Maternal Mortality Crisis: Black Women in Mississippi

Maternal Mortality among Black Women in Mississippi Mia Leeds Southern New Hampshire University PHE 101: Introduction to Public Health DIRECTIONS: Anything in [ ] is for you to fill in with information related to your chosen issue/problem. Remove the brackets after filling in the information. 1

Background (Milestone One) • U.S maternal mortality rates are on the rise. • Black women in Mississippi see the highest rate. Maternal death is defined by the WHO as “the death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” (Hoyert, 2023) Although the maternal mortality rate for the whole United States was 32.9 deaths per 100,000 live births, black women are seeing rates at almost double the nations rates. In 2021, the maternal mortality rate was 69.9 deaths per 100,000 live births for black women in the nation. More than 85% of maternal deaths in Mississippi are happening postpartum, which means within two months after birth. 2

Background (Milestone One) • 2017 – 51.9 deaths/100,000 • 2022 – 65.1 deaths/100,000 • Lack of coverage Maternal mortality rates are not much for concern, unless you are a black women living in Mississippi. While the state has the highest birth rates among black women, they also see the highest death rates. In 2017 the pregnancy related mortality ratio for black women was 51.9 deaths per 100,000 live births. Now in 2023, black women's percentages are getting worse while white women's rates are improving. Black women are now more than 4 times as likely to die during or after pregnancy at a rate of 65.1 deaths per 100,000 live births. Pregnant women are some of the most vulnerable people in our society, and we aren’t taking the correct steps to address it. Many mothers in Mississippi have a lack of health care coverage, there has been pressure within the state to extend coverage for moms on Medicaid. (Ganucheau, 2023) Promoting medical care among all stages of pregnancy, and offering support to mothers that may be struggling with pregnancy and access to healthy options can help to prevent many of the preventable maternal deaths. 3

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Who, What, Where, Why, and When (Milestone Two) • 69.9 deaths per 100,000 births • 2.5 times higher • Cardiac Issues [Speaker notes: Introduce this section here, what are you seeing and why is it relevant? Why is it happening? Who is affected? Where? When?] Black women have the highest maternal mortality rate in the nation and have since at least 2014 at 69.9 deaths per 100,000 births. When looking at Mississippi, black mothers make up 42% of all births in the state, while also accounting for 82 deaths per 100,000 births. In 2021 black women had a maternal mortality rate that was 2.5 times higher than for white women, whose rate was at 26.6 deaths per 100,000 births. Black women don’t receive the same care that other races receive, which is causing them to die at higher intervals. The primary cause of death among black mothers is cardiac issues. 4

Who, What, Where, Why, and When (Milestone Two) • [Social Determinants:] Lack of access • Physicians lack of empathy • [Known Disparities:] 87.5% were preventable [Speaker notes: continue with explaining who and examining the impact - – see rubric for details.] The Mississippi Mortality Review found for 2017-2019 that in the 93 recorded maternal deaths, 43% were directly related to pregnancy, 88% was determined to be preventable, and more than half of them occurred during pregnancy or within 2 months after delivery. ( Latest Maternal Mortality Report: Health Disparities Increase , 2023) These numbers show that there is a lack of care from providers. 34% of black women report doctors not listening to their concerns, while also reporting that income levels don’t make a difference in this. (Funk, 2022) Mississippi's state health officer advocates for access to care in order to help the vulnerable populations such as black mothers. Giving people access to health environments and healthy foods can help reduce the chronic diseases that are causing maternal deaths among black women. 5

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A graph that shows the negative experiences that younger black women experience. This shows how black women are not being taken seriously within health care. 7

Public Health Interventions (Milestone Three) • Standardized approaches to emergency obstetric care • Notable gaps in response to emergencies. • Primary • Economic stability, education access, neighborhood and built environment There are a lot of gaps within how emergencies are handled in the obstetric field. The National partnership for Maternal Safety has recognized and called for the development of safety approaches that address different emergencies from hemorrhage to venous thromboembolism. This intervention would help to stop the unnecessary deaths before they happen, which would make this a primary prevention. In 2019 the CDC released their Morbidity and Mortality Weekly Report which identified that those living in “undesirable” areas with lack of access to clinical care and unstable housing are a major cause for pregnancy-related deaths (Ahn et al., 2020) . There is a long-standing pattern in healthcare that people from these communities are not listened to by their healthcare providers which leads to these unnecessary deaths. 8

