Unfortunately, maternal mortality does not receive as much attention as it should in the maternal and child health field because the majority of the focus is placed on improving the outcome of the infant. It is a poorly known fact that 1982 was the last year the United States witnessed a reduction in the maternal mortality rate—since 1982, the rate has steadily increased. To add to the problem of the increase in maternal mortality is the serious problem of underreporting. The Centers for Disease Control report
approximately 350 to 400 official documentations yearly of a maternal death, but believe that the actual number is double or triple the 350-400 (Gaskin I.M. 2002). An example of how a maternal death can not be counted is in the case of hemorrhage. In many cases, hemorrhage is associated with cesarean section; if the cause of death is listed as
Table 1.2: Parish and National Comparisons for Prenatal Care Black Entry in 1st Trimester White Entry in 1st Trimester Black No Prenatal Care White No Prenatal Care Nation 74.3 88.5 2.9 0.7 EBR Parish 69.3 91.7 2.4 0.36
certificate as a hemorrhage due to a cesarean section, then the maternal death may not be recorded as such. Another is a complication such as a bowel obstruction as the result of a cesarean section that doesn’t actually result in death until months later—these are
commonly also not reported as a maternal death. Maternal death is defined as a death of a pregnant woman during or within one year after the end of the pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The maternal mortality ratio is the number of maternal deaths for every 100,000 live births and
includes deaths related to live births, stillbirths, abortion, and ectopic pregnancy. The official U.S. maternal mortality rate for 1987 was 6.6 per 100,000. A large racial disparity existed in 1987 with the maternal mortality rate for blacks being 14.2 per 100,000 compared to 5.1 per 100,000 for whites (U.S. Department of Health and Human Services, 1991). By 1995 the overall maternal mortality rate had increased to 7.1 per 100,000 and the racial disparity had also increased. The maternal mortality rate for the black population had increased to 22.1 per 100,000 and the rate for the white population had dropped to 4.2 per 100,000—a ratio of over 5:1 (U.S. Department of Health and Hospitals, 1998). However, due to underreporting, the number of maternal deaths is actually higher and the actual racial disparity may be higher or lower. The 1999 maternal mortality rate of 7.7 per 100,000 live birth ranked 21st among developed countries and placed the United States among countries such as Slovenia and Portugal. Spain, Norway, and Canada had the best rates with a risk of less half than that of the U.S. (Webber R. 2001).
Maternal mortality is quite different from infant and perinatal mortality. While infant mortality is regarded to be an important measure of a nation’s health and a worldwide indicator of health status and social well-being, maternal mortality is a measure of a country’s health care delivery system. The fact that the United States’ health care system is based on a marketplace model is one possible explanation of why the maternal morality rate is higher than those of countries with universal health care (ibid). Many states have attempted to expand prenatal care so that more women are eligible, but it has not had a profound effect on maternal mortality. Eugene Leclercq, a maternal health professor at Boston University School of Public Health, states that prenatal care is not enough and that is often focuses on the baby, not the woman. “In the U.S. just a few percent of women get no prenatal care, but that’s a major risk factor for maternal death” however, it’s not enough because “states decide to provide prenatal care to make sure the mother and baby are healthy, as if that resolves all the lack of care she had before and will continue to have afterwards…It may also say something about how we value women—it seems to say that her main role here is just to delivery the baby. That’s shortsighted” (Leclercq E. as quoted in Webber, 2001). Many women who qualify for Medicaid for delivery loose benefits shortly after delivery and are not properly
followed after delivery. Not all maternal deaths happen shortly after delivery and if the woman has lost Medicaid benefits than she will most likely be unable to receive the care needed. An example of a maternal death that occurred months after delivery was the case of Nancy Lim, a young mother who contracted an illness during a cesarean section, required a colostomy, and died after eight months of illness (Gaskin I.M., 2002). Many maternal deaths have occurred due to the mother’s inability to receive proper follow-up
after delivery even though the baby may still be eligible for Medicaid benefits. Maternal mortality is “a measure not only of what is happening during pregnancy, but as a measure of women’s health before and after pregnancy…Maternal mortality and maternal health is really an indicator of what’s going on during their reproductive years” (Wilcox, as quoted in Webber, 2001).