maternal mortality

Reducing Maternal Mortality Requires ‘Care Across the Lifespan’

In the US, where two-thirds of maternal deaths occur during pregnancy or post-partum, a community-based care model can provide preventive and life-saving services to mothers, writes Eugene Declercq in a new report by the Aspen Health Strategy Group.

The maternal mortality rate in the United States remains the highest of any high-resource country in the world—700 people die each year as a result of pregnancy-related complications—and Black women are three times more likely to die in childbirth than White women. Reversing this trend calls for a national commitment to building a maternity care system that suits the needs of people who are pregnant, according to a new report by the Aspen Health Strategy Group.  

The report, titled “Reversing the U.S. Maternal Mortality Crisis,” is the result of a years-long study conducted by 23 health experts, including Eugene Declercq, professor of community health sciences and a certified childbirth educator. The group was co-chaired by Kathleen Sebelius and Tommy G. Thompson, former US Secretaries of Health and Human Services.

The publication is the fifth report by the nonprofit organization, which releases annual publications aimed at improving policy and practice on a variety of critical health issues.

The report proposes five “Big Ideas” to address maternal mortality and includes four background papers, one of which Declercq wrote, that informed the group’s decisions. The key national recommendations include making a national commitment to lower maternal mortality and morbidity rates; building and supporting community care models; redesigning insurance around women’s needs; tackling the racism that undermines women-centered maternity care; and investing in research, data, and analysis.

Declercq’s paper focuses on the fundamental idea that decreasing maternal deaths in the US will require improved hospital care, as well as a national commitment to expanding and strengthening health and social services in community settings. He proposes the development of a national community care model that frames maternity care as “part of a continuum that predates pregnancy and carries on after birth.

“Maternity care epitomizes many of the challenges of the US healthcare system, from an overreliance on specialists to a failure to address racial, ethnic, and class discrimination at the intersection of social, policy, and healthcare systems,” writes Declercq. “There has been a concentration of resources in equipping and staffing hospitals to serve the highest-risk cases, far more than building a community-based infrastructure focused on prevention that might reduce the frequency of those cases.”

This current model of hospital-based maternity care has been exacerbated by a sharp rise in cesarean sections, the closure of small, often rural, maternity services, and the widening disparity in maternal mortality among Black and White mothers, Declercq writes. While more than 98 percent of US births occur in hospitals, there has been a rapid increase in out-of-hospital births at home or in freestanding birth centers with midwives and doulas—“perhaps the clearest indication of maternal dissatisfaction with the predominant model of hospital-based care” he writes, citing mothers’ reports about a lack of support and respect from providers in clinical settings, and an increase in discrimination and abuse.

Midwives and doulas often serve in community health settings such as the birth centers, as well as community health centers, and provide more personalized care to mothers over a longer period of time.

With two-thirds of maternal deaths occurring during pregnancy or within a year of birth, it’s critical to expand maternal care outside of the hospital, Declercq writes.

“Research has found that midwifery models of care improve outcomes, are cost effective, are popular with women, and have the potential to substantially reduce maternal mortality internationally,” he writes.

Ultimately, he writes “reducing maternal mortality is not just about better maternity care, but about improving women’s healthcare across the life span. The key is reconceptualizing pregnancy as an opportunity to engage and keep a connection to those higher-risk women who otherwise remain outside the system.”