scholarly journals Working Agenda for Black Mothers

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Rachel M. Bond ◽  
Kecia Gaither ◽  
Samar A. Nasser ◽  
Michelle A. Albert ◽  
Keith C. Ferdinand ◽  
...  
Keyword(s):  
United States ◽  
Black Women ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Task Force ◽  
The United States ◽  
Maternal Deaths ◽  
Health Crisis ◽  
Live Births ◽  
The Right

Following decades of decline, maternal mortality began to rise in the United States around 1990—a significant departure from the world’s other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable—a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights—the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality.

Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1414-1422
Author(s):  
Cande V. Ananth ◽  
Justin S. Brandt ◽  
Jennifer Hill ◽  
Hillary L. Graham ◽  
Sonal Grover ◽  
...  
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Maternal Mortality ◽  
Birth Cohort ◽  
White Women ◽  
Gestational Hypertension ◽  
The United States ◽  
Chronic Hypertension ◽  
Maternal Deaths ◽  
Live Births

We evaluated the contributions of maternal age, year of death (period), and year of birth (cohort) on trends in hypertension-related maternal deaths in the United States. We undertook a sequential time series analysis of 155 710 441 live births and 3287 hypertension-related maternal deaths in the United States, 1979 to 2018. Trends in pregnancy-related mortality rate (maternal mortality rate [MMR]) due to chronic hypertension, gestational hypertension, and preeclampsia/eclampsia, were examined. MMR was defined as death during pregnancy or within 42 days postpartum due to hypertension. Trends in overall and race-specific hypertension-related MMR based on age, period, and birth cohort were evaluated based on weighted Poisson models. Trends were also adjusted for secular changes in obesity rates and corrected for potential death misclassification. During the 40-year period, the overall hypertension-related MMR was 2.1 per 100 000 live births, with MMR being almost 4-fold higher among Black compared with White women (5.4 [n=1396] versus 1.4 [n=1747] per 100 000 live births). Advancing age was associated with a sharp increase in MMR at ≥15 years among Black women and at ≥25 years among White women. Birth cohort was also associated with increasing MMR. Preeclampsia/eclampsia-related MMR declined annually by 2.6% (95% CI, 2.2–2.9), but chronic hypertension–related MMR increased annually by 9.2% (95% CI, 7.9–10.6). The decline in MMR was attenuated when adjusted for increasing obesity rates. The temporal burden of hypertension-related MMR in the United States has increased substantially for chronic hypertension–associated MMR and decreased for preeclampsia/eclampsia-associated MMR. Nevertheless, deaths from hypertension continue to contribute substantially to maternal deaths.

Aging, Vulnerability and Managing Type 2 Diabetes During a Pandemic

2020 ◽  
Vol 7 (6) ◽  
pp. 106-111
Author(s):  
Jasmin Tahmaseb McConatha
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Black Women ◽  
Well Being ◽  
Immigrant Woman ◽  
The United States ◽  
Health Crisis ◽  
Men And Women ◽  
Class Differences

Older men and women have been found to be more vulnerable to negative outcomes should they contract Covid19, particularly if they also have comorbid conditions such as type 2 diabetes. Cultural, racial, ethnic, and social class differences exist in vulnerability to Covid19 and in the prevalence of type 2 diabetes. In the United States, for example, diabetes rates for minority and immigrant populations are higher than for non-Hispanic whites. During the a social health crisis, it is helpful to explore the ways that illness management and associated vulnerability influences the ways that minority elders attempt to maintain and promote their well-being. This paper presents a case study example of an older immigrant woman, diagnosed with type 2 diabetes, and her struggle to manage her illness during a pandemic. The risk of developing diabetes in the United States is 3 to 1 and risks increase with age (American Diabetes Association, 2020).  Almost 50 % of black women as well as Hispanic men and women will develop diabetes in their lifetime (CDC, 2019). Disparities such as these have their origin in intersecting risk factors such as health care and lifestyle factors such as tress, poverty, weight, diet, and exercise patterns. Being a member of an ethnic minority and being overweight are the two significant factors associated with the onset of type 2 diabetes. During the coronavirus epidemic, these same factors also increase the risk for infection and for greater complications, even death as a result of infection (Society for Women’s Health Research, 2020). This essay illustrates the increased vulnerability and challenges including loneliness facing older women with type 2 diabetes during pandemic isolation.    

