Maternal Health Disparities ___________________________________________________________________
2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019. More than 80% of all pregnancy-related deaths that occur in the United States are considered preventable [5]. Maternal mortality rates in the United States are higher among American Indian, Alaskan Native, Pacific Islander/Native Hawaiian, and Black women than among Asian, Hispanic, or White populations [6]. In 1933, the first time all states reported maternal deaths, the maternal mortality rate for Black women (1,000 deaths per 100,000 births) was 1.8 times greater than the rate for White women (564 deaths per 100,000 births). As of 2021, maternal death rates among Black women (69.9 per 100,000 births) had risen to 2.6 times higher than the rate noted for White women (26.6 per 100,000 births) [7]. Increases in maternal mortality rates are significantly greater among women 40 years of age and older. In this group, the mortality rate was 138.5 deaths per 100,000 live births in 2021 [7]. This represents an 83.4% increase compared with 2019. Data reported by the U.S. Government Accountability Office between 2020 and 2021 indicate the COVID-19 pandemic is a contributing factor to the increasing maternal mortality rate. This was believed to be linked to the chronic physiologi- cal stress present during pregnancy paired with severe illness from COVID-19 [8]. The CDC considers the following diagnoses/procedures as indicators of delivery hospitalizations with severe maternal mortality [9]: • Acute myocardial infarction • Aneurysm • Acute renal failure • Acute respiratory distress syndrome (ARDS) • Amniotic fluid embolism • Cardiac arrest/ventricular fibrillation • Conversion of cardiac rhythm • Disseminated intravascular coagulation • Eclampsia • Heart failure/arrest during surgery or procedure
INTRODUCTION Substantial differences in maternal morbidity and mortality among racial and ethnic groups exist in the United States. Black women are more than twice as likely to die related to maternal complications compared with White women [1]. The Centers for Disease Control and Prevention (CDC) reports that nearly 20% of surveyed women reported experiences of mistreatment during their pregnancy and/or the delivery of their child/children [2]. However, the reported rates were higher among Black (30%), Hispanic (29%), and multiracial (27%) patients. Increasingly, research has shown that the quality of health care is an important lever for expanding positive outcomes for racial and ethnic minority women [1]. This course will identify underlying drivers of maternal disparities, review potential contributing factors (with the intention of support- ing amelioration), and outline approaches to improve maternal outcomes. This course will also explore supportive measures, particularly in minority populations to reduce explicit and implicit bias in perinatal care.
EPIDEMIOLOGY
WORLDWIDE The United Nations International Children’s Emergency Fund (UNICEF) reports an overall global 34% decline in the mater- nal mortality rate, from 342 maternal deaths per 100,000 live births in 2000 to 223 maternal deaths per 10,000 live births in 2020 [3]. This decrease is consistent with achieving the sus- tainable development goal of 70 maternal deaths per 100,000 live births by 2030. However, the maternal mortality rates plateaued in Western Europe and North America between 2016 and 2022, and Latin America and the Caribbean noted an increase over the same period. The goal annual reduction rate is 15% for every country [3]. The location with the largest number of maternal deaths is sub-Saharan Africa, where the rate is 545 maternal deaths per 100,000 live births. Countries with the lowest rates of maternal mortality include Australia and New Zealand (with 4 maternal deaths per 100,000 live births) [3]. Among regions, women in sub-Saharan Africa face the highest lifetime risk of maternal death (1 in 41), which is approximately 268 times higher than in Western Europe (1 in 11,000), the lowest-risk region [3]. UNITED STATES In the United States, maternal deaths represent the largest disparity among all populations within perinatal health measures. The maternal mortality rate in the United States is unacceptably high and rising. In 2021, 1,205 women died of maternal causes in the United States, compared with 861 in 2020 and 754 in 2019 [4]. The maternal mortality rate for
• Puerperal cerebrovascular disorders • Pulmonary edema/acute heart failure • Severe anesthesia complications
• Sepsis • Shock
• Sickle cell disease with crisis • Air and thrombotic embolism • Hysterectomy • Temporary tracheostomy • Ventilation
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MDNJ1525
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