Global maternal mortality has dropped between 2000 and 2017, but the same can’t be said for rates in the United States. Despite being a high-resource nation, maternal mortality rates have more than doubled since the late 1980s. Data compiled by the Centers for Disease Control and Prevention (CDC) suggests that more than one-third of maternal deaths in the U.S. occur between one week and one year postpartum—over 60 percent of those deaths are preventable.
Maternal health outcomes in the U.S. have been widely covered, but many aren’t aware that 34 percent of pregnancy-related deaths are caused by heart disease and stroke, according to the CDC. Heart health and maternal care are intrinsically linked. This is why the American Heart Association (AHA) issued a policy statement on Sept. 8, recommending efforts to improve maternity care quality.
“When [someone] suffers from any adverse outcome during pregnancy, it doesn’t just go away when the baby is delivered,” says Laxmi S. Mehta, MD, the director of Preventive Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center and lead author on the AHA policy statement. “Some of the effects are longer-lasting, and we have data to show even many years and decades later, they can impact our health.”
A large portion of the year-long research examined why and how marginalized demographics such as Black and Indigenous women, immigrants, uninsured people, and individuals experiencing homelessness were bigger targets for inequitable maternal care. The researchers found that social determinants of health—which include factors like racism, sexism, housing insecurity, transportation access, health care access, food insecurity, unemployment, and public safety—create inequities in access and quality of care. To that end, the policy statement includes a call for improving public awareness and health literacy before someone conceives.
“If we really want to make a huge change in terms of maternal mortality, we have to look at a woman, not just at the time of pregnancy,” says Dr. Mehta. “We need to be looking at women before they get pregnant to get them in the best health they possibly can before they get pregnant, ” she says. Dr. Mehtha says this is increasingly important if they already have underlying medical issues, and they should be monitored at least up to one year postpartum so that all risk factors and issues are treated.
Additionally, the AHA policy calls for provider-focused programs that increase cultural competency and reduce bias. Racial disparities persist at every socioeconomic level: Black women, for instance, are three times more likely to die than their non-Hispanic white counterparts regardless of affluence or education levels, the CDC says. Additionally, undocumented immigrants are at higher risk of adverse pregnancy outcomes due to lack of insurance, greater risk of poverty, and poor access to equitable care.
So, in addition to implicit bias training, the statement emphasizes recruiting a diverse maternal care workforce that accounts for race, ethnicity, and socioeconomic background. The AHA policy also calls for transforming payment systems which can include extending healthcare coverage for up to a full year after giving birth, modernizing health care delivery technology, expanding coordination among care teams, improving public health infrastructure and digitally-enabled health care, as well as adequate reporting on maternal outcomes and health metrics. In short, the AHA is asking for a substantial overhaul of maternal health.
“I would imagine that the American Heart Association along with other cardiology associations—as well as patient advocacy groups and legislators—need to meet together to make these changes,” Dr. Mehta says. “Individual organizations may be able to look at ways to improve some of the pre-pregnancy [and pregnancy] counseling…but some of the higher-level recommendations are really going to [happen] at a larger level.”
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