Poster Paper:
Maternal Mortality in the United States: Lessons Learned from California and Policy Recommendations
Thursday, November 7, 2019
Plaza Building: Concourse Level, Plaza Exhibits (Sheraton Denver Downtown)
*Names in bold indicate Presenter
Background
In recent decades, maternal health outcomes for U.S. women have worsened, while women in Western Europe have seen improvements. The U.S. maternal mortality rate nearly doubled between 1990 and 2013 (WHO, 2014). The U.S. ranks 138th globally for maternal mortality (CIA, 2015), but most pregnancy-related deaths (deaths during pregnancy or within the first year of the end of pregnancy) in the U.S. may be preventable (Creanga et al., 2014). Substantial inequalities in maternal health exist, including by race/ethnicity and urban/rural status.
Myriad systemic issues affect U.S. women’s pre- and post-partum experiences, including limited access to quality health care, non-standardized hospital practices, and incomplete data collection.
Approach
We first review the literature and identify four critical maternal health issues in the U.S.: underinvestment in maternal health, lack of access and increasing rates of disparities, rate of unnecessary cesarean section deliveries, and inconsistent data collection.
We then conduct a case study of California’s policies and practices that have improved maternal health outcomes (maternal mortality decreased by >50% from 2006-2018; CMMR, 2018), with an eye towards lessons that can be scaled nationwide. We selected California as an informative case study based on their improved maternal mortality outcomes, innovative interventions, and scale (California is home to a plurality of U.S. births; Martin et al., 2017).
Findings
We identify four problems that may contribute to the U.S.’s maternal mortality burden: inadequately investing in women’s health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues.
In recent decades, maternal health outcomes for U.S. women have worsened, while women in Western Europe have seen improvements. The U.S. maternal mortality rate nearly doubled between 1990 and 2013 (WHO, 2014). The U.S. ranks 138th globally for maternal mortality (CIA, 2015), but most pregnancy-related deaths (deaths during pregnancy or within the first year of the end of pregnancy) in the U.S. may be preventable (Creanga et al., 2014). Substantial inequalities in maternal health exist, including by race/ethnicity and urban/rural status.
Myriad systemic issues affect U.S. women’s pre- and post-partum experiences, including limited access to quality health care, non-standardized hospital practices, and incomplete data collection.
Approach
We first review the literature and identify four critical maternal health issues in the U.S.: underinvestment in maternal health, lack of access and increasing rates of disparities, rate of unnecessary cesarean section deliveries, and inconsistent data collection.
We then conduct a case study of California’s policies and practices that have improved maternal health outcomes (maternal mortality decreased by >50% from 2006-2018; CMMR, 2018), with an eye towards lessons that can be scaled nationwide. We selected California as an informative case study based on their improved maternal mortality outcomes, innovative interventions, and scale (California is home to a plurality of U.S. births; Martin et al., 2017).
Findings
We identify four problems that may contribute to the U.S.’s maternal mortality burden: inadequately investing in women’s health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues.
California offer strategies that could be scaled up to improve maternal health outcomes nationwide, including funding programs that can address social determinants of maternal health; supporting health care strategies to improve maternal health, including developing national standards and goals for health care systems; and investing in maternal health monitoring and surveillance, including by using technology. We encourage researchers, practitioners, and policy-makers to work together to develop evidence-based policies and practices that can improve maternal health and reduce maternal mortality nationwide.
Conclusions
Efforts to improve U.S. maternal health should increase: 1) funding for federal programs that can address social determinants of maternal health (California’s Black Infant Health Program offers one model); 2) support for health care strategies to improve maternal health, including developing national standards and goals for health care systems; and 3) investments in maternal health monitoring and surveillance, including by using technology (e.g., the California Maternal Quality Care Collaborative’s public-private partnership model for data collection). The Preventing Maternal Deaths Act of 2018 offers a promising starting point for federal action, but more federal work is needed to reduce disparities across states (substantial policy variation currently exists) and among mothers. Researchers and practitioners should collaborate on evidence-informed policies and practices that can improve maternal health determinants and outcomes nationwide.
