Recent media reports have coupled a startling set of facts with an equally startling explanation.

Women who want to start or grow their families face greater risks during childbirth than their mothers did. Over the last two decades, the number of American women who die each year from a pregnancy- or childbirth-related cause has skyrocketed by more than 50 percent. The risks for black women are more than three times higher than for white or Hispanic women, regardless of income or education.

The most common explanation? Hospitals have been failing to protect pregnant women. But as maternal health researchers who have been studying this trend, we believe an essential piece of the story is missing.

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The Centers for Disease Control and Prevention’s newly released annual report on U.S. deaths indicates a larger challenge than maternal mortality: death rates are rising for all women of reproductive age, not just those who are giving birth. This suggests we need to widen our lens.

The public image is that these deaths are caused by a hemorrhage or other acute condition that suddenly arises during labor and leads to a terrible tragedy. That certainly does happen, and clinicians and hospitals have been taking steps to address these emergencies with new guidelines, and the use of simulations to better handle obstetric crises. While it’s clear that some hospitals could be doing more, this type of response is fundamentally what we’ve structured the U.S. health care system to do — apply abundant resources to better treat emergencies in hospitals.

Although these efforts are essential, they address just part of the problem. The same CDC research that documented the rise in maternal deaths also examined the timing of these deaths. Only about one-third of them occurred during labor and delivery or in the following week. Roughly one-third occur during pregnancy and another third between one week and one year after birth.

That means we have to look at care in the community as well as in the hospital if we truly want to prevent maternal deaths.

In the U.S. each year, an estimated 700 women die from pregnancy- or birth-related causes. Each one of these deaths is heart-wrenching. Yet they constitute only about 1.3 percent of all deaths each year among women of reproductive ages, generally set as ages 15 to 45. Compare their death rates to those among women younger than 15 or older than 45 and an even more disturbing pattern emerges. In the U.S., the death rates for women under 15 and over 45 have been decreasing for decades. But between 2010 and 2016 (the most recent years for which data are available), the death rate for reproductive-age women increased an average of 14 percent. For women between the ages of 25 and 34, the death rate increased by 20 percent.

More data on the trends we describe here are available at Birth by the Numbers.

This wider picture shows that the well-being of all women of reproductive age is on the decline and, contrary to the headlines, it’s not only because of their pregnancies. Over the past decade, the number of maternal deaths associated with life-threatening conditions that are specific to pregnancy, such as postpartum hemorrhage, pre-eclampsia, and infection, have actually been declining. At the same time, life-threatening conditions that are chronic in nature and not directly caused by pregnancy, such as cardiac disease and mental health conditions, have been rising.

In addition to these insidious conditions, a recent CDC report attributed the lion’s share of avoidable deaths to broader failures of social support: not seeking timely care, not following medication plans, abusive relationships, unstable housing, and substance use.

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Efforts by clinicians and hospitals to improve maternity care are essential. But we can’t solve the problem of maternal deaths unless we acknowledge that women’s health isn’t something to be concerned about only during pregnancy and then disregarded after the baby is born.

At a minimum, policymakers should resist recent efforts to drop maternity benefits from core health insurance coverage. But they also need to revise current state policies that expand Medicaid coverage for women only during pregnancy and then drop them 60 days after giving birth.

Once we focus on the health of all reproductive-age women, we’ll see that the current concern with deaths during pregnancy was the equivalent of a canary in a coal mine warning of a much larger problem.

Eugene Declercq, Ph.D., is a professor of community health sciences at Boston University School of Public Health and founder of Birth by the Numbers. Neel Shah, M.D., is a professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and director of the Delivery Decisions Initiative at Ariadne Labs. Both are directors of the March for Moms.

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  • Nothing to get concerned about here folks! The article in a way blames the victims, since they are low income or couln’t afford decent care. The mass media has effectively censored the number of adverse events in Childbirth, to please the advertisers and keep the “Right To Lifers” happy. In Post Face America even the watered down reported numbers have not led to any real action. Due to the interference of Corporate healthcare’s lobbying efforts the facts are not readily available. There are considerable gaps in the data by design, they were inconvenient for the industries profiting here.
    In my community the only services for pregnant women are run by the Catholic Church. To keep their monopoly and to discourage abortions, they made sure that other clinics were shut down in rural areas. A woman and her fetus died in a roll over accident, on their way 160 miles to an appointment.
    Here in Post Fact, Post Science America, Misogyny spreads way beyond the number of dead mothers and infants, it even keep the dead from being counted. Instead of addressing the problems, our community set up various Alternative healthcare “options.” They created Midwife clinics where young misinformed women are provided “pre natal Services. They don’t explain that alternative medicine won’t save them in a Crisis Situation or for difficult pregnancies, but it sounds nice anyway.
    One local area decided that sex ed should be taught by a “Crisis Pregnancy” religious group. The same religious fanatics that advertise “Pregnancy Services” so they can talk women out of abortions, are now peddling their Faith Based Sex Ed for public schools.
    The actual number of Infant Maternal Deaths are being hidden. Healthcare Corporations know how to work around reporting requirements. Physicians are remaining silent, after all they could be fired or threatened with Liability if they do speak up. Someday this is going to be compared to Nazi Germany, The silence of the providers and profiteers, who even turned this into a marketing opportunity.
    To make matters even worse the women who experience this are subject to Institutional Gas-lighting since the media has been silent. These cases are treated as Outliers, instead of indicators of a failed system. Low Income pregnant women are disposable. They are shamed, vilified and demeaned every step of the way. When they do seek pre natal care, they are treated like cattle, or livestock. The Death Rate for minorities is higher than for wealthy Whites, but that does not mean that any woman is immune. Good Luck “Shopping” for healthcare, when the numbers of deaths at local hospitals have been under reported, just like the numbers of adverse events.

    It is proof that we need Universal Healthcare or Medicare For All! This makes it pretty clear that healthcare is more like a Criminal Enterprise, and the For Profit Model is not working.

    Silence Is Complicity!

  • The reason one third happens after a week is because of more advanced life support which keeps them alive a bit more than a week, so they dont go into the stats. Same with perinatal death. It is going down not because less die, but because life support keeps them alive till they get past the one week definition.
    Maternal mortality is up to 1 in every 4000 in the US not because of suicide- but women are dying at the 1.5 million cesareans per year at the rate of about 1 in 5,000 or so. Thats 300 women. but life support keeps a lot of them alive for a month or so until someone pulls the plug.
    There is very little effort to lower cesarean rates, they are hanging at 30% for years now.
    I have a protocol that completely eliminates hemorrhage at vaginal birth and i dont know of a single doctor who has tried it. Search Judy’s 3,4,5 on Pubmed.

    • That is how they game the system! Like everything else the “Reported” rate is much different than reality.

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