U.S. Bill Seeks to Fund State-Level Inquiries of Pregnancy Related Deaths and Complication

Lawmakers, researchers, advocates, and survivors of maternal complications gathered on Capitol Hill last month to call attention to the worsening state of maternal health in the United States—as well as a new bill that could help answer why so many women die during pregnancy and childbirth in one of the world’s most developed nations.

Maternal health in the United States: A worsening outlook
The United States in 2010 ranked behind 49 countries on maternal mortality—meaning that U.S. women are at a greater risk of dying from pregnancy and childbirth-related complications than women in 49 other nations. While this figure is staggering enough, it marks a sharp decline from last year, when the country ranked 41st.

This slip in performance comes just as the global community is paying unprecedented attention to the issue of maternal health. For example, 2010 saw the launch of the United Nation’s Global Strategy for Women’s and Children’s Health, the hosting of the second Women Deliver conference, and the establishment of the U.N. Commission on Information and Accountability for Women’s and Children’s Health, which featured Women Deliver President Jill Sheffield as a commissioner (read the Commission’s report here).  

As the world makes a collective effort to achieve safe motherhood for all, maternal mortality in the United States is marked by a long history of stagnation. Maternal deaths have not decreased in the last 20 years, with the maternal mortality ratio lagging far behind the government’s stated goal, according to an Amnesty International report called Deadly Delivery. In 2010, the maternal mortality ratio was 12.7, three times higher than the government’s 4.3 deaths per 100,000 live births goal.

Disaggregating this number shows a wide disparity based on race and ethnicity, location, and income. For example, the risk of maternal mortality has remained three to four times higher among black women than white women during the last 60 years. In addition, states where more than 18 percent of people live below the poverty level were found to have 77 percent higher maternal mortality ratios. The geographic variance in maternal mortality ratios reflects “significant differences in health care access, funding, policies, and staffing,” from a low of 1.4 deaths per 100,000 live births in Maine to 41.6 deaths per 100,000 live births in the District of Columbia, according to Deadly Delivery.

A bill that’s looking for answers
Rep. John Conyers (D) represents one of the worst states in the country for a women giving birth. With a maternal mortality ratio of 26 deaths per 100,000 live births, Michigan is a state in need of the type of funding proposed in Conyers’ recently introduced “Maternal Health Accountability Act of 2011” or H.R. 894.

The bill proposes providing $10 million in grant funding for states to establish Maternal Mortality Review Committees focused on examining pregnancy and childbirth-related deaths and complications. The objective of the legislation is to reduce preventable maternal mortality and morbidity and eliminate disparities in maternal health outcomes.

To discuss the need for the legislation, Conyers convened a hearing with U.S. and international experts—all of whom affirmed the need for research to identify the underlying causes and social determinants of deteriorating maternal health outcomes in the country.

Amnesty International’s Deadly Delivery—which informs much of the proposed bill—highlights Illinois as one state that routinely reviews maternal morbidity and mortality data and uses this research to improve care. All birthing hospitals in the state are required to report any cases of obstetric patients admitted to the ICU or who receive more than three units of blood. Based on the cases the Maternal Mortality Review Committee have led to state-wide postpartum hemorrhage education program and the creation of rapid response teams to address hemorrhage cases.

The largely partisan bill was introduced in March and has 41 co-sponsors, including one Republican, Rep. Andy Harris (Md.) who is also a physician.