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Why pregnant women in Mississippi keep dying

Expectant mothers in the United States remain at a high risk for pregnancy-related death. (iStock)
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NEW YORK CITY -- There's a quiet medical crisis going on in this country: the number of women dying in childbirth.

The United States is the only advanced economy in the world with a rising maternal mortality rate. Deaths related to childbirth in the United States are nearing the highest rate in a quarter-century. An estimated 18.5 mothers died for every 100,000 births in 2013, compared with 7.2 per 100,000 in 1987. This means a woman giving birth here is twice as likely to die than in Saudi Arabia and three times as likely than in the United Kingdom.

The problem is particularly acute in the South. For instance, Mississippi’s maternal mortality rate, one of the highest in the country, has been climbing for more than a decade. From 2010 to 2012, the last measure, an average of nearly 40 women died for every 100,000 births. Risk varied drastically by race: The rate for black women, 54.7, was much higher than the rate for white women, 29.3.

[Read: Why are poor women so much likelier to have unintended pregnancies?]

Common causes for maternal death include heavy bleeding, high blood pressure and obstructed labor. But nearly half of related deaths in the country each year are preventable, said Priya Agrawal, executive director of Merck for Mothers. Oftentimes, women lack access to regular check-ups. In other words: They’re entering pregnancies unhealthier.

“The U.S. maternal health community doesn’t know exactly why,” Agrawal said. A number of factors may exacerbate the problem, which she called a human rights crisis.

Mississippi, for example, did not expand Medicaid, leaving 107,000 people — nearly half of whom are women — with no insurance options at all, according to the Kaiser Commission on Medicaid and the Uninsured. It also has the country’s lowest physician-to-resident ratios: 159.4 doctors for every 100,000 people. Some health advocates say racial discrimination may play a role in poor care for pregnant women. And doctors sometimes mistake a pregnant woman’s distress for nerves or paranoia.

The cost of care for pregnant women, meanwhile, has sharply risen. The average cost of delivery here has nearly tripled since 1996, according to a Truven Health Analytics analysis for the New York Times. Maternal and newborn care make up the largest category of hospital payouts for most insurers and state Medicaid programs. Our country's approximate four million annual births cost more than $50 billion.

Despite heavy spending, the United States was one of just eight countries to see a rise in maternal mortality over the past decade, ranking 60 for pregnancy-related deaths on a list of 180 countries, according to research last year from the University of Washington’s Institute for Health Metrics and Evaluation. Other countries that also saw a rise in maternal mortality included Afghanistan, Greece, El Salvador and South Sudan. 

“A big problem is providers don't always listen to women,” said Elise Turner, a certified midwife and associate professor at Belhaven University in Jackson, Miss.

Turner described a recent "near-miss" to a crowd at the sixth annual Women in the World Summit on Thursday: “One mom came to the hospital and said, 'I don’t feel right.' The doctor said, ‘You’re fine. You’re just being a nervous Nelly.'"

The woman, who was about eight months along in her pregnancy, reluctantly drove home, Turner recalled. Soon after, she went into labor and started profusely bleeding. "A next-door neighbor happened to find her. Otherwise, she might have died."

A lot of these stories don't get told, Turner said, because the women who survive often blame themselves. “You’ve got to be vocal about what you need,” she said. “You’ve got to raise a ruckus."

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