Considering maternal mortality in Lane County
November 17, 2010
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Yesterday, I attended the UO Women’s Law Forum discussion of maternal mortality. Among the invited speakers was certified nurse midwife Hilary Prager from the PeaceHealth Birth Center.
Anyone remotely interested in or familiar with maternal and infant well being knows US rates are significantly higher than those in other developed and developing countries. Recently, Amnesty International issued a report – Deadly Delivery: The Maternal Health Care Crisis in the USA – outlining the total disconnect between US maternal health care spending (more than any other country) and maternity outcomes. Women in this country have a higher risk of dying from pregnancy-related complications than their counterparts in 40 other countries. The report also describes the extreme variations among women. Perhaps the starkest disparity is that African-American women are nearly four times more likely to die of pregnancy-related complications than white women.
I don’t know what Lane County’s maternal mortality rate is but I do know its fetal-infant mortality rate tops Oregon counties and hovers around or above national rates. Despite being home to a major university and hospital system in the developed world, Lane County’s fetal-infant mortality rate is more in line with developing world outcomes. It would be useful to know what local rates for maternal mortality are, too. At the UO Women’s Law Forum I asked if maternal and infant mortality rates tend to track similarly and was told they do not. That said, where there is a poor maternal mortality rate, there will also be a poor infant mortality rate (or vice versa). ). In other words, our maternal mortality rate probably isn’t so great.
Mother and baby mortality rates are the gold standard report card for local and national entities. They are a significant metric for overall public wellbeing because pregnancy often happens to women who otherwise would not interface with the healthcare system. As pregnancies progress, the capacity for a community to provide adequate care is revealed. Bad outcomes suggest systemic, community-wide problems made apparent by but reaching beyond women and babies. Maternal and fetal-infant mortality are among the most extreme of negative outcomes euphemistically described as the “tip of the iceberg.” They frequently occur where access to healthcare and social service systems is inadequate or limited.
According to the latest Lane County data for fetal-infant mortality, 62 women suffered a fetal or infant mortality between July 2007 and June 2009. Barely two-thirds of these women accessed prenatal care during the first trimester. Among candidates for the Oregon Health Plan, many no doubt delayed or skipped coverage due to the OHP requirement of a certified birth certificate at application time.
Bureaucratic barriers are not limited to OHP-eligible pregnant women. These kinds of barriers plus significant financial obstacles, as reported on NPR’s health blog, make it extremely difficult for pregnant women to purchase individual policies, too. At the same time, recent coverage by the Washington Post connects a healthy nation with healthy pregnancies:
“Investing in maternal health would return larger and longer-lasting dividends than almost any other comparable public health investment.”