Factors Cause of Maternal Death in Timor-Leste

2017 ◽  
Vol 3 (2) ◽  
pp. 30
Author(s):  
Feliciano Pinto ◽  
I Ketut Suwiyoga ◽  
I Gde Raka Widiana ◽  
I Wayan Putu Sutirta Yasa
Keyword(s):  
Health Status ◽  
Maternal Health ◽  
Health Behaviors ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Good Health ◽  
Birth Spacing ◽  
Maternal Deaths ◽  
Live Births ◽  
Timor Leste

Maternal mortality was an indicator of basic health services for mothers or women of reproductive age of a country and was one of the eight Millennium Development Goals (MDGs). Factors that affect maternal mortality, among others: medical factors, non-medical factors, and health care system factors. Meanwhile, WHO (2010) reported that the cause of maternal mortality in the world is 25% of bleeding, 15% of infection/sepsis, 12% eclampsia, 13% of abortions are unsafe, 8% obstructed and ectopic pregnancy, 8% embolisms and other related issues with anesthetic problems. WHO (2010) has determined that the maternal mortality rate (MMR) in 40 countries ≥ 300 / 100,000 live births including República Democrática de Timor-Leste at 557 / 100,000 live births. Objective: This study aimed to determine the relationship between the variables of age, parity, spacing pregnancies, health behavior, and health status of mothers with maternal deaths. Methods: The study design was a cross-sectional study with a sample of 298 pregnant women in 13 districts throughout Timor-Leste. Results: Maternal deaths are caused by independent variables simultaneously and the remaining 28.0% were prescribed other factors. Low maternal health behaviors that lead to maternal death by 40.348 times higher compared with mothers who have good health behaviors. The health status of low maternal causes of maternal mortality by 23.340 times higher than mothers who have a good health status. Birth spacing ˂ two years caused the death of the mother of 16.715 times higher than women with birth spacing ˃ 2 years. Maternal age and parity variables showed no significant effect. Conclusion: There was a significant relationship between behavioral maternal health, maternal health, birth spacing with maternal mortality while age and parity are not related.

scholarly journals Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018

2020 ◽  
Vol 10 (1) ◽  
pp. 29-42
Author(s):  
Gopal K. Singh
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Black Women ◽  
Maternal Mortality ◽  
Social Inequalities ◽  
The United States ◽  
Deprivation Level ◽  
Mortality Trends ◽  
Race Ethnicity

Background: Despite the previous long-term decline and a recent increase in maternal mortality, detailed social inequalities in maternal mortality in the United States (US) have not been analyzed. This study examines trends and inequalities in US maternal mortality by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, area deprivation, urbanization level, and cause of death. Methods: National vital statistics data from 1969 to 2018 were used to compute maternal mortality rates by sociodemographic factors. Mortality trends by deprivation level were analyzed by using censusbased deprivation indices. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: Maternal mortality declined by 68% between 1969 and 1998. However, there was a recent upturn in maternal mortality, with the rate increasing from 9.9 deaths/100,000 live births in 1999 to 17.4 in 2018. The large racial disparity persisted over time; Black women in 2018 had a 2.4 times higher risk of maternal mortality than White women. During 2013-2017, the rate varied from 7.0 for Chinese women to 42.0 for non-Hispanic Black women. Unmarried status, US-born status, lower education, and rural residence were associated with 50-114% higher maternal mortality risks. Mothers in the most-deprived areas had a 120% higher risk of mortality than those in the most-affluent areas; both absolute and relative disparities in mortality by deprivation level widened between 2002 and 2018. Hemorrhage, pregnancy-related hypertension, embolism, infection, and chronic conditions were the leading causes of maternal death, with 31% of the deaths attributable to indirect obstetric causes. Conclusions and Global Health Implications: Despite the steep long-term decline in US maternal mortality, substantial racial/ethnic, socioeconomic, and rural-urban disparities remain. Monitoring disparities according to underlying social determinants is key to reducing maternal mortality as they give rise to inequalities in social conditions and health-risk factors that lead to maternal morbidity and mortality. Key words: Maternal mortality • Socioeconomic status • Deprivation • Race/ethnicity • Rural-urban • Disparities • Cause of death • Trend. Copyright © 2021 Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals A social law lens on maternal mortality in the U.S.: Lessons from Germany and the Netherlands

