub-regions roughly halved their MMRs during this period: Eastern Africa, Central Asia, Eastern Asia, and Northern Africa and Western Europe reduced their MMR by around one third. Overall, the maternal mortality ratio (MMR) in least-developed countries* declined by just under 50%. In land locked developing countries the MMR decreased by 50% (from 729 to 368). In small island developing countries the MMR declined by 19% (from 254 to 206).

* For details of countries considered in the group of “least developed” please refer to standard country or area codes for statistical use (M49) available at:

https://unstats.un.org/unsd/methodology/m49/

Where do maternal deaths occur?

The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between rich and poor. The MMR in low-income countries in 2020 was 430 per 100 000 live births versus 12 per 100 000 live births in high income countries.

Humanitarian, conflict, and post-conflict settings hinder progress in reducing the burden of maternal mortality. In 2020, according to the Fragile States Index (1), 9 countries were “very high alert” or “high alert” (from highest to lowest: Yemen, Somalia, South Sudan, the Syrian Arab Republic, the Democratic Republic of the Congo, the Central African Republic, Chad, Sudan and Afghanistan); these countries had MMRs ranging from 30 (the Syrian Arab Republic) to 1223 (South Sudan) in 2020. The average MMR for very high and high alert fragile states in 2020 was 551 per 100 000, over double the world average.

Women in low-income countries have a higher lifetime risk of death of maternal death. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5300, versus 1 in 49 in low-income countries.

 

Why do women die?

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal deaths are (2):

  • severe bleeding (mostly bleeding after childbirth);
  • infections (usually after childbirth);
  • high blood pressure during pregnancy (pre-eclampsia and eclampsia);
  • complications from delivery; and
  • unsafe abortion.

 

How can women’s lives be saved?

To avoid maternal deaths, it is vital to prevent unintended pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.

Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the women as well as for the newborn.

Severe bleeding after birth can kill a healthy woman within hours if she is unattended. Injecting oxytocics immediately after childbirth effectively reduces the risk of bleeding.

Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner.

Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.

 

Why do women not get the care they need?

Poor women in remote areas are the least likely to receive adequate health care (3). This is especially true for SDG regions with relatively low numbers of skilled health care providers, such as Sub-Saharan Africa and Southern Asia.

The latest available data suggest that in most high income and upper middle income countries, approximately 99% of all births benefit from the presence of a trained midwife, doctor or nurse. However, only 68% in low income and 78% in lower-middle-income countries are assisted by such skilled health personnel (4).

Factors that prevent women from receiving or seeking care during pregnancy and childbirth are:

  • health system failures that translate to (i) poor quality of care, including disrespect, mistreatment and abuse, (ii); insufficient numbers of and inadequately trained health workers, (iii); shortages of essential medical supplies; and (iv) the poor accountability of health systems;.
  • social determinants, including income, access to education, race and ethnicity, that put some sub-populations at greater risk;
  • harmful gender norms and/or inequalities that result in a low prioritization of the rights of women and girls, including their right to safe, quality and affordable sexual and reproductive health services; and
  • external factors contributing to instability and health system fragility, such as climate and humanitarian crises.

To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at both health system and societal levels.

 

What was the impact of COVID-19 pandemic on maternal mortality?

It is clear from the data that the stagnation in maternal mortality reductions pre-dates the start of the COVID-19 pandemic in 2020. The COVID-19 pandemic may have contributed to the lack of progress but does not represent the full explanation.

The level of maternal mortality during the COVID-19 pandemic may have been impacted by two mechanisms: deaths where the woman died due to the interaction between her pregnant state and COVID-19 (known as an indirect obstetric deaths), or deaths where pregnancy complications were not prevented or managed due to disruption of health services.

A robust global assessment of the impact of COVID-19 on maternal mortality is not possible from the data currently available: only around 20% of the countries and territories have thus far reported empirical data on their maternal mortality levels in 2020, and high-income and/or relatively smaller populations are over-represented in this group – with implications for generalizability of findings.

The current estimates only extend to include the year 2020. Given the limited data, we expect these estimates to be revised in future updates.

 

The Sustainable Development Goals and maternal mortality

In the context of the Sustainable Development Goals (SDG), countries have united behind the target to accelerate the decline of maternal mortality by 2030. SDG 3 includes an ambitious target: “reducing the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average”.

The global MMR in 2020 was 223 per 100 000 live births; achieving a global MMR below 70 by the year 2030 will require an annual rate of reduction of 11.6%, a rate that has rarely been achieved at the national level. However, scientific and medical knowledge are available to prevent most maternal deaths. With 10 years of SDGs remaining, now is the time to intensify coordinated efforts, and to mobilize and reinvigorate global, regional, national, and community-level commitments to end preventable maternal mortality.

 

WHO response

Improving maternal health is one of WHO’s key priorities. WHO works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States on developing and implementing effective policy and programmes.

As defined in the Strategies toward ending preventable maternal mortality (EPMM) and Ending preventable maternal mortality: a renewed focus for improving maternal and newborn health and well-being, WHO is working with partners in supporting countries towards:

  • addressing inequalities in access to and quality of reproductive, maternal and newborn health care services;
  • ensuring universal health coverage for comprehensive reproductive, maternal and newborn health care;
  • addressing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities;
  • strengthening health systems to collect high quality data in order to respond to the needs and priorities of women and girls; and
  • ensuring accountability in order to improve quality of care and equity.

References

 

Preventing Pregnancy-Related Deaths

CDC.GOV

The death of a woman during pregnancy, at delivery, or soon after delivery is a tragedy for her family and for society as a whole.

During pregnancy, a woman’s body goes through many changes. These changes are entirely normal, but may become very important in case there are complications or problems.

A pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

 

What can women do to prevent a pregnancy-related death?

Many factors influence pregnancy-related health outcomes. It is important for all women of reproductive age to adopt healthy lifestyles (e.g., maintain a healthy diet and weight, be physically active, quit all substance use, prevent injuries) and address any health problems before getting pregnant. Visit your health care provider to discuss if or when you are thinking about getting pregnant. This is important to make sure you receive appropriate medical advice and care, and have healthy pregnancies.
A healthy pregnancy begins before conception and continues with prenatal care, along with early recognition and management of complications if they arise. Health care providers can help women prepare for pregnancy and for any potential problems during pregnancy. Early initiation of prenatal care by pregnant women, and continuous monitoring of pregnancy by health providers, are key to helping to prevent and treat severe pregnancy-related complications.

What is CDC doing?

CDC is committed to preventing pregnancy-related deaths, and ensuring the best possible birth outcomes. CDC is engaged or supports the following activities:

 

 

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