Serena Williams’ accomplishments are nothing short of amazing, but it’s not just her skills on the tennis court that empower women. In September 2017, Williams nearly died from post-birth complications. Her story is, unfortunately, all too common. But if there’s any silver lining to her terrifying ordeal, it’s that her fame has allowed her to spread an important message: The maternal mortality rate is a huge problem, especially in the United States and especially for Black women.
Think about it. If a celebrity who presumably has access to the best possible care in the world can face these issues, what does that say about the current state of prenatal and postnatal care?
In this post, we’ll break it all down, including:
- What maternal mortality rate is—and why the current statistics are so deplorable
- Risk factors for maternal morality
- Plus, what we can do to help move the needle and develop a better standard of care for moms, particularly women of color
Maternal Mortality Rate Definition
First thing’s first. What is the maternal mortality rate?
The maternal mortality rate is an umbrella terms that includes death during pregnancy, labor and delivery, and even in the six weeks (42 days) after childbirth.
To calculate the maternal mortality rate in a particular country or region, the following formula is used:
- [Total number of maternal deaths in a given time] / [Total number of live births in the same given time] = X
- X is then multiplied by 100,000
For example, in 2016, the maternal mortality rate was close to 17. The math looks like this:
- [700 estimated deaths] / [3,941,109 live births] = 0.000169
- 0.000169 multiplied by 100,000 = 16.9
This means that out of every 100,000 live births, almost 17 women died due to complications.
How Are Women Dying?
According to the CDC’s Pregnancy Mortality Surveillance System, only a small fraction of maternal deaths (6 percent) are due to unknown causes. The remaining 94 percent of maternal death causes including:
- Cardiomyopathy and other cardiovascular conditions accounts for almost 27 percent of deaths.
- All types of embolisms account for over 15 percent of deaths.
- Infection accounts for 12.5 percent of maternal deaths.
- Hemorrhage accounts for 11.0 percent of maternal deaths, according to the same CDC data.
- Hypertensive disorders like preeclampsia account for 6.9 percent of deaths.
- The remaining deaths are due to other medical conditions.
This statistics are jarring, but what’s even scarier is that the majority of these deaths occur after mom has been released from medical care. In fact, more than half of maternal deaths occur in the postpartum period—and one third of these deaths happen more than seven days after delivery. (source)
Who Is Most At Risk?
Studies show that an increasing number of pregnant women in the United States have chronic health conditions, like obesity, hypertension, diabetes, and heart disease—all things that can put a pregnant woman at higher risk for complications during the pregnancy and postpartum period. (source)
But not all groups of women share the same risk for the above conditions. Research shows that women of color, particularly Black and American Indian/Alaskan Native women, are especially at risk for postpartum death, regardless of their income. Here’s a look at the stats:
- 42.4 deaths per 100,000 live births for Black non-Hispanic women.
- 30.4 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
- 14.1 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
- 13.0 deaths per 100,000 live births for white non-Hispanic women.
- 11.3 deaths per 100,000 live births for Hispanic women.
What Is Behind the Racial Disparities?
While there are many factors that affect maternal morbidity, it’s clear there is statistical difference in rates of death among different races. In the 2017 survey Discrimination in America: Experiences and Views of African Americans, many Black women said prejudices affect the level of care they receive. In the survey, nearly 33 percent of the women said that felt prejudice at some point during their prenatal or postnatal care. And a whopping 21 percent of black women said they avoided their doctor, at least once, out of fear of prejudice.
Shalon Irving‘s story highlights this fact. She was a highly educated woman of color, and she worked as an epidemiologist for the Centers for Disease Control and Prevention. Unfortunately, Irving passed away a few short weeks after giving birth due to blood pressure complications. Irving, however, knew the warning signs of high blood pressure problems and repeatedly sought medical care. Her concerns weren’t addressed, and her voice was unheard.