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Tonti
Keyword(s):  
United States ◽  
The Netherlands ◽  
Maternal Mortality ◽  
Postnatal Care ◽  
The United States ◽  
Live Births ◽  
Social Law ◽  
Insurance Benefit ◽  
Legal Interventions ◽  
The U.S

Abstract The United States has one of the worst maternal mortality rates among developed nations. American mothers are three times more likely than Canadian mothers and six times more likely than Scandinavian mothers to die from pregnancy-related deaths. Currently, for every 100,000 live births, 26.4 mothers are dying in the U.S, with significant disparities between White mothers and mothers of color. Projections indicate that by 2030, the maternal mortality rate will rise to 45 maternal deaths out of 100,000 live births. In direct contrast, most other similarly situated high-income nations have decreased their maternal mortality rates in recent years, evidencing only single-digit mortality per 100,000 mothers. This research examines how social protection measures afforded by the law can facilitate differences in these rates. Specifically, this presentation compares legal interventions enshrined in social law that impact maternal health in the United States, Germany, and the Netherlands, including mandated access to prenatal care, midwifery reimbursement, and obligatory duration of postnatal care. Compared to the United States, both Germany and the Netherlands enshrine more comprehensively midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes. Evidence accumulated by comparing these interventions with maternal mortality statistics suggests that legal interventions that spur extra attention to mothers during and after birth may help prevent pregnancy-related deaths. It also opens a discussion about how policymakers can use legal interventions to help eliminate racial disparities in maternity practice. Key messages Codified legal interventions that mandate extra attention to mothers during and after birth may help prevent pregnancy-related deaths. Compared to the U.S., both Germany and the Netherlands better enshrine midwifery compensation and access to postnatal care in their social legal codes and insurance benefit schemes.

scholarly journals Reducing Cardiovascular Maternal Mortality by Extending Medicaid for Postpartum Women

2021 ◽  
Author(s):  
Janki P. Luther ◽  
Daniel Y. Johnson ◽  
Karen E. Joynt Maddox ◽  
Kathryn J. Lindley
Keyword(s):  
United States ◽  
Maternal Mortality ◽  
Access To Care ◽  
Rural Areas ◽  
Maternal Morbidity ◽  
The United States ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Maternal Deaths ◽  
Risk Of Death

Abstract Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high‐income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60 days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60 days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high‐risk populations is extension of Medicaid coverage for 1 year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.

Abstract P318: Wide State-By-State Variation in Maternal Mortality and Chronic Diseases That Contribute to Pregnancy Complications

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Sarah Milder ◽  
Jamie Kenealy ◽  
Mary Ann Honors ◽  
Thomas Eckstein
Keyword(s):  
United States ◽  
Heart Disease ◽  
Mortality Rate ◽  
Maternal Mortality ◽  
Chronic Diseases ◽  
Pregnancy Complications ◽  
The United States ◽  
Reproductive Age ◽  
Maternal Mortality Rate ◽  
Live Births

