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Broadening The Focus During Pregnancy To Total Women’s Health, Not Just Healthy Babies

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Reports of high US maternal mortality rates combined with heartbreaking stories of the preventable deaths of women led policy makers in 2018 to pass bipartisan legislation to expand the number of maternal mortality review committees (MMRCs) in the US. Almost all states now have MMRCs. Passage was followed by an array of proposals to expand care for pregnant and postpartum women. That’s all great news, but it’s not enough because the MMRCs, tasked to primarily study the 650–700 annual pregnancy-related deaths, have the opportunity to speak for the more than 55,000 women of reproductive age who die annually in the US.

Rising Concern With Maternal Mortality

How did we get here? It began with the recent focus on maternal mortality in the US that arose from several sources. First, there was frustration because we didn’t know what the actual US maternal mortality rate was for more than a decade until the January 2020, publication of the 2018 rate. Second, the new rate showed the US ranking fifty-sixth internationally, behind Russia and Iran and only slightly ahead of Ukraine. If we limit the analysis to comparably large, wealthy, industrialized countries, we’d rank tenth out of 10 countries. Third, the US is one of only two countries in the world (along with the Dominican Republic) that reportedly experienced an increase in maternal mortality since 2000. Finally, the focus on maternal mortality has brought attention to persistently wide racial disparities in maternal deaths. Black women were 2.5 times as likely as White women to experience a maternal death in 2018—the exact same ratio as in 1987 and in 1942, and higher even than the 1930s America of Jim Crow and segregated facilities that denied Black women in labor access to hospitals.

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