In Improving Birth

Women’s eNews summarizes a New York City Department of Health report on maternal mortality between 2006 and 2010 finding that women of color were more likely to die of pregnancy-related causes during pregnancy or within 1 year of delivery than white, non-Hispanic women. Specifically, black women (56.3 per 100,000 live births) were 12 times more likely, Asian/Pacific Islanders (19.9 per 100,000) were more than 4 times more likely, and Hispanic women (15.9 per 100,000) were more than 3 times more likely to die compared with white, non-Hispanic women (4.7 per 100,000). Pregnancy-related mortality in NYC overall fluctuated between a high of 27.9 per 100,000 in 2006 to a low of 17.6 per 100,000 in 2010 compared with a rate of 33.9 per 100,000 live births in 2001. In black women, the gap widened from a 7 times greater mortality risk in the period from 2001 to 2005, largely driven by a 45% decline in pregnancy-related mortality in white, non-Hispanic women.

The leading causes of death were hemorrhage (27%), embolism (19%), pregnancy-induced hypertension (14%), cardiovascular conditions (13%), and infection (7%). The proportion of deaths due to hemorrhage increased compared with 2001 to 2005, when it was 17%, mainly due to an increase in deaths related to ectopic pregnancies (11% in 2006-2010 vs. 3% in 2001-2005), an increase that disproportionately affected black women who comprised 80% of ectopic-pregnancy related deaths. The majority (59%) of women who died had a pre-existing chronic condition, most commonly high BMI (30%) or hypertension (16%).

The report’s Executive Summary attributes the excess to the “well-established” excess mortality “associated with obesity, underlying chronic illness and poverty–all conditions that disproportionately affect New York City’s Black population” (p. 5), adding that “the chronic stress of racism and social inequality also likely contribute to racial disparities in health . . . and may play a role in pregnancy-related mortality.” The summary concludes: “The New York City Health Department recognizes that reducing maternal mortality and eliminating the racial/ethnic gap requires attention to a woman’s well-being throughout her lifetime, not just during pregnancy,” and commits to “stimulating and fostering partnerships with stakeholders, clinicians, policymakers and others to combat what has, for decades, been an unrelenting problem.” Let us hope that the commitment goes beyond words and succeeds in its objectives.

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