Maternal Mortality Rates in the United States Case Study
Public Health Policy / Decision Making
Natalie Sepulveda
Problem Statement
How can the United States improve the maternal mortality rate (MMR) from one of the highest compared to other industrialized countries?
Background
According to the CIA, in 2015, the MMR of the United States ranks 138 out of 184 countries with 14 deaths per 100,000 live births compared to Greece (184), Iceland (183), Poland (182), and Finland (181) all having the best rate with 3 maternal deaths for every 100,000 live births (Central Intelligence Agency, n.d.). Per the Centers for Disease Control and Prevention (CDC), the amount of reported pregnancy-related deaths in the United States has continuously increased with 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014 (CDC, 2018). While the reason for the increase in pregnancy-related death is unclear, studies have shown an increase of pregnant women have chronic diseases, such as diabetes, chronic heart disease, and hypertension (CDC, 2018). The largest difference in mortality rates in the United States is defined by race with African American women dying at a rate of three to four times that of their Caucasian counterparts with 42 deaths per 100,000 live births among African American women versus 12 deaths per 100,000 live births among Caucasian women in 2010 (Maternal Health Task Force, n.d.).
In 2010, Alaskan Native and American Indian had twice as many pregnancy-related deaths per 100,000 live births compared to Caucasian women (Maternal Health Task Force, n.d.). Women who receive no prenatal care are three to four times more likely to have a pregnancy-related death compared to women who receive prenatal care with 25% of all American women not receiving the recommended number of prenatal visits which increases to 32% among African American women and 41% among Alaska Native or American Indian women (Maternal Health Task Force, n.d.)
Although the World Health Organization (WHO) states that cesarean section rates about 10% increase maternal mortality rates, one third of all births in the United States are C-sections (Gaumard, 2018). C-sections, when medically necessary, can save the lives of mothers and children, physicians in the United States perform them to expediate the labor process increasing the risk of maternal mortality through complications, such as blood clots and infections while the midwifery model of childbirth focuses on allowing labor to advance naturally and only using medical interventions when absolutely essential (Gaumard, 2018).
According to the documentary, The Business of Being Born, the number of home births has drastically decreased in the last century with 95% of births taking place at home in 1900 to 50% of births at home in 1938 then to less than 1% of births taking place at home in 1955 to now (Lake & Epstein, 2008) and only 8% of total births attended by a midwife (Gaumard, 2018)....
