Priya V a Vedula, a, M MPH Health Policy Analyst Institute for - PowerPoint PPT Presentation

Priya V a Vedula, a, M MPH Health Policy Analyst Institute for Health Policy and Leadership

M a t e r na l M or t a l i t y T h e P l i g h t o f A m e r i c a n M o t h e r s A P r e s e n t a t i o n b y P r i y a V e d u l a , M P H

Lauren Bloomstein S a t u r d a y O c t o b e r 1 , 2 0 1 1

H emolysis El evated Liver Enzymes HELLP Syndrome L ow P latelet Count A life-threatening version of preeclampsia

Maternal Mortality vs Health Expenditures Over Time

Chances of Dying During Childbirth

Source: The Lancet Credit: Rob Weychert/ProPublica The US Defies the Trend

B l a c k m o t h e r s a r e 3-4 Disparities and times Inequities in m o r e l i k e l y t o d i e i n t h e U S t h a n w h i t e m o t h e r s Maternal Deaths Maternal Deaths per 100,000 Live Births Asian/Pacific Islander 11.6 Latina 12.2 Caucasian 18.1 I n s o m e c i t i e s , b l a c k m o t h e r s a r e American Indian and Alaskan Native 12 38.8 African American 47.2 times 0 10 20 30 40 50 Maternal Deaths per 100,000 Live Births m o r e l i k e l y t o d i e t h a n w h i t e m o t h e r s

Source: Harvard School of Public Health

Defining Maternal Deaths

Differences in Data Maternal Mortality Rate 1990: 7.2 per 100,000 live births 2015: 18 per 100,000 live births

Differences in Data Source: Obstetrics & Gynecology: January 2017 - Volume 129 - Issue 1 - p 91- 100 doi: 10.1097/AOG.000000000000 1810

Timing Pregnancy-related/ Pregnancy-associated Maternal mortality 37% 45% 18% of maternal deaths of maternal deaths occur of maternal deaths occur during within the first 42 days occur between 43 days pregnancy after childbirth and 365 days after childbirth

Underlying Health Conditions C-sections Main Causes in the Rise of Opioids and Substance Abuse Maternal Deaths Lack of Access to Perinatal Care

Underlying Health Conditions C-sections Main Causes in the Rise of Opioids and Substance Abuse Maternal Deaths Lack of Access to Perinatal Care

Underlying Health Conditions Causes of maternal mortality Causes of pregnancy-related worldwide (2000-2010) mortality in the United States Indirect 18% Hemorrhage 35% Other Direct 12% Abortion 9% Sepsis Hypertension 8% 18% Hemorrhage Hypertension Sepsis Abortion Other Direct Indirect

Underlying Health Conditions C-sections Main Causes in the Rise of Opioids and Substance Abuse Maternal Deaths Lack of Access to Perinatal Care

C-sections

C-sections

Underlying Health Conditions C-sections Main Causes in the Rise of Opioids and Substance Abuse Maternal Deaths Lack of Access to Perinatal Care

Opioids and Substance Abuse Colorado Massachusetts Texas Source: State reports from Texas, Massachusetts, and Colorado Public Health Departments

Underlying Health Conditions C-sections Main Causes in the Rise of Opioids and Substance Abuse Maternal Deaths Lack of Access to Perinatal Care

PERINAT ATAL Prenatal al Postp tpartu tum

Lack of Access to Perinatal Care “Women receiving no prenatal care are 3-4 times more likely to have a pregnancy-related death than women who receive prenatal care.” Maternal Health Task Force at the Harvard Chan School “In 2016, American Indian and Alaskan women (12%) and non-Hispanic black women (10%) were the most likely to report not receiving prenatal care.” ChildTrends.org

Lack of Access to Perinatal Care Post partum care matters Percentage of Maternal Deaths Attributed to Mental Health Conditions as the Underlying Cause (includes overdoses from substance abuse) Within 365 Days 16.2% 4.1% Within 42 Days 6.6% While Pregnant