Background: Among developed countries, the United States has the highest maternal mortality rate. Between 1987 and 2011, the US maternal mortality rate more than doubled from 7.2 to 17.8 deaths per 100,000 live births. More than 1,300 pregnancy-related deaths occurred in the United States in 2011-2012. Additionally, an increasing number of women have chronic health conditions, such as hypertension, diabetes, and chronic heart disease, that increase their risk of pregnancy complications, including maternal mortality. Reducing the prevalence of these diseases may be an important step toward reducing maternal mortality. To examine the current state of maternal mortality and chronic diseases in the United States, the geographical variation of these factors was examined. Methodology: State-level prevalence estimates were calculated for diabetes, heart disease, and hypertension awareness among women of reproductive age (18 to 44 years) using data from the 2013-2014 Behavioral Risk Factor Surveillance System. State-level maternal mortality rates were calculated using CDC’s 2010-2014 National Vital Statistics System. Maternal mortality was defined as the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births. Results: The maternal mortality rate is 6.8 times higher in Georgia (39.3 deaths per 100,000 live births) than in Massachusetts (5.8 deaths per 100,000 live births). Nationally, there are an estimated 19.9 maternal deaths per 100,000 live births. The prevalence of chronic diseases that increase risk of pregnancy complications also vary by state. For example, diabetes (excluding gestational diabetes) ranges from a low of 1.9% of women aged 18 to 44 in Alaska, Minnesota, and Wisconsin to a high of 4.8% in Alabama. Nationally, an estimated 3.1% of women aged 18 to 44 have been told by a doctor that they have diabetes. Conclusion: The prevalence of chronic diseases in women of reproductive age vary based on state of residence, as does the maternal mortality rate. Raising awareness about the variation in these measures is an important step toward identifying what strategies are being utilized in states with a low prevalence of diabetes, heart disease, and hypertension, and determining how their public health efforts may help those states facing challenges in these areas.

scholarly journals Votes for Women: An Economic Perspective on Women’s Enfranchisement

2020 ◽  
Vol 34 (2) ◽  
pp. 3-23 ◽  
Author(s):  
Carolyn M. Moehling ◽  
Melissa A. Thomasson
Keyword(s):  
United States ◽  
Black Women ◽  
Empirical Studies ◽  
State Level ◽  
Voting Rights ◽  
Theoretical Models ◽  
The United States ◽  
Nineteenth Amendment ◽  
History Of ◽  
The Right

The ratification of the Nineteenth Amendment in 1920 officially granted voting rights to women across the United States. However, many states extended full or partial suffrage to women before the federal amendment. In this paper, we discuss the history of women's enfranchisement using an economic lens. We examine the demand side, discussing the rise of the women's movement and its alliances with other social movements, and describe how suffragists put pressure on legislators. On the supply side, we draw from theoretical models of suffrage extension to explain why men shared the right to vote with women. Finally, we review empirical studies that attempt to distinguish between competing explanations. We find that no single theory can explain women's suffrage in the United States and note that while the Nineteenth Amendment extended the franchise to women, state-level barriers to voting limited the ability of black women to exercise that right until the Voting Rights Act of 1965.

Mitigating Implicit Bias in Clinical Decision Making

2021 ◽  
Author(s):  
Keith Scally
Keyword(s):  
United States ◽  
Decision Making ◽  
Black Women ◽  
Clinical Decision Making ◽  
Implicit Bias ◽  
Clinical Decision ◽  
The United States ◽  
Healthcare Outcomes ◽  
Maternal Deaths ◽  
The Past

Background: Evidence supports that maternal deaths among Black women in the United States have substantially increased over the past three decades. While the cause of these deaths can be multifactorial, research reveals that implicit bias can be a contributing factor. Implicit bias can negatively influence clinical decision making abilities, and therefore, negatively impact healthcare outcomes. Purpose: To improve awareness of implicit bias and reduce its impact on clinical decision making.

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