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Health-Fall 2020

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10 HE ALTH • Fall 2020 T he U.S. has some of the highest maternal mortality and morbidity rates compared to other developed countries. "What's particularly striking is that for an American today, you're 50% more likely to die during childbirth than your own mother was," said Dr. Neel Shah, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and director of the delivery decisions initiative at Harvard's Ariadne Labs in Boston. However, dying is still not a common outcome during childbirth. Massachusetts itself has low mortality rates in comparison with the rest of the U.S., but it needs to keep working, said Dr. Eugene Declercq, professor at Boston University School of Public Health, who has worked with the Massachusetts' Maternal Mortality and Morbidity Review Committee. "The concern with maternal mortality is not that it's really big numbers [from a public health perspective], but rather that it is so eminently preventable. In so many of the causes the death could have been prevented," said Declercq, "In 2018, that was about 658 deaths, which is less than how many people die of COVID a day. So why the concern? Because it is often something that could have been prevented. Women shouldn't have to worry about dying while giving birth." "Maternal health is a barometer, the bellwether for the well-being of all of us," Shah said. "If you see moms suffering, it means we're all suffering. It is the leading indicator in every humanitarian crisis." An issue of mortality and morbidity Mortality is extremely tragic, but is only the tip of the iceberg, said Dr. Julianne Lauring, OB/GYN-maternal and fetal medicine at UMass Memorial Medical Center and assistant professor at UMass Medical School in Worcester. It is important to extend the conversation to morbidity. Measuring morbidity allows researchers to capture all the preventable difficulties happening during birth, like transfusions and hemorrhages. "Those happen about 1.4% of the time roughly and count for about 50,000 births per year. When you put it in those terms, you're dealing with a much larger issue," said Declercq. Looking at both allows the data to represent how unequal and insufficient treatment can be. "Morbidity includes all of those other people who have had something happen to them that they shouldn't have had," said Lauring. For every death, there are hundreds of major injuries and tens of thousands who suffer, said Shah. It is not just deaths during delivery, but deaths caused by factors outside delivery. "Women need better access to healthcare in general so that they can manage their healthcare morbidities, decide when they want to have pregnancies, be at the optimal weight before pregnancy. All of those things play into this, and those societal issues need to be addressed before the patients even get to us," said Lauring. • By Devina Bhalla High U.S. rates of maternal mortality harm families Jennifer Romanski, a registered nurse at UMass Memorial Health Care, which is adjusting its communication policies to improve maternity outcomes, helps care for a newborn. PHOTO/UMASS MEMORIAL HEALTH CARE Serving our mothers Maternal mortality rates by country Global pregnancy-related mortality ratios per 100,000 births Note: Developed countries is defined as those with a high sustainable development index. Source: "Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015," The Lancet. 1990 2000 2015 USA 16.9 17.5 26.4 Russia 56.1 49.3 18.7 China 114.2 85.2 17.7 UK 10.9 13.4 9.2 Germany 20.2 11.3 9 France 16.9 11.7 7.8 Canada 6 7.7 7.3 Japan 12.8 8.8 6.4 Spain 12.5 7.5 5.6 Australia 7.5 7.6 5.5 Ireland 7 5.1 4.7 Italy 10.1 6.9 4.2 Average for developed countries 25.4 19.1 15

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