If we can make maternal deaths as rare as they are in the healthiest countries we can save almost 300,000 mothers each year

Figures from ourworldindata.org

If you are a woman, you are going to struggle to access unbiased levels of care. If you are woman who is Black, Brown Asian, Indian or any dark skinned complexion, and poor to boot, you are really going to struggle to access any form of care. If you are unfortunate enough to live in areas where these biases or prejudices are marked, you could end up paying for this discrimination with your life.

Another often unappreciated factor in the delivery of care to women is their physiology. Women get the short end of the stick, biologically speaking, when it comes to developing conditions that require medical interventions. The ability to create life comes at a price. The female body requires preventative care from a young age, for instance the HPV vaccine, administered to young girls to prevent cervical cancers later in life.

A woman’s womb exposes her to real healthcare challenges that often require invasive, expensive and technically challenging procedures. Procedures that rely on hospitals and clinics to provide the infrastructure and qualified providers to provide the skills. In some countries, facilities are often lacking and in certain more rural location, both are absent.

The main direct causes of maternal death are severe bleeding, unsafe abortion, infection, eclampsia, and obstructed labor; the indirect causes include anemia, malaria, heart disease, and HIV. Pregnancy complications are the main cause of death for women aged 15-19. Access to proper care can dramtically impact these figures. Risks of poor outcomes during pregnancy and childbirth are exacerbated by poverty, low status of women, lack of education, poor nutrition, heavy workloads and violence.

Then there is the issue of unsafe abortions. Around 73 million induced abortions take place worldwide each year. Six out of 10 (61%) of all unintended pregnancies, and 3 out of 10 (29%) of all pregnancies, end in induced abortion. The World Health Organization estimates that 30 women die for every 100,000 unsafe abortions in developed regions, while 220 women die for every 100,000 unsafe abortions in developing regions,

It’s unacceptable that a woman in Sierra Leone is 300 to 400 times more likely to die during pregnancy or childbirth than a woman in Sweden or Finland, and we know it is possible to prevent these deaths.

In more advanced societies, the issue of accessing care is often reduced to one simple determining factor. Money. Countries like America have healthcare systems that are beleaguered by profiteering and it is a trend that is being mirrored in more and more first world world countries. Healthcare again, reflects societies that are turning their backs on disadvantaged communities. Poverty breeds indifference. Indifference that is fatal to many women and, by association, their newborn.

Infant Mortality: 18 deaths per 1,000 live births in 2021

UNICEF Data

The first 28 days of life – the neonatal period – is the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life at an average global rate of 18 deaths per 1,000 live births in 2021, down by 51 per cent from 37 deaths per 1,000 live births in 1990, but figures have been impacted again by the pandemic and figures, not yet released, reflect a worrying increase.

Maternal Mortality: 223 deaths per 100,000 live births

UNICEF Data

Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 2000 to 2020, the global maternal mortality ratio (MMR) declined by 34 per cent – from 342 deaths to 223 deaths per 100,000 live births, according to UN inter-agency estimates. It is widely accepted that these figures are underreported, with deaths occurring in isolated, remote areas, not accounted for.

Every 16 seconds, a baby dies. Every 2 minutes a pregnant mother dies

To put the problem into context, a few additional figures.

The UN estimates that around 385,000 babies are born each day around the world (140 million a year). This number will remain relatively stable in the 50 years from 2020 to 2070. From 2070 to 2100, the number will decline to around 356,000 (130 million a year). The five countries with the highest number of maternal deaths in 2017 were: Nigeria (67,000); India (35,000); Democratic Republic of Congo (16,000); Ethiopia (14,000); and Tanzania (11,000).https://ourworldindata.org/grapher/maternal-mortality

Of course, the chances that a woman dies from maternal causes are not only dependent on the risk per pregnancy – which the graph above shows – but also the number of pregnancies she has.

The average woman in the UK or Sweden has one or two children. In Niger, she has seven children. Not only is the risk per pregnancy higher at lower incomes, but also the number of births. Maternal mortality rates tend to be higher where women have more children. These amplify the differences in risk between high and low-income countries.https://ourworldindata.org/grapher/lifetime-risk-of-maternal-death

In 2020 in the U.S., the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women. Rates for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and Hispanic women. The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women were significant.

The CDC lists the following four roadblocks to improving maternal care in the U.S.

• Eliminate racial and ethnic disparities in maternal mortality.
• Invest in and partner with communities.
• Ensure access to care for all pregnant and postpartum persons.
• Ensure quality care for all pregnant and postpartum persons

Admirable goals, but with no clearly defined plan of action in place, articles like these are merely pandering to a patient population that, according to the CDC and others, needs to restructure the very fabric of the societies they live in to access meaningful care. It’s a common refrain, sung by the WHO and many other global health bodies and it is a cop-out of monumental proportions.

