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Can 'Deadly Deliveries' Be a Wake-Up Call to Physicians, Hospitals?

Janice Simmons, for HealthLeaders Media, March 18, 2010

Amnesty International is probably best recognized in the U.S. for its work worldwide that reports on issues such as human rights violations, discrimination, or health disparities. But for its latest report, the group turns its focus on the U.S.

While this country may have one of the most advanced healthcare systems in the world, AI said, it also has major problems with maternal mortality and pregnancy-related complications when compared with other industrialized nations.

In the U.S., women have a greater lifetime risk of dying from pregnancy related complications than women in 40 other countries, according to the report, Deadly Delivery: The Maternal Health Care Crisis in America, which was released last week.

From a comparative standpoint, the likelihood of a woman dying in childbirth in the U.S. is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain.

The Centers for Disease Control and Prevention (CDC) statistics back this up: They show that 13.3 maternal deaths now occur for every 100,000 live births—well over the target of 3.3 maternal deaths per 100,000 live births, a goal of the US Healthy People 2010 initiative.

"This country's extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful," said Larry Cox, executive director of Amnesty International USA.

"Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies," Cox added.

Maternal mortality actually doubled from a low of 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. While the increase may partially reflect improved data collection, an increase to double digits is a cause for concern, according to the report.

Similar maternal mortality rates have been recently found in California as well, where maternal mortality rates nearly tripled from 1996 2006—and are 4.5 times higher than the Healthy People 2010 benchmark, according to the California Maternal Quality Care Collaborative. No specific reason is identified for this troubling increase.

In the 1990s, California's rates ranged from 5.6 to 10.7 deaths per 100,000 live births, which is consistent with the overall U.S. rate. Beginning in 2000 the rate climbed to 10.9, then to 14.6 and in the last reported year it is nearly 17. Also concerning is a similar rise in the entire U.S. rate.

The five main causes of maternal death the U.S. are:

  • Embolism or blood clots, 20%.
  • Hemorrhage or severe blood loss, 17%.
  • Pre eclampsia or eclampsia, 16%.
  • Infection, 13%
  • Cardiomyopathy or heart muscle disease, 17%.

Complications associated with pregnancy are a major issue as well. In 2004 and 2005, more than 68,000 women almost died in childbirth in the US. These complications, known as "near misses," increased by 25% between 1998 and 2005.

In addition, more than a third of the women who give birth in this country—1.7 million women annually- experience at least one complication that will have adverse effect on the mother's health.

Native American and other minority women, women living in poverty, are immigrants, speak little or no English, or are living in rural or isolated areas are particularly impacted, the report noted. But, even for white women, the maternal mortality ratios are higher than for women in 24 other industrialized countries.

These disparities have not improved in more than 20 years.

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