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.

I live in Seattle, a wonderful verdant environment. It is also a place where a glass of wine or a cocktail is ubiquitous. A new study reminds us to be mindful of our alcohol consumption.

Drinking too much alcohol is linked with numerous leading causes of death among young adults in the USA, including heart disease, cancer, unintentional injury, and liver disease.

Unfortunately, deaths due to causes fully attributable to alcohol (such as alcoholic liver disease) have risen over the last decade, including among young folks.

However, a United States-based assessment of alcohol-attributable deaths among this population accounting for partially alcohol-attributable causes (such as cancers) is lacking.

Today we explore a study published in JAMA Network Open examining some of the perils of alcohol use in excess. Researchers examined the average annual deaths secondary to too much alcohol use among adults aged 20 to 64.

“[I]t is the wine that leads me on,
the wild wine
that sets the wisest man to sing
at the top of his lungs,
laugh like a fool — it drives the
man to dancing… it even
tempts him to blurt out stories
better never told.”
― Homer, The Odyssey

Alcohol and mortality

I will begin with a striking observation from Dr. Marissa Esser, the US Centers for Disease Control and Prevention’s alcohol program leader. Speaking to CNN, she observes this:

“While the percentage of deaths attributed to alcohol use varies state by state, it’s a leading cause of preventable death in the USA.” She adds that “alcohol is often overlooked as a public health problem.”

While the percentage of deaths attributed to alcohol use varies state by state, it’s a leading cause of preventable death in the USA. She adds that “alcohol is often overlooked as a public health problem.

Approximately one in five deaths of young adults appeared secondary to excessive alcohol use. For those 20 to 64, drinking-related deaths accounted for one in eight.

The researchers examined national and state mortality data from 2015 to 2019 and noted deaths fully (or partially) attributable to excessive drinking.

The causes included deaths from motor vehicle accidents, alcohol poisoning, and other health impacts (for example, liver disease or pancreas failure). They obtained mortality data from the National Vital Statistics System.

Such deaths have been on the rise, increasing by up to seven percent annually in the two decades before the COVID-19 pandemic.

Alcohol and mortality — My take

The study reminds us to limit our alcohol consumption to a reasonable level. The alcohol-attributable death estimates in this study are likely underestimates. The researchers did not estimate alcohol-attributable deaths due to partially alcohol-attributable conditions — the Behavioral Risk Factor Surveillance System does not collect the prevalence of former alcohol consumption.

The numbers are disturbing, with one in five deaths among adults 20 to 49 attributable to excessive alcohol consumption. Moreover, the study data showed that deaths due to alcohol have gone up in the past decade.

I do not know the solution, but the study authors note that some have proposed increased implementation of evidence-based alcohol policies (for example, increasing alcohol taxes and regulating alcohol outlet density), alcohol screening, and brief intervention.

Be careful

The Centers for Disease Control (CDC) defines moderate drinking as two drinks or less daily for men or one drink or less for women. The organization notes that two-thirds of adults consume more than moderate amounts at least once per month.

The CDC also estimates that one in six adults binge drink — women consuming four or more drinks in one sitting and men drinking five or more — with a quarter of those doing so at least weekly.

Thank you for joining me in this brief look at how one in five deaths among young adults is due to alcohol. One more thing:

A Centers for Disease Control tool can help individuals evaluate their drinking and devise a plan to make healthier alcohol choices.

The post One in Five Deaths Among Young Adults is Due to Alcohol appeared first on Medika Life.