The COVID-19 pandemic and renewed focus on racial justice has shown a spotlight on longstanding health disparities and inequalities in our health care system. Indeed, health care has never occurred in a vacuum; it’s influenced by where we live, work and play. These social determinants of health (SDoH) impact a wide range of health risks and outcomes, including behavioral health, chronic conditions and maternal mortality.
But these recent events have only served to put into stark relief the depth of these crises. One key indicator has been flashing red for some time. The U.S. is in the midst of a maternal health crisis and it’s one that disproportionately affects Black women.
In 2018, the maternal mortality rate was 17.4 deaths per 100,000 live births – far worse than other countries of similar wealth. Even more alarming is that this rate is trending upwards: American women today are 50% more likely to die in childbirth than their mothers were. Moreover, Black women are affected by this crisis more than any other racial or ethnic group, with the CDC reporting rates of maternal mortality nearly three times that of white women. To reduce these rates, we must first understand why the U.S. is an outlier.
Social Determinants of Health and the Maternal Mortality Crisis
While some new trends, such as more women becoming pregnant later in life, are contributing to poor outcomes, many drivers of maternal mortality in the U.S. reflect deep-rooted issues within our health system. For example, the health outcomes and increased challenges Black women face are due to a number of social determinants, like limited access to pregnancy and reproductive health care services that meet their needs.
Additionally, many chronic disease risks that are associated with poor obstetrical outcomes are more common in Black women compared to other racial or ethnic groups, due to structural barriers to care. In fact, a recent study by CVS Health found that 48% of Black Americans (versus 39% of non-Hispanic white adults) said a member of their household has hypertension. Additional research shows that 12.7% of Black women have diabetes and Black Americans are disproportionately affected by obesity, a driving cause of both hypertension and chronic heart disease.
Understanding Preeclampsia, a Leading Cause of Death
One of the leading causes of maternal and infant illness and death is preeclampsia, a condition characterized by new-onset hypertension, or high blood pressure, during pregnancy. Preeclampsia can cause organ damage to the kidneys, liver and placenta. Presently, as many as one in 12 pregnancies are impacted by the condition, and that number is growing.
Preeclampsia also has long-term health implications, making it even more important to understand and treat. Women who experience preeclampsia are twice as likely to experience heart disease and/or stroke and four times as likely to have hypertension later in life.
How to Help Prevent Preeclampsia and Other Factors Contributing to Maternal Mortality
- Educating and empowering patients: Encouraging expectant mothers to learn as much as possible about pregnancy-related complications, signs and symptoms, is key to earlier detection and prevention of pregnancy complications. This also allows women to have more informed and engaged conversations with their providers throughout their pregnancies, enabling shared decision-making.
- Talking to your provider about low-dose aspirin for preeclampsia prevention: Despite research showing that low-dose aspirin reduces the risk of developing preeclampsia, many providers may not be aware of this affordable, proven solution.[1],[2] That’s why it’s important for expectant women to proactively discuss this option with their doctors.
- Seeking out community resources: Community resources and health care initiatives focused on maternal wellbeing can be a good source of assistance during pregnancy. For example, Aetna’s Maternity Program is identifying high-risk members and providing them with kits containing education on preeclampsia and the positive effects of low-dose aspirin as well as resources for continued support. These kits are designed to encourage women to discuss their options with their doctor, ultimately empowering them with the knowledge they need to advocate for themselves. Aetna is also notifying in-network OB/GYNs of this outreach, encouraging them to discuss the use of low-dose aspirin with their patients.
- Learning about the birth experience: Expectant mothers should gather as much information as possible—including information about prenatal and delivery care, as well as personal and family health history—to help inform and shape their own birth experiences. This approach allows women to advocate for themselves throughout the entire process.
- Adhering to care: Even during a pandemic, people need to prioritize all of their health care needs. That’s why CVS Health launched “Time For Care,” a campaign to educate people on the importance of seeking preventive care and ongoing treatment for chronic diseases.
Though there is no single solution to ending maternal mortality in the United States—or even preventing preeclampsia—patients, providers and payors alike can take important steps to identify, personalize and localize care. As we work to collectively lower maternal mortality rates in the U.S., we must consider which effective solutions can best be utilized in each patient’s pregnancy journey.
[1] https://www.nejm.org/doi/full/10.1056/NEJMoa1704559?query=recirc_curatedRelated_article
[2] https://www.smfm.org/publications/257-joint-committee-opinion-743-low-dose-aspirin-use-during-pregnancy