Maternal Death Reform in the United States

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Annually in the US, 700-900 women die as a result of pregnancy and 65,000 almost die. It is estimated that 60% of these deaths are avoidable.

We are looking for a change. And we need your voice. We need the voice of everyone you know to demand change. It is our mission to collect 1,000,000 signatures to take to our nation’s capital and speak on behalf of all the women who have needlessly given up their lives simply by giving birth.

In 1986, the CDC began collecting and studying data, voluntarily submitted, from all 50 states and the cities of Washington, DC. and New York City.  CDC scientists analyse the information for cause and risk factors, releasing the data through its website and in peer-reviewed literature, in order to help healthcare professionals understand and address the factors leading to maternal death.

In 1987, the number of reported  pregnancy related deaths in the US was 7.2 per 100,000. In 2013, this rate had climbed to 17.3 per 100,000. And the news was much worse if you happen to be black. When broken down along racial lines, black women had a pregnancy related death rate of 43.5 per 100,000. The higher incidence of death among black women is not well understood. It is known that the leading cause of death among those reported in the years 2011, 2012, and 2013 was cardiovascular disease. In the black community, there is a higher incident of high blood pressure which affects them at an earlier age than non-blacks and is more severe. What is not known is how significantly, if at all, this relates to maternal death.

The statistics surrounding pregnancy-related mortality in the US are best classified as guesstimates. This is largely due to the inconsistent data collection from state to state and the voluntary reporting system. But there is one thing that we do know. The pregnancy-related death rate in the United States is on the rise, whereas in all other developed countries in the world, it is declining.

The World Health Organization definition of the “pregnancy-related death ratio” differs from the CDC. The WHO limits the time definition to within 42 days following the termination of pregnancy, while the CDC measures this up to 1 year from the end of the pregnancy. This accounts for the larger number in US deaths reported by the CDC vs the number reported by the WHO. But it does not alter the fact that for a country that purports to have the best healthcare in the world, The US has the highest number of women dying as a result of pregnancy in the developed world.

A small sample of those numbers published by the WHO from 2000 and 2015: Australia 9 in 2000 and down to 6 in 2015; Canada 9 in 2000 and down to 7 in 2015; France 12 in 2000 and down to 8 in 2015; Italy 5 in 2000 and down to 4 in 2015; Israel 8 in 2000 and down to 5 in 2015; Sweden 5 in 2000 and down to 4 in 2015; United Kingdom 12 in 2000 and down to 9 in 2015; USA 12 in 2000 and increased to 14 in 2015.

So what is driving this increase in our pregnancy-related death rate? We don’t know because our data is incomplete.The first glaring problem is inconsistent, voluntary reporting. It will be impossible to get to the cause if we cannot even get accurate numbers. Secondly, annual reporting leaves large amounts of data to be scrutinized, categorized and analyzed. Any relevant findings are slow in coming.  Third, there are no interviews of witnesses, i.e. the family, doctors, nurses, and support team. For those women who die outside the hospital, this  should include other critical witnesses like family, law enforcement, and first responders, among others.  These individuals should be interviewed in order to obtain a complete picture of the events leading to death. 

Following their analysis, the CDC publishes the results in peer-reviewed literature and on their website to help healthcare professionals understand the circumstances and develop action plans. However, despite these data, the pregnancy related death rate more than doubled between 1987-2013, a 27-year span.  It has continued to climb in the years since (putting an exact figure on this is very difficult. A CBS report from HealthDay in August, 2016, put the pregnancy related death rate in 2014 at 24.) This is a clear failure of the prevention part of the CDC mission. It is a failure on the part of healthcare providers in the US as well. We have to take some ownership of this problem.

The way to fix this issue is through an honest look at what the causes are and what concrete actions can be taken to correct those problems.

A coordinated national effort that is managed by knowledgeable, impartial investigators is an important first step. It must have the power of the law behind it and carry a stiff penalty for noncompliance. In the U.S., we have a healthcare system that is, at its core, a business, and as such seeks to protect its bottom line. The prevalence of litigation in bad outcomes has incentivised hospitals and doctors to obfuscate and coverup facts. Couple that with the inconsistent reporting methodology and failure is inevitable. ?To correct this, each maternal death and “near miss” should be reported immediately to an independent federal agency. This agency should have teams trained to investigate negative outcomes, with the ability and jurisdiction to confiscate records, interview witnesses and report findings.

We have an excellent model for this approach in the Independent Safety Board Act of 1975, which established the National Transportation Safety Board (NTSB) as a fully independent federal agency.  The safety of commercial travel, whether by air, surface or sea, is largely a result of this agency. In this case, a non-partisan, independent investigation led to unparalleled travel safety. Indeed, no one would imagine leaving it up to airlines, rail, highway or marine transporters to voluntarily report accidents or near-misses. And yet that is exactly what we have permitted in our healthcare systems.

We are asking you to stand with us and support this important initiative. Ask everyone you know to stand with you.

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