Maternal Mortality in the Nation's Capital
In order to accurately reflect the data sources, this story uses the terms "woman," "women," and "mother." Not every person who carries a pregnancy or gives birth identifies with all or any of these terms.
This story refers to two theoretical women and their pregnancies. These women are not based on any individual or their story, but on the data informing the story.
Over the last two decades, the US has fallen behind its peers in maternal mortality.
Questions Surround Data Collection
The US government has struggled to collect good data nationally and has also struggled to compel states to collect and report data. Improvements in data collection over the last two decades might account for some of the increase that the US has seen, experts say that these changes can't explain all of it .
The continuing lack of cohesive and regular data impacts solutions. Some countries and cities have put together their own maternal mortality review committees and databases, but these efforts are frequently underfunded, if they are funded at all.
Without trustworthy data, health experts can't enact solutions. In the meantime, pregnant people suffer. Said Dr. William Callaghan , who leads the CDC's maternal and infant health branch:
What we choose to measure is a statement of what we value in health.
Risk Factors
Due to the dearth of consistent and accurate data, as well as privacy concerns that restrict sharing data, many researchers analyze risk factors as indicators for maternal mortality risk.
We'll look at an index of three risk factors, but it's important to note that these factors don't exist in a vacuum. Education, poverty, and race are entangled in a white supremacist system, along with many other risk indicators like access to healthcare, food insecurity, and pollution.
Zooming into DC
We'll zoom into the US capital, Washington, DC. Here, socioeconomic disparities are vast and the city has become both more diverse and more segregated over the last several decades. Two individuals might live very different lives in the same city and have drastically different pregnancy outcomes.
Even if they make it to a hospital in time, lack of access also affects women after they give birth. While there are almost 40 places where women can seek prenatal care in DC, low-income women often find it difficult to access postpartum care in the city.
According to the CDC , 36% of maternal deaths happen at delivery or within a week of delivery and 33% happen 1 week to 1 year postpartum. Without postpartum care, women are at greater risk of dying of treatable conditions like high blood pressure, infection, and severe bleeding.
What's next?
What role does the government play?
The federal government can help by standardizing and funding data collection and research, which the current administration seems ready to do. In September 2021, the Department of Health and Human Services announced $350 million in funding to expand home visiting services to low-income families, increase access to doulas, address infant mortality disparities, and improve maternal mortality data reporting.
DC Mayor Muriel Bowser and the DC Council have acted in recent years to address the disparities. In September 2021, Mayor Bowser held the 4th Maternal and Infant Health Summit , which brought together DC residents, elected officials, health officials, and community partners to address disparities in maternal and infant mortality outcomes. The city's proposed budget for fiscal year 2022 includes almost half a million dollars to fund transportation for women traveling to and from medical appointments and about $1 million for doula and midwife services.
Community efforts are focused on the individual context.
Mamatoto Village has been providing support and resources for women of color in DC since 2012. They provide " free or low-cost maternal health services and education to women and families from pregnancy through the first year of a child's life " and train women of color in the community as specialized doulas through a program called Community Birth Workers Program. Community Birth Workers are paired with a pregnant woman and work with her throughout the pregnancy and after.
Said a woman who partnered with a Community Birth Worker during her pregnancy and later became a Community Birth Worker herself,
She helped me with my pregnancy journey, which ended up more wonderful than I could ever have imagined. I was able to have a really beautiful birth at home. I was empowered by her strength and wanted to give that to other women.
Government funding of data collection and research could address a number of issues that pregnant people face in the US while community-focused organizations like Mamatoto Village are doing the important work of considering the context of every pregnant individual with whom they work. We'll need to leverage both government and community to make pregnancy and birth a safe and joyful experience in the United States.