It takes generations to engender change in a society and these changes can be ephemeral, here today, gone tomorrow. Take abortion and a woman’s right to choice. Society is not where we look to resolve healthcare’s biases.

There are simple, actionable solutions to address the healthcare issues faced by women, and they all begin at the door of healthcare itself. Read this follow up article to understand how the Clinics IV Life model seeks to improve access to care for disenfranchised and disadvantaged communities across the globe. While we most certainly don’t have all the answers, we are implementing workable solutions that have an immediate and positive impact on the health outcomes of these vulnerable communities.

None of us can afford any longer to be spectators to one of healthcare’s most damning indictments.

The post Health Care and Its Deadly Biases Toward Women  appeared first on Medika Life.

After Texas passes the heartbeat bill limiting abortion access, Representative Rose hopes to prove Texans care about women and children after pregnancy ends.

Dallas Representative Toni Rose sponsored House Bill 133. She proposed extending Medicaid benefits to low-income women after they have a baby. Rose told The Austin Statesman, “For the past few years, I’ve heard from families across the state who have lost loved ones due to complications of childbirth. Believe me when I say that this issue knows no political or geographical boundaries.”

Under current guidelines, pregnant people qualify for Medicaid for sixty days after delivery. During the Covid-19 pandemic, Texas extended postpartum Medicaid coverage for one year. Some women qualify for a Healthy Texas Women program that provides contraception access and basic primary care coverage.

House Bill 133 is titled “Relating to the provision of certain benefits under Medicaid and the Healthy Texas Women program, including the transition of case management for children and pregnant women program services and Healthy Texas Women program services to a managed care program.”

The bill would allow pregnant people who qualify for Medicaid to continue their health coverage for twelve months after having a baby. The bill passed the Texas House in bipartisan fashion 121-24. The Texas Senate amended the bill reducing the coverage from twelve to six months. The Texas Medical Association is lobbying to extend health coverage back to one year.

Preexisting medical conditions cause many pregnancy complications. To address preexisting conditions, patients need access to medical providers. Primary care, Obgyn, and specialist care before, during, and after pregnancy reduce the risk of maternal deaths.

Many Americans access the US Health system through the Medicaid program. Medicaid covers almost half of the births in our country. In Texas, 54% of pregnant women qualify for Medicaid. But many states, like Texas, chose not to expand Medicaid under the provisions of the Affordable Care Act.

Federal law dictates states must provide prenatal coverage through the Medicaid program. Pregnant women with family incomes up to 138% of the federal poverty level qualify for mandatory prenatal coverage.

Medicaid coverage does not begin until the pregnant woman completes the pregnancy verification process. For many women, this process is slow and arduous. Federally mandated prenatal coverage also ends sixty days postpartum.

In Texas, we provide Medicaid AFTER patients get pregnant and take it away when they deliver. Women gain temporary access to the US health system once they become pregnant and lose access once they deliver their baby. Health providers lose many opportunities to address health needs and prevent complications.

Pregnant people qualify for free health coverage through Medicaid for Pregnant Women, which makes Medicaid available during pregnancy and for two months after birth if they fall under certain monthly income thresholds based on family size ($2,126 or less for a single woman or $3,624 for a family of three).

But to qualify after the two-month postpartum period, the income threshold is significantly lower: $196 a month for a mother with one child or $230 for a mother with two children ($285 a month for a two-parent household with two children).

The maternal mortality rate in Texas is above the national average. According to 2018 data from the U.S. Centers for Disease Control and Prevention, the estimated maternal mortality rate (women who died while pregnant or within 42 days of delivery) was 17.4 deaths per 100,000 live births. In Texas, the maternal mortality rate was 18.5 deaths — that’s nearly 700 deaths nationally and about 70 in Texas each year.

Black and other women of color are two to three times more likely to die from pregnancy-related causes than white women. This risk increases with age. For women over the age of 30, the risk of dying during or after pregnancy is the risk dying before or after pregnancy is four to five times higher than white women.

The 2010 Affordable Care Act (ACA) increased coverage in our country, but millions of Americans are still without health insurance.

The lack of access to high-quality, affordable healthcare increases poor health outcomes and widens the racial disparities.

Why do pregnant women die?

1. Cardiomyopathy and another cardiac disease
2. Thrombotic pulmonary embolism
3. Preeclampsia and hypertensive disorders of pregnancy
4. Hemorrhage
5. Cerebrovascular accidents (strokes)
6. Infections

Representative Toni Rose proposed House Bill 133 to bridge the gap, ensuring Texas provides care for pregnant people after they give birth. This legislation will save lives.

Representative Toni Rose is serving her fourth term in the Texas House of Representatives. District 10 covers the diverse communities of Oak Cliff, Highland Hills, Pleasant Grove, Balch Springs, and Mesquite.

