Dr. Eugene Declercq: "Maternal Mortality as a Public Health Challen...

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Maternal Mortality as a Public Health
Challenge
Gene Declercq, PhD
Community Health Sciences Dept.
www.birthbythenumbers.o...

Definitions (in the U.S.)
• Maternal Mortality Ratio – the death of a woman while pregnant or
within 42 days of terminatio...

Is there a problem
in the U.S.?

Is there a problem
in the U.S.?
Yes

U.S. Maternal Mortality (per 100,000 live births),
1951-2007
0
10
20
30
40
50
60
70
80
1951 1953 1955 1957 1959 1961 1963 ...

U.S. Maternal Mortality (per 100,000 live births),
1951-2007
0
10
20
30
40
50
60
70
80
1951 1953 1955 1957 1959 1961 1963 ...

U.S. Maternal Mortality (per 100,000 live births),
1951-2007
0
10
20
30
40
50
60
70
80
1951 1953 1955 1957 1959 1961 1963 ...

U.S. Maternal Mortality (per 100,000 live births),
1951-2007
0
10
20
30
40
50
60
70
80
1951 1953 1955 1957 1959 1961 1963 ...

U.S. Maternal Mortality (per 100,000 live births),
1951-2007
0
10
20
30
40
50
60
70
80
Note: The U.S. NCHS hasn’t reported...

Pregnancy Related Mortality,
U.S., 1987-2013
Source: CDC. Pregnancy
Mortality Surveillance
System
https://www.cdc.gov/repr...

Pregnancy Related Mortality,
U.S., 1987-2013
Source: CDC. Pregnancy
Mortality Surveillance
System
https://www.cdc.gov/repr...

So can we compare the U.S. to
other countries?

Estimated MMRs, 48 states* and DC, 2000-2014
0
5
10
15
20
25
30
2000 2005 2010
18.8
23.8
Rateper100,000livebirths
2014
*Ex...

Maternal Mortality Ratios, OECD* Countries,
2014
0 5 10 15 20 25
United States^
Chile*
Turkey
New Zealand#
Korea
Austria
D...

Using a more conservative estimate
Adjusting the CDC Pregnancy Related Mortality data
to reflect a maternal mortality rate...

U.S. Maternal Mortality (per 100,000 live births),
1951-2007 by Race
0
50
100
150
200
250
1951 1953 1955 1957 1959 1961 19...

U.S. Maternal Mortality Ratio of Black to
White Rates 1951-2007
0
1
2
3
4
5
6
1951 1953 1955 1957 1959 1961 1963 1965 1967...

U.S. Infant & Maternal Mortality Black to
White Ratios of 1980-2014
0
1
2
3
4
5
6
Infant
Maternal
Why is disparity greater...

Using the more conservative
measure in an international
comparison
Estimated for 2011-2013 (per 100,000 live births):
All ...

U.S. MMR* Compared to Countries with
300,000+ births, 2014, using WHO Estimates
14.8
11
9
8
7
6
6
5
5
4
0 2 4 6 8 10 12 14...

U.S. MMR* Compared to Countries with
300,000+ births, 2014, using WHO Estimates
14.8
11.3
11
9
8
7
6
6
5
5
4
0 2 4 6 8 10 ...

Interracial Differences
Hispanic 10.0 (Lithuania 10/Portugal 10)
Where would estimated rates leave the U.S.
in internation...

Interracial Differences
Hispanic 10.0 (Lithuania 10/Portugal 10)
NH White 11.3 (Bulgaria 11/S. Korea 11)
Where would estim...

Interracial Differences
Hispanic 10.0 (Lithuania 10/Portugal 10)
NH White 11.3 (Bulgaria 11/S. Korea 11)
NH Black 36.2 (Uz...

So, by even a conservative
standard the US fares poorly in
international comparisons.
What can be done?

Key is a combined clinical, public
health and policy response.
Dr. Main will describe the
exceptional efforts underway to
...

Why a public health response is also needed.
Timing of Maternal Deaths
30.5%
16.8%
18.2%
21.3%
13.2% Before Delivery
Day o...

Why a public health response is also needed.
Timing of Maternal Deaths
30.5%
16.8%
18.2%
21.3%
13.2% Before Delivery
Day o...

What’s the policy response needed?
•Investment in the public health infrastructure
so we can better determine just who is ...

WOMEN’S HEALTH WHEN THEY ARE NOT
PREGNANT
Infant & Maternal Mortality Black to White Ratios of 1980-2014
0
1
2
3
4
5
6
Inf...

Level of
Coverage:
Variation in
Medicaid
Eligibility by
Pregnancy
Status
As of January, 2017 Medicaid Eligibility
Pregnanc...

Source: Daw J.
Health Affairs
2017; 36:598-606
Note:
Data is all
pre-ACA Period covered by pregnancy related mortality
Tim...

Maternal Mortality is the tip of the iceberg on
women’s health.
Maternal deaths account for about 1% of all deaths
to wome...

FACEBOOK: www.facebook.com/BirthByTheNumbers
Twitter: @BirthNumbers
Email: birthbynumbers@gmail.com
Slides will also be
po...

Extra slides if there are questions

Death rates, by
age, females:
United States,
1955–2014
Number of female
deaths, 15-49 in 2014
75,192.
Maternal deaths = ~1...

Dr. Eugene Declercq: "Maternal Mortality as a Public Health Challenge" 10.04.17

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