Kira Johnson is another Black mama — fit, educated, and wealthy — who died after childbirth. Healthcare workers failed to prioritize her care, and despite blood in her catheter, failed to get her the swift care she needed when she hemorrhaged post-birth.
Both of these women passed on because no one listened to their concerns.
In an effort to help Black mama’s voices be heard better during childbirth, the following associations have created directories for Black doulas and midwives to support mamas during and after childbirth:
Mamas can also look to deliver at a hospital trained by the California Maternal Quality Care Collaborative. The CMQCC is dedicated to ending preventable maternal deaths during childbirth. As part of their mission, they are also committed to ending racial disparities when it comes to childbirth.
More women affected…
But maternal morbidity is not just a race issue. One of the women in our Mama Natural Birth Course came dangerously close to these statistics. After giving birth to her son, Courtney noticed that she was very swollen, but the Labor & Delivery nurses, her son’s pediatrician, and her own nurse practitioner all told her swelling was normal. Then, Courtney developed chest tightness and increased sweating. Still… no response from doctors. After checking herself in to the L&D triage, she was finally acknowledged when her blood pressure stats came back high. She was admitted for postpartum preeclampsia.
Courtney’s story highlights another fact: mothers aren’t being credited for knowing when something is wrong with their bodies.
Maternal mortality rates are high in America, regardless of race and class, as seen in this chart:
And the Maternal Mortality Rate is on the Rise in the US…
Here’s a stark look at the upward trend of the maternal mortality rate in the United States since 1987:
Maternal Mortality Rate in the US – Chart
Perhaps even more alarming? On a global level, American women are more at risk than women in other developed countries.
According to the World Health Organization, nearly 700 women die each year during or after childbirth in the United States. Our country has a much higher maternal morbidity rate than other Western countries.
Global Maternal Mortality Rates Chart
How’s this for some perspective: According to data by the Indiana State Department of Health and the CIA’s World Factbook, women in Iraq and the Gaza Strip are more likely to survive childbirth than many women in Indiana. (source)
Maternal Mortality Rate Around the World – Map
Put simply: Women aren’t getting the care they need. In our country, there is a serious lack of awareness and understanding when it comes to postpartum care from many in our medical system. Right now, we have a “hands-off” approach that is clearly not working. There is very little education for mom and no routine care practice for mom until six weeks postpartum. The reality is moms don’t know what to look out for and postpartum conditions can escalate quickly, putting mom in a grave situation.
We Need Systematic Reform
In other countries, moms receive much more support.
Healthcare professionals conduct home visits in all northern and western European countries (source).
- In the Netherlands, a continuous one-week home care program is covered by insurance after birth.
- In Norway, new mothers, newborns, and their families can stay together in maternity centers for postpartum care.
- In Taiwan, new mothers can stay in private maternity centers where both mom and baby received round-the-clock care by nurses.
This care extends past the immediate postpartum period too:
- In Sweden, new parents can take a one-year leave at 80 percent of their salary
- In Finland, mothers can take a one-year maternal leave supported by a state grant
This is in stark contrast to the United states, where mom’s don’t get evaluated until six weeks postpartum and maternity leave is often nonexistent, or just a few short weeks.
Thankfully we’re seeing some progress…
Various states are creating programs to help reduce material death. In California, for instance, hospitals can use The Maternal Data Center, a tool that helps hospital administrators find the weak spots in their care so they can make the necessary improvements to their policies and programs.
But we have a long way to go, and we can’t just sit back and wait for policies to change.
You can do your part by helping spread awareness of these policy changes by speaking up—talk to your friends, talk to your healthcare practitioner, and consider writing letters to or calling your congressperson. No action is too small—in fact, our health depends on it.
We also need to advocate for more women of color birth workers. Consider donating to the Birth Workers of Color Scholarship, which raises money for midwife students who are women of color.
What About You?
Did you have to advocate for yourself after childbirth? How did you demand the care you need?