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

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

Jan 13, 2023 295 likes •915 views

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

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Priya V a Vedula, a, M MPH

Health Policy Analyst Institute for Health Policy and Leadership

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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

M a t e r na l M or t a l i t y

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

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Lauren Bloomstein

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

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Hemolysis

HELLP

Syndrome Elevated Liver Enzymes Low Platelet Count

A life-threatening version of preeclampsia

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Maternal Mortality vs Health Expenditures Over Time

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Chances of Dying During Childbirth

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The US Defies the Trend

Source: The Lancet Credit: Rob Weychert/ProPublica

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12 times Disparities and Inequities in Maternal Deaths

47.2 38.8 18.1 12.2 11.6 10 20 30 40 50 African American American Indian and Alaskan Native Caucasian Latina Asian/Pacific Islander

Maternal Deaths per 100,000 Live Births

Maternal Deaths per 100,000 Live Births

3-4 times

B l a c k m o t h e r s a r e 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 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 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

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Source: Harvard School

  • f Public Health
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Defining Maternal Deaths

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

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Differences in Data

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

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37%

  • f maternal deaths
  • ccur during

pregnancy

Timing

45%

  • f maternal deaths occur

within the first 42 days after childbirth

18%

  • f maternal deaths
  • ccur between 43 days

and 365 days after childbirth

Pregnancy-related/ Pregnancy-associated Maternal mortality

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Main Causes in the Rise of Maternal Deaths

Underlying Health Conditions C-sections Opioids and Substance Abuse Lack of Access to Perinatal Care

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Main Causes in the Rise of Maternal Deaths

Underlying Health Conditions C-sections Opioids and Substance Abuse Lack of Access to Perinatal Care

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Hemorrhage 35% Hypertension 18% Sepsis 8% Abortion 9% Other Direct 12% Indirect 18% Hemorrhage Hypertension Sepsis Abortion Other Direct Indirect

Causes of maternal mortality worldwide (2000-2010) Causes of pregnancy-related mortality in the United States Underlying Health Conditions

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Main Causes in the Rise of Maternal Deaths

Underlying Health Conditions C-sections Opioids and Substance Abuse Lack of Access to Perinatal Care

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C-sections

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C-sections

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Main Causes in the Rise of Maternal Deaths

Underlying Health Conditions C-sections Opioids and Substance Abuse Lack of Access to Perinatal Care

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Colorado Texas Massachusetts Opioids and Substance Abuse

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

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Main Causes in the Rise of Maternal Deaths

Underlying Health Conditions C-sections Opioids and Substance Abuse Lack of Access to Perinatal Care

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PERINAT ATAL Prenatal al Postp tpartu tum

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“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

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Post partum care matters

6.6% 4.1% 16.2%

While Pregnant Within 42 Days Within 365 Days

Percentage of Maternal Deaths Attributed to Mental Health Conditions as the Underlying Cause (includes overdoses from substance abuse)

Lack of Access to Perinatal Care

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“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 )

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ACCE CCESS

Lack of Access to Perinatal Care

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Lack of Access to Perinatal Care

% of Federal Poverty Level Single Person’s Annual Income 61% $7,618 100% $12,490 138% $17,236 200% $24,980 250% $31,225

Source: Kaiser Family Foundation

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Medicaid expansion status by state Maternal death rates within 42 days of pregnancy per 100,000 live births

Lack of Access to Perinatal Care

Adopted and Implemented Adopted but not implemented Not Adopted Maternal Mortality Rate (<16.9) Maternal Mortality Rate (16.9-20.6) Maternal Mortality Rate (>20.7)

Source: Kaiser Family Foundation Source: America Health Rankings

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Washington D.C.: The Maternity Desert

Lack of Access to Perinatal Care

Source: The Atlantic

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  • Older age of first time mothers
  • Growing number of conditions: chronic

health disease, hypertension, and diabetes

Underlying Health Conditions

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  • 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

C-sections

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  • “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

Opioids and Substance Abuse

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  • 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
  • utcomes

Lack of Access to Perinatal Care

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A Success Story

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Since 2006, one state has been reversing the trend.

Maternal Mortality Rates

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California (blue line) has been reversing the trend.

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Toolkit

Source: CMQCC Tool Kit from the CMQCC Website

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Hemorrhage Cart

Source: Gray’s Anatomy

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California Maternal Quality Care Collaboration

88% 95%

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California Maternal Quality Care Collaboration Hospitals using CMQCC Toolkits Hospitals not using CMQCC toolkits

Maternal Morbidity 20.8% 1.2%

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California Maternal Quality Care Collaboration

Source: CMQCC

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SOLUTIONS

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

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Spotlight on Health Policy

Passed

H.R. 1318: Preventing Maternal Deaths Act H.R. 315: Improving Access to Maternity Care Act

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Spotlight on Health Policy

  • S. 116:

Modernizing Obstetric Medicine Standards (MOMS) Act of 2019

Introduced

  • S. 916:

Mothers and Offspring Mortality and Morbidity Awareness (MOMMA’s) Act

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Lost Mothers

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Thanks for joining us! For health policy resources, please check out IHPL.LLU.EDU

Please sign up for our weekly newsletter! Email ihpl@llu.edu

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APPENDIX

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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 115th Congress

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

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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

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Underlying Health Conditions

7 7.4 8.4 10.7 10.7 14 14

2 4 6 8 10 12 14 16

Mental Health Conditions Preeclampsia and Eclampsia Embolism Infection Cardiomyopathy Hemorrhage Cardiovascular and Coronary Conditions

Percent of total pregnancy-related deaths (2009-2017)

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The decline in the rate of C-sections coincides with the Affordable Care Act (passed in 2010)

C-sections

Cesarean delivery rates in the US by age of mother: 2009, 2015, and 2016

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