Representative Rose was born and raised in Dallas. Her passions are mental health, social justice, and criminal justice. Her biography states she works on legislation to help “mental health reform, access to affordable healthcare, improving the quality of life for our aging population and underserved communities.”

Mental health access is a key component of her legislation. One in seven women suffers from postpartum depression. Perinatal mood and anxiety disorders can occur anytime from conception to one year after the delivery of a baby.

Perinatal depression is darker and debilitating. A mom feels unable to function for an extended period. Women need access to mental health care to address their needs when certain symptoms are present.

Postpartum depression symptoms include crying spells, feeling sad, feelings of hopelessness, and feeling guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have feelings of hurt themselves or their baby. All of these symptoms indicate it is time to seek medical attention.

A study written by Mathematica in collaboration with St. David’s Foundation and Texans Care for Children examined the economic impact on Texas for failing to provide postpartum mental health care. Texas loses 2.2 billion dollars each year by not providing access to care for people after having a baby.

HB 133 is an opportunity for Texas to show we care about pregnant during and after delivery. A bipartisan group of Dallas leaders in the Texas House of representatives is working together on prison reform. Let’s hope more leaders come together to support Representative Rose’s common-sense legislation to save tax-payer money and save the lives of new Texas mothers.

The post Dallas Representative Toni Rose Fighting for Medicaid Extension for Women After Having a Baby appeared first on Medika Life.

She was only 26 weeks pregnant, and her life was in imminent jeopardy. The doctors recommended immediate delivery. Her baby survived the emergency c section but spent the first three months in the neonatal care unit.

Now that she is pregnant again. She wants to know how to reduce her risk.

Reducing the rate of preeclampsia in pregnant women through daily low-dose aspirin in high-risk patients may save lives and reduce the risk of poor pregnancy outcomes.

The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Services Task Force (USPSTF) are two leading medical associations that recommend daily low-dose aspirin for women with an increased risk of developing preeclampsia during pregnancy. Low-dose aspirin is an inexpensive and easily-accessible medication that lowers the risk of preeclampsia in high-risk women.

What is preeclampsia?

Preeclampsia is a common blood pressure disorder affecting 2–8% of pregnancies worldwide. Preeclampsia is the cause of 12% of maternal deaths. The USPSTF reports one-third of severe obstetric complications and 15% of preterm births in the United States arise from preeclampsia.

Preeclampsia is a leading cause of US maternal deaths, severe maternal morbidity, maternal intensive care admissions, cesarean section, and prematurity. Each year, preeclampsia and other pregnancy blood pressure disorders cause over 70,000 maternal and 500,000 fetal deaths worldwide.

Preeclampsia is diagnosed when high blood pressure occurs after the 20th week of pregnancy in conjunction with other signs and symptoms. Symptoms include headache, right upper abdominal pain, or visual changes. Signs include swelling, weight gain, urine protein leakage, or fluid retention in the lungs. Lab work may show low platelets, poor kidney function, or an elevation in liver enzymes.

Preeclampsia risk factors include:

• Previous pregnancy complicated by preeclampsia
• Chronic hypertension
• Pregestational diabetes mellitus
• Antiphospholipid syndrome
• Obesity
• Advanced maternal age
• Young maternal age
• Racial disparities — Black women are at increased risk of developing pregnancy-related blood pressure complications.
• Underlying kidney disease
• Pregnancies from assisted reproductive technologies

Low-dose aspirin reduces the risk of preeclampsia

The USPSTF and ACOG recommend the use of low-dose aspirin for women at risk of developing preeclampsia. Any pregnant woman with one or more of the above risk factors may benefit from this low-cost, low-risk intervention to reduce their pregnancy hypertension risk. 

The current clinical trial data shows daily low-dose aspirin reduces the risk of preeclampsia by 24%. The recommendation is to begin low-dose aspirin (81 mg/day) between 12 weeks and 28 weeks of gestation and continue daily until delivery.

The studies also show aspirin use in pregnancy is safe with a low risk to mom and baby. A USPSTF meta-analysis did not show aspirin increased the risk for bleeding complications such as placental abruption, postpartum hemorrhage, or fetal intracranial bleeding. 

The underlying cause of preeclampsia is unknown, but we know it is a complex multisystem inflammatory syndrome. Low-dose aspirin has anti-inflammatory, antiangiogenesis, and antiplatelet properties. These unique features may account for the beneficial effects on placenta development and placenta perfusion. 

An aspirin a day keeps preeclampsia away

Scientists continue to study preeclampsia. Researchers are looking to understand its origins and triggers. Medical studies attempt to find reliable biomarkers and improve diagnostic tools.

In the meantime, we can reduce the risk of preeclampsia by encouraging the daily low-dose aspirin in women who have an increased risk for high blood pressure in pregnancy.

The post Daily Aspirin; This Simple Solution Saves Pregnant Women’s Lives appeared first on Medika Life.