“I knew it wouldn’t be easy when I decided to keep my baby, but I don’t believe that anyone should have to give up their children or not have their children because they’re poor or because they’re homeless,” she says. “Having this baby is the best thing that ever happened to me, and I know I’m going to be a good mother if I have available resources. The problem is they can give me job training and education programs but if I don’t have stable housing none of that is going to be helpful.” J e s s i c a C r a w f o r d ( 2 8 )

Lack of Access to Perinatal Care ACCE CCESS

Lack of Access to Perinatal Care % of Single Federal Person’s Poverty Annual Level Income 61% $7,618 100% $12,490 138% $17,236 200% $24,980 250% $31,225 Source: Kaiser Family Foundation

Lack of Access to Perinatal Care Maternal death rates within 42 days of Medicaid expansion status by state pregnancy per 100,000 live births Adopted and Implemented Maternal Mortality Rate (<16.9) Adopted but not implemented Maternal Mortality Rate (16.9-20.6) Source: Kaiser Source: America Family Foundation Health Rankings Not Adopted Maternal Mortality Rate (>20.7)

Lack of Access to Perinatal Care Washington D.C.: The Maternity Desert Source: The Atlantic

Underlying Health Conditions Older age of first time mothers • Growing number of conditions: chronic • health disease, hypertension, and diabetes

C-sections Historically increasing over time • Chance of getting a C-section is more likely determined • by hospital of care than by need Can increase the risk of morbidity and mortality •

Opioids and Substance Abuse “Opioid use in pregnancy has escalated dramatically in • recent years, paralleling the epidemic observed in the general population.” – American College of Obstetricians and Gynecologists Majority of substance abuse-related deaths occur • postnatally

Lack of Access to Perinatal Care Access refers to coverage, timeliness, and services • For low-income women, length of coverage is determined by • the state in which the pregnant woman lives Both prenatal and postnatal care can impact a mother’s health • outcomes

A Success Story

Since 2006, one state has been reversing the trend. Maternal Mortality Rates

California (blue line) has been reversing the trend.

Toolkit Source: CMQCC Tool Kit from the CMQCC Website

Hemorrhage Cart Source: Gray’s Anatomy

California Maternal Quality Care Collaboration 88% 95%

California Maternal Maternal Morbidity Quality Care Collaboration Hospitals using Hospitals not using CMQCC Toolkits CMQCC toolkits 1.2% 20.8%

California Maternal Quality Care Collaboration Source: CMQCC

SOLUTIONS Standardized Consistent Parental National Data Review Leave Promotion of Collection Process Best Practices Healthcare Data Coverage and Transparency Accountability Access

Spotlight on Health Policy H.R. 1318: Preventing Maternal H.R. 315: Improving Access to Deaths Act Maternity Care Act Passed

Spotlight on Health Policy S. 116: S. 916: Modernizing Obstetric Mothers and Offspring Medicine Standards (MOMS) Mortality and Morbidity Act of 2019 Awareness (MOMMA’s) Act Introduced

Lost Mothers

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APPENDIX

Spotlight on Health Policy S. 3363: Maternal Care Access and Reducing Emergencies (CARE) Act S. 3494: Maximizing Outcomes for Moms Through Medicaid Improvement and Enhancement of Services (MOMMIES ) Act S. 463: FAMILY Act Introduced 115 th Congress

https://www.americashealthrankings.org/explore/health-of-women-and- children/measure/postpartum_depression/state/CA

9 States (+DC) with the lowest maternal death rate : 1) California 2) Massachusetts 3) Nevada 4) Connecticut 5) Colorado 6) Minnesota 7) Oregon 8) West Virginia 9) Hawaii 10)Wisconsin

Underlying Health Conditions Percent of total pregnancy-related deaths (2009-2017) Cardiovascular and Coronary Conditions 14 Hemorrhage 14 Cardiomyopathy 10.7 Infection 10.7 Embolism 8.4 Preeclampsia and Eclampsia 7.4 Mental Health Conditions 7 0 2 4 6 8 10 12 14 16

C-sections Cesarean delivery rates in the US by age of mother: 2009, 2015, and 2016 The decline in the rate of C-sections coincides with the Affordable Care Act (passed in 2010)