AT 29, she was pregnant with twins. She had no health insurance. Though she’d had complications with a previous pregnancy, she received no prenatal care until late in her second trimester. Diagnosed with gestational diabetes, she had a Caesarean section at 34 weeks but after giving birth suffered a seizure and died.
Another woman, 20, tested positive on a home pregnancy kit but didn’t seek care. When she began to experience severe abdominal pain, she went to a clinic and was found to have an ectopic pregnancy. While arrangements were being made for surgery, her blood pressure dropped and she lost consciousness. She also died.
The cases, recounted by a Planned Parenthood doctor at a D.C. Council hearing, highlight the national problem of maternal mortality, which has taken on crisis proportions in the District. About 41 women in the District die for every 100,000 live births, according to a 2016 analysis by the United Health Foundation. That is far higher than in neighboring Virginia (13.2 maternal deaths) or Maryland (25.7 maternal deaths) and double the national rate. Moreover, there is wide disparity within the District, based on race and ethnicity, with African American women at greater risk for pregnancy-related death and complications. Seventy-five percent of the maternal deaths recorded by D.C. health officials between 2014 and 2016 were of African Americans.
The sobering statistics are prompting the District to undertake a long-overdue effort to investigate and understand the causes of maternal mortality and — hopefully — do something about them. Under legislation passed by the council and set to undergo standard congressional review, the District would follow about 35 states in establishing a maternal mortality review committee to conduct a comprehensive analysis of the medical and nonmedical circumstances of deaths that occur during pregnancy and up to one year after.
The number of women who die as a result of pregnancy or delivery complications is relatively small — about 700 a year in the nation, according to the Centers for Disease Control and Prevention — but what makes the deaths so horribly unacceptable is that most could be prevented. If the woman had had access to health care early in her pregnancy; if she had told her doctor she thought something wasn’t right; if the doctor had listened; if health personnel had responded with appropriate and timely action.
A maternal mortality review program is seen as instrumental in identifying correctable shortcomings and suggesting solutions. California credits its program — which included development of established protocols to deal with emergencies — with helping to reduce mortality rates.
In the District, it is clear that a major issue is inequity in the health-care delivery system that denies many women of color and low-income residents access to preventive and prenatal care. Coming up with effective solutions that involve both the public and private sectors should be at the top of this new committee’s agenda.
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