Tackling America's rising maternal mortality rate

Posted on Thursday, August 8, 2019

American women are more likely to die due to complications related to childbirth than women in some undeveloped countries, including Afghanistan.

Read that first sentence again. Startling, isn’t it? Why does this happen? And how can we change such a shocking statistic?

It’s not for lack of spending. With health care expenditures in the U.S. reaching $3.5 trillion in 2017, America spends more on health care than any other country in the world. But our clinical outcomes don’t match that spending and our maternal mortality rate is a prime example. The World Health Organization defines maternal mortality is any death of a woman while pregnant or within 42 days of delivery caused by a related condition. Related conditions include diabetes, cardiovascular disease, and hypertension.

  • The Centers for Disease Control (CDC) reports that pregnancy-related deaths in the U.S. have increased from 7.2 deaths per 100,000 live births in 1987, to 17.2 deaths per 100,000 live births in 2015 - That’s a 139% increase!
  • Of the approximately four million women who give birth in America each year, 700 die due to fatal complications during pregnancy, while in labor or post-partum.
  • Another 65,000 women face near-fatal complications after delivering their babies.

Getting at the root causes

We have a huge opportunity to turn these numbers around because the CDC estimates that 3 out of 5 pregnancy-related deaths are preventable. A woman’s age and health status are primary issues impacting maternal mortality. But Social Determinants of Health (SDOH), the environment and conditions where a woman is born, lives, and works, also a have major impact on her health. In fact, SDOH are often at the root of preventable diseases, including diabetes and high blood pressure, that are driving up maternal mortality rates.

For example, pregnant women who live in ZIP codes with “food deserts” -- areas with limited access to affordable, quality, fresh food -- have a much harder time accessing good nutrition which is so critical during pregnancy. Lack of education due to poor neighborhood schools can limit a woman’s ability to understand the necessary steps required to support a healthy pregnancy and post-partum period. If a woman doesn’t have reliable transportation, getting to important pre- and post-natal medical appointments is difficult. When added together, these can be significant obstacles to a woman’s health and well-being.

The government and health plans take action

Recognizing the clear connection between maternal health and SDOH, the federal government and insurance plans are now focusing on ways to address the impact of social determinants.

Late last year, the federal government took the lead as a critical first step, because Medicaid finances almost half of all births nationally[mf9] . Congress passed and the President signed the bipartisan Preventing Maternal Deaths Act in December 2018. The bill supports state-level Maternal Mortality Review Committees (MMRCs) designed to learn more about the maternal mortality rate and the demographic disparities -- including SDOH -- that contribute to those deaths.

A separate piece of legislation working its way through Congress now, the “Mothers and Offspring Mortality and Morbidity Awareness Act” or MOMMA’s Act, includes expanding post-partum Medicaid coverage for expectant mothers from two months to a full year. It also includes a provision to increase training for hospitals and clinicians on improving access to culturally-competent care. If passed, the MOMMA’s Act would have a dramatic effect on maternal health in America and could help save many lives.

Health plans increase focus on nutrition

Some Medicaid plans are addressing SDOH to lower maternal mortality. Some[mf10] states extend post-partum coverage beyond the 60-day federal requirement. 

Improving nutrition is one of the most effective ways to support better maternal health. Many chronic conditions associated with complications during pregnancy and rising maternal mortality rates, including diabetes, cardiovascular disease, and high blood pressure, are preventable and can be managed by proper nutrition. This also helps to minimize the cost of pregnancy due to complications.

Consider Mikayla, a 27-year-old mother-to-be who struggles with obesity and who has been diagnosed with gestational diabetes. Because her plan includes a home-delivered meal benefit, Mikayla receives two meals a day for the duration of her pregnancy, and for two weeks after she delivers her baby. Each dish is designed to meet her needs of proper nutrition and blood glucose control. As a result, Mikayla is better able to keep her HbA1c under control, and her baby has normal birth weight.

That’s why nutrition is a major focus for the health care industry, especially health plans and providers such as Mom’s Meals. Many health plans partner with Mom’s Meals to enroll their pregnant members in a meal-delivery program to ensure they have regular, easy access to the nutrient-rich foods that support a healthy pregnancy and post-partum period. Mom’s Meals offers a range of options for pregnant women managing chronic conditions including diabetes-friendly, health-friendly and low-sodium meals.

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