Public Health Interventions (Milestone Three) • AIM Program • Implementation of maternal safety bundles. • Primary. • Education access, Health Care access and quality Alliance for Innovation on Maternal Health (AIM) is an HRSA-funded program that was implemented to reduce maternal morbidity and mortality by improving the quality and safety of maternity care services (Ahn et al., 2020). This program assists state-based teams in the implementation of maternal safety bundles like, obstetric hemorrhage, severe hypertension in pregnancy, the safe reduction of c-sections in primary births, extra obstetric care for mothers with opioid use disorder, postpartum care basics for maternal safety from birth that transitions into well-woman care, and the reduction of peripartum racial and ethnic disparities. As of October 2020, 38 states were enrolled in AIM with 1500 hospitals actively participating. AIM- Community Care Initiative was created in 2019 to address the community-focused implementation of non-hospital-focused maternal safety bundles (Ahn et al., 2020). The AIM program is a primary intervention as it focuses on fixing the problem before it becomes one, as more than 80% of pregnancy related deaths are preventable. 9

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Public Health Response (Milestone Four) • CDC • The CDC manages 2 national data sources of maternal death: • NCHS • Division of Reproductive Health's PMSS • MMRCS – identify and review pregnancy related deaths • Hear Her Campaign Maternal mortality is a problem throughout the whole world. The World Health Organization is responsible for tracking and collecting data from pregnancy related deaths throughout the world. Within our nation maternal mortality is of concern by the Centers for Disease Control and Prevention, and they have done their part to broaden the classifications of maternal mortality. The CDC manages 2 national data sources of maternal deaths; the National Vital Statistics System which is compiled annually by the National Center for Health Statistics (NCHS) and the Pregnancy Mortality Surveillance System (PMSS) which is a program ran by the Division of Reproductive Health. These sources are responsible for correctly classifying maternal mortality to shed light on the major problem that is happening in our nation. MMRCs are state-based maternal mortality review committees, they are considered the gold standard in identifying and reviewing pregnancy-associated and pregnancy-related deaths. They collect all necessary data from prenatal records, hospital records and autopsy records. They are responsible for classifying these deaths as preventable or not, which can be used to jump start the change that is necessary for at-risk mothers (Collier & Molina, 2019). The CDC has a campaign called the Hear Her Campaign which is aimed at Healthcare Professionals to really listen to women’s concerns during and after pregnancy in order to do their part in eliminating preventable maternal mortality (Healthcare Professionals | CDC, 10

2022). 10

Effectiveness • [Effectiveness of past and current responses:] • [Obstacles to meeting goals:] • [Theoretical public health framework–how work and advantages:] [Speaker notes: elaborate on how effective past and current responses have been, what keeps these organizations from meeting their goals and discuss the unique perspective that public health theoretical frameworks provide in addressing the issue–see rubric for details.] 11

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Ethical Reflection • [Response to: Is public health response equitable?] • [Response to: Conditions in the community improved?] “A person knows their body best. Listening and acting upon their concerns during or after pregnancy could save a life.” Dr. Wanda Barfield, Director of CDC’s Division of Reproductive Health [Reflect on the connections between the public health response to this issue and broader ethical questions of social justice, poverty, and systematic disadvantage. Specifically, how does the response help to improve conditions for people in their communities?] Maternal mortality is a problem that should not be a problem. The United States has some of the best healthcare in the world, yet our maternal mortality rates are as high as some third world countries. 12

References Ahn, R., Gonzalez, G. P., Anderson, B. L., Vladutiu, C. J., Fowler, E. R., & Manning, L. (2020). Initiatives to reduce maternal mortality and severe maternal morbidity in the United States. Annals of Internal Medicine , 173 (11_Supplement), S3–S10. https://doi.org/10.7326/m19-3258 Collier, A. Y., & Molina, R. L. (2019). Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. NeoReviews, 20(10), e561–e574. https://doi.org/10.1542/neo.20-10-e561 Funk, C. (2022, April 7). 3. Black Americans’ views about health disparities, experiences with health care . Pew Research Center Science & Society. https://www.pewresearch.org/science/2022/04/07/black-americans-views-about-health-disparities-experiences-with-health- care/#:~:text=Among%20Black%20women%2C%2034%25%20say Ganucheau, A. (2023, January 26). Mississippi’s already troubling maternal mortality rate is worsening . Mississippi Today. https://mississippitoday.org/2023/01/26/maternal-mortality-rate-worsens/ Healthcare Professionals | CDC. (2022). https://www.cdc.gov/hearher/healthcare-providers/index.html?s_cid=DRH_Hear_Her_SearchOY1_HCPs_Brand_Main Hoyert, D. L. (2023, March 16). Maternal Mortality Rates in the United States, 2021 . Www.cdc.gov. https://www.cdc.gov/nchs/data/hestat/maternal- mortality/2021/maternal-mortality-rates-2021.htm#:~:text=In%202021%2C%201%2C205%20women%20died Latest Maternal Mortality Report: Health Disparities Increase . (2023, January 26). MSDH. https://msdh.ms.gov/msdhsite/_static/23,25161,341.html Use APA style https://www.pewresearch.org/science/2022/04/07/black-americans-views-about- health-disparities-experiences-with-health- care/#:~:text=Among%20Black%20women%2C%2034%25%20say,least%20one%20 of%20these%20experiences. 13

PHE Milestone 4

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