Maternal Health Disparities in the United States: Understanding the Issue

Anisah Alladeen Sara Baaser Careers in Medicine Enhancement Program MATERNAL HEALTH DISPARITIES

Maternal Health According to the WHO, Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period. Image UN SDG Maternal Health. World Health Organization, World Health Organization, www.who.int/health-topics/maternal-health#tab=tab_1.

Why is this important? In the United States people of color such as African Americans, American Indians, and Native Alaskans are three times more likely to die from maternal and pregnancy related health problems than white women. This imbalance in health inequity increases with age. W H Y I S T H I S I M P O R T A N T Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Sept. 2019, www.cdc.gov/media/releases/2019/p0905-racial- ethnic-disparities-pregnancy-deaths.html.

Pregnancy-Related Mortality Surveillance System (PMSS) CDC performs a national pregnancy-related mortality surveillance to understand certain risk factors for and causes of pregnancy- related deaths in the US. P R E G N A N C Y - R E L A T E D M O R T A L I T Y S U R V E I L L A N C E S Y S T E M ( P M S S ) This system defines a pregnancy-related death as the death of a women while pregnant or within 1 year of the end of her pregnancy term. CDC found that PRMRs increases from 15.0 to 17.0 pregnancy related deaths per 100,000 births. Non-Hispanic black (black) and non-Hispanic American Indian/Alaska Native women- 40.8 and 29.7 (higher than all other racial/ethnic populations) White - 12.7 This was 3.2 and 2.3 times higher than the PRMR for white women and the gap widened among older age groups. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Nov. 2020, www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance- system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality- surveillance-system.htm Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Sept. 2019, www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html. Image from CDC

Example: Obstetric Fistula What? One of the most serious and tragic childbirth injuries. Medical condition in which a hole is made in the birth canal or bladder and rectum which can be fatal. Causes? Caused by prolonged, obstructed labor without access to timely, high quality medical care/health services. Problem? Those who do not have access to proper healthcare services may choose to leave this untreated. Leaves women leaking urine, feces, or both. Can sometimes lead to chronic medical problems (Ex. depression, social isolation, poverty). If left untreated for a while, it can put women at a risk for developing cancer in the fistula tract. Treatment? Simple to treat. Either the tract or fistula can be opened or the tract and the pocket inside are completely removed. Obstetric Fistula. United Nations Population Fund, www.unfpa.org/obstetric-fistula.

Solution Improve access to quality prenatal care and delivery of care. Give minorities information and educate them on how to start the early steps of taking care of one s health during pregnancy. -Proper diagnosis, communication, standardizing delivery across hospitals. Education, Instruction, and Communication about Health Disparities. -Increase understanding of cultural, racial, and bias beliefs and reasonings to healthcare givers. Learn to monitor health disparities in communities and hospitals by implementing a disparity dashboard that metrics quality of care based on race and ethnicity. -Allows health caregivers and hospitals to measure care and help creates solutions to disparities. End Racial Disparities in Maternal Health, Call a Midwife. Search the Website, 2 Feb. 2020, www.publichealth.columbia.edu/public-health- now/news/end-racial-disparities-maternal-health- call-midwife. Howell, Elizabeth A. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology, U.S. National Library of Medicine, June 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/.

Maternal Health in Guyana INFANT AND MATERNAL DEATH RATES IN GUYANA ARE AMONG THE HIGHEST IN THE CARIBBEAN/LATIN AMERICA. THERE PROBLEMS ARE DUE TO INSUFFICIENT PUBLIC INVESTMENT IN HEALTHCARE WHICH LEADS TO INSUFFICIENT PREVENTIVE HEALTHCARE SERVICES AND POOR-QUALITY HEALTH CARE SERVICES. GUYANA HAS ONE OF THE HIGHEST MOTHER AND CHILD DEATH RATES IN LATIN AMERICA AND THE CARIBBEAN, MOSTLY FROM PREVENTABLE CAUSES. GUYANA BUDGET & POLICY INSTITUTE, 5 NOV. 2018, GBPI.INSTITUTE/2017/12/06/GUYANA-HAS-ONE-OF-THE-HIGHEST-MATERNAL- AND-CHILD-DEATHS/.

Maternal Health in Afghanistan Afghanistan is one of the countries that has the highest maternal mortality rates. Around 638 women per 100,000 births die. Less than 60% of births are taken care by a qualified healthcare professional War, poverty and lack of access to healthcare has lead to huge disparities and death. Midwives on the Front Lines Working to Reverse Afghanistan's High Maternal Death Rate. United Nations Population Fund, 21 Oct. 2020, www.unfpa.org/news/midwives-front-lines-working-reverse- afghanistans-high-maternal-death- rate#:~:text=Afghanistan%20has%20one%20of%20the,die%20per%20100%2C000%20live%20births.&text=She%20has%20since%20worked%20in,has%20served%20hundreds%20of%20women.

Howell, Elizabeth A. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology, U.S. National Library of Medicine, June 2018, www.ncbi.nlm.nih.gov/p mc/articles/PMC5915910/ .

REFERENCES Maternal Health. World Health Organization, World Health Organization, www.who.int/health-topics/maternal-health#tab=tab_1. Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Sept. 2019, www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Nov. 2020, www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance- system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality- surveillance-system.htm Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Sept. 2019, www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html. Obstetric Fistula. United Nations Population Fund, www.unfpa.org/obstetric-fistula. Howell, Elizabeth A. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology, U.S. National Library of Medicine, June 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/. Fistula. Cedars Sinai , www.cedars-sinai.org/health-library/diseases-and-conditions/f/fistula.html. Midwives on the Front Lines Working to Reverse Afghanistan's High Maternal Death Rate. United Nations Population Fund, 21 Oct. 2020, www.unfpa.org/news/midwives-front-lines-working-reverse-afghanistans-high-maternal-death- rate#:~:text=Afghanistan%20has%20one%20of%20the,die%20per%20100%2C000%20live%20births.&text=She%20has%20since%20worke d%20in,has%20served%20hundreds%20of%20women.