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Infant and Maternal Mortality Rate

Facts from the WHO- World Health Organization

Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.

Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal deaths per 100,000 live births) dropped by about 38% worldwide.

94% of all maternal deaths occur in low and lower middle-income countries.

Mortality 

Maternal mortality is unacceptably high. About 295 000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented

After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. 

According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events

Texas 

· Texas has had a sharp increase in maternal mortality rates in 2011-2012 

· Decline internationally, increase in the US

· The US has not posted an official rate since 2007

· Identifying the causes

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· The CDC recently examined the factors behind this spike in maternal deaths. 

· Heart disease, hemorrhage, and infections appear most frequently on death certificates. 

· Lack of access to care, unstable housing, limited access to transportation, poor understanding of danger signs, and not following medical advice

Risk Factors for Maternal Mortality

· Hypertension

· Diabetes

· Chronic Heart Disease

· Race

· Insufficient hospital care

· Untreated infections

· Insufficient prenatal care

Source: Centers for Disease Control and Prevention

After decades of decline, the maternal mortality rate in the United States has increased over the last 10 years. 

According to the Centers for Disease Control and Prevention (CDC), between 800 and 900 women in the United States die each year from pregnancy-related complications, illnesses or events

2017

In 2017, the total number of infant deaths in the United States was approximately 22,258. The infant mortality rate was 5.8 deaths per 1,000 births, down from 7.1 in 2005

In 2018, the U.S. maternal mortality rate (MMR)—the rate the CDC defines as the number of women that die during pregnancy, child delivery or within 42 days of giving birth—was 20.7 deaths per 100,000 live births.

What is Infant Mortality Rate

Infant mortality is the death of a child within the first year of life. Worldwide, infant mortality continues to decrease, and in the past 10 years, rates in the United States have fallen by 15% (CDC). The infant mortality rate is the number of infant deaths for every 1,000 live births.

Risk Factors for Birth Defects

· Family history of birth defects.

· Prenatal exposure to tobacco smoke, alcohol or drugs.

· Certain medications, such as isotretinoin and lithium.

· Maternal age greater than 35.

· Untreated infections.

· Untreated gestational diabetes.

· Insufficient prenatal care.

Source: Centers for Disease Control and Prevention

Racial and Socioeconomic

Racial and socioeconomic factors are impossible to overlook. African American, Alaska Native, and American Indian women die at a rate almost three times as high as White women. Although women of all backgrounds may be at risk, poverty is linked to the higher rates of maternal deaths.

Solutions

Providing quality prenatal care 

This includes physical exams

laboratory screening tests

nutrition counseling 

and referral to mental health services for pregnant women

Solutions: Referral to Doula for support 

Doula code of ethics, as of DONA international, maintaining fairness to all, esp mother and baby

· Women who go to a doula have lower rates of preterm birth and LBW

· Women in disadvantaged areas/groups benefit (financially, emotionally, etc.)

Suggests that Medicaid/insurance should pay doulas a fixed salary so that it is more accessible.

Doulas provide home visits: Home visiting improves maternal and child health and has been shown to reduce infant mortality, preterm births and emergency room utilization (NCSL; NCSL; HRSA).

Benefits

· “doula care is associated with lower epidural use and cesarean delivery rates, shorter labors, higher rates of spontaneous vaginal birth, and higher levels of satisfaction.”

· “Having a doula plays an important role in a woman's ability to make an informed decision while positively influencing her belief in herself”

· “doula contributed to her personal security by addressing her health concerns after an encounter with her provider.”

· “doula's presence, particularly during the childbirth process, would facilitate greater autonomy and respect in decision making.”

· “they relied on their doula to help “translate” their clinical encounters”

· Women feel connected to their doula 

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CITATION

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·   Gingrey, J. “Maternal Mortality: A US Public Health Crisis.” American Journal of Public Health (1971), vol. 110, no. 4, American Public Health Association, Apr. 2020, pp. 462–64, doi:10.2105/AJPH.2019.305552.

·  Pollack, Emily. “CDC: 3 In 5 Pregnancy-Related Deaths Among US Women Could Be Prevented.” The Nation’s Health (1971), vol. 49, no. 6, The Nation’s Health, Aug. 2019, pp. 5–5.

· Disrupting the Pathways of Social Determinants of Health: Doula Support during Pregnancy and Childbirth,Katy B. Kozhimannil, Carrie A. Vogelsang, Rachel R. Hardeman, Shailendra Prasad The Journal of the American Board of Family Medicine May 2016, 29 (3) 308-317; DOI: 10.3122/jabfm.2016.03.15030

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