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[Editorial] Centring the invisible mother

Tags: General

The USA had an average pregnancy-related mortality (PRM) of 17·2 per 100 000 livebirths between 2011–15, according to a report from the US Centers for Disease Control and Prevention (CDC). Released May 7, the report found that approximately 700 women in the USA die each year because of pregnancy-related conditions, and 60% of maternal deaths were preventable if “one or more reasonable changes” had occurred. Causes of death varied by time prepartum and postpartum, but the most common were cardiovascular conditions.

The study drew on the CDC's Pregnancy Mortality Surveillance System and state data. In 1987, the CDC reported an initial national PRM of 7·2, which has risen steadily nearly every year since. Factors that contribute to maternal mortality range from patient issues, such as poor knowledge of warning signs, to larger, more systemic issues that could affect maternal health: lack of transportation access, inadequate care, and lack of obstetric emergency knowledge from care providers. All of these factors highlight a lack of attention to the health of mothers before, during, and after they give birth—only 6% of state and federal funding for child and maternal health in the USA focuses on the mother.

The USA has the highest maternal mortality in the developed world, which worsens in light of stark racial disparities. African-American women have a pregnancy-related mortality of 42·8 per 100 000 livebirths, three times that of white women, ranking between Turkmenistan and Brazil. At 13 PRM, even white women in the USA rank behind Saudi Arabia and Kazakhstan. That one of the world's richest countries, with the highest per capita health-care spending globally, has backslid so far is a shocking development. The image of maternal death we see in the media is often a woman in labour being wheeled into the delivery room and a slow fade to black. But the vast majority of deaths (82%) occur before or after the day of delivery. The USA needs to recommit to ensuring health-care providers centre the needs and health of mothers—of all races—not just on the day of birth, but throughout the entirety of their pregnancy and beyond.
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