Maternal Health's 1%

I was invited back to St Luke's-Roosevelt Hospital earlier this week, where I delivered both of my children, for a screening of No Woman, No Cry.
 
Dr. Jacques Moritz, Director, Gynecology Division, Department of OB/GYN there, hosted the event, who just also happens to be the OB who backed my midwife Elizabeth Boyce, when I delivered my daughter Grace back in 2003, served as my host for a fascinating conversation that followed about maternal mortality right here at home- many times citing the Amnesty International's Deadly Delivery report, which came out in 2010, just a month before NO WOMAN, NO CRY premiered at the Tribeca Film Festival. In his presentation Dr. Moritz not only shared some shocking statistics with his colleagues about our national statistics, but also about NYC in particular.

 I often look at these issues globally and it’s true that in general 99% of deaths take place outside the US but the US still ranks 50th in the world and our rates have been on the rise. NY State is currently ranked 4^th with the worst maternal mortality rate in the country. In 2009, New York City had an maternal mortality rate of 37 deaths out of 100,000 births.

In general, the causes of maternal deaths do not differ too greatly around the world. Here in the US, as we look at climbing rates, a frustration is that the exact causes for the rise isn’t exactly understood, but there are some blaring related statistics that cant be ignored.
 
Between 2001 and 2005, 49.1% of women who died of pregnancy- related causes were obese.In addition to obesity, it is clear that race is also a factor. African-Americans are 4 times more likely to die in pregnancy or in childbirth than Caucasian women.

The highest risks come when those risk factors are combined: obesity was more common among black non-Hispanic women, representing 60.2% and white women 43.7% who died in pregnancy. Hispanic women who are obese accounted for 34% and Asian women were at 21%.
 
One doctor in the audience questioned whether the rise in our cesarean section rates was really to blame, comparing the US to China (48.3 deaths per 100,000 births) Singapore  (6 deaths per 100,000 births) and Brazil (75 deaths per 100,000 births) in relation to the US, which is in 50th place and has an MMR of 13.3 deaths per 100,000 live births. Those countries have even higher cesarean section rates than we do. Here at home, the cesarean section rate in the United States is 32% (the World Health Organization recommends that countries should have no more than a 15% cesarean rate).

Dr. Moritz argued that while that may be true, those countries didn't have the number of obese women that the US does either (although in places like China it has been recently stated that obesity rates are on the rise. There obesity levels currently range from below 5%, yet even in relatively low prevalence countries like China, rates are almost 20% in some cities.)
 
Another issue that came up in the Q&A that did apply to our population AND the developing countries profiled in the film were cultural and social barriers to access care in a timely fashion. While this city is loved for its melting pot, along with that ethnic diversity come some of the cultural barriers that we examine in the film in countries such as, Bangladesh, Tanzania and Guatemala. Women don’t always know to seek care or it may not always be culturally acceptable to do so. These barriers sit beneath the surface and can be even more difficult to address than basic access to services.