Expanding Access to Lower Maternal Morbidity

Dr. Nancy Muller Headshot
Dr. Nancy Muller

We face a crisis, not just nationally, but right here in South Carolina where maternal mortality rates among African American women have soared by over 300% in recent years. The most important next step for us in South Carolina is to improve access to health care, not just during pregnancy and the first 60 days after childbirth but for the entire perinatal period extending the full year past childbirth while a woman is exposed to risk factors for postpartum morbidity and mortality. Research concludes that extending coverage improves health outcomes and results in fewer deaths.

Actually, racial disparities facing perinatal African American women compared to others have persisted for more than 25 years in the U.S. Still, the gap didn’t grab our nation’s attention until five years ago when the World Health Organization listed the U.S. as one of only eight countries in the world with increasing maternal mortality rates. By 2019, we were only one of three such countries, alongside Afghanistan and Sudan.

Over a decade ago, WHO concluded that “the social conditions in which people are born, live and work are the single most important determinant of one’s health status.” Soon after, the Centers for Disease Control and Prevention introduced the use of socio-spatial data to highlight factors contributing to maternal deaths, e.g., lack of access to reliable transportation, affordable groceries and public spaces for recreation and fitness, as well as lack of access to health care providers. This is especially important for addressing the most striking disparity in maternal health in the U.S.

Today, black women have a 3 to 4 times higher risk of dying from pregnancy complications than white women. It’s not just the poor, unemployed or uneducated, however. Tennis champion Serena Williams nearly died from a pulmonary embolism days after giving birth.

Data show that more than 60% of pregnancy-related deaths are preventable. South Carolina was one of the first nine states to begin a collaborative dialogue among clinicians and epidemiologists about the issue. The Nine Maternal Mortality Review Committees estimated that preeclampsia and embolism are leading causes of death among non-Hispanic black women. In early 2018, the CDC estimated that 60,000-plus women experience severe maternal complications, or morbidity, during delivery hospitalizations.

An increasing number of maternal deaths, which are defined as deaths during pregnancy and up to 365 days after, are occurring in the postpartum period. CDC data confirm that one-third of all pregnancy-related deaths occur one week to one year after a pregnancy ends. In some states, the number is much higher. In Illinois, for example, 56 percent of pregnancy-associated deaths occurred between 43 and 364 days postpartum.

A multi-stakeholder collaborative called the S.C. Birth Outcomes Initiative, led by the South Carolina Department of Health and Human Services, was launched in 2011 to improve the health outcomes for all moms and babies. They are championing the efforts to reduce health disparities and improve access and care coordination, among other goals.

Three years ago, under the joint leadership of Trident United Way, MUSC and Roper St. Francis, we began to take responsibility for these deaths by creating a plan with goals, implementation steps, measurable targets and commitments by multiple parties and key stakeholders. The Tri-County Health Improvement Plan emerged. Maternal, infant and child health is one of five areas of priority.

A Section 1115 waiver application has been submitted by the state of South Carolina to the Centers for Medicare and Medicaid, requesting federal authority and matching funds to expand Medicaid coverage to all women in our state during their entire one-year postpartum period. The provision still lacks approval.

I urge all readers to contact U.S. Sens. Tim Scott and Lindsey Graham and U.S. Rep. Joe Cunningham to ask them to lean in and make their support known. It’s high time to save and nurture all of our mothers.

Nancy Muller is co-chair of the Tri-County Health Improvement Plan’s Maternal and Infant & Child Subcommittee. She is director of the Lowcountry Graduate Center and a visiting associate professor of public health at the College of Charleston.

Original Article Location: www.postandcourier.com