La. tackles pregnancy-related deaths among Blacks and all women

3rd April 2018   ·   0 Comments

By Susan Buchanan
Contributing Writer

Deaths during and after pregnancy are on the rise nationally and in Louisiana, with rates higher among Black mothers than other women. Louisiana’s doctors, officials and legislators want to reduce them.

Governor John Bel Edwards is concerned. “Consistently, Louisiana has ranked among one of the worst rates of maternal mortality in the nation, and that’s simply unacceptable to me,” he said on March 9. Edwards has asked the state’s Department of Health to closely examine deaths related to childbirth and to produce a full report on policy recommendations.

Louisiana was 47th among states in maternal mortality, according to this year’s America’s Health Rankings from the United Health Foundation. Vermont scored best, while Georgia was worst. The foundation is affiliated with UnitedHealth Group in Minnesota.

Seventy-five of 122 pregnancy-related deaths identified through Louisiana Vital Records in the 2014-2016 span were among non-Hispanic Black women, according to data from Robert Johannessen, spokesman for Louisiana’s Department of Health. Racial disparities in maternal deaths seen nationally exist locally.

This winter, tennis champ Serena Williams advocated for lower maternal mortality among African Americans. She developed life-threatening, postpartum blood clots in her lungs after delivering her daughter in a Florida hospital on September 1. “According to the Centers for Disease Control, Black women are over three times more likely than white women to die from pregnancy- or childbirth-related causes,” the 36-year-old athlete said in a January 15 Facebook post. “We have a lot of work to do as a nation, and I hope my story can inspire a conversation that gets us to close this gap.”

At the Centers for Disease Control and Prevention in Atlanta, spokeswoman Nikki Mayes said considerable racial disparities in pregnancy-related mortality exist. During 2011 to 2013, the agency’s most recent data, mortality was 43.5 deaths per 100,000 live births for Black women, 12.7 deaths per 100,000 live births for whites and 14.4 deaths per 100,000 for women of other races.

“Why such significant racial disparities exist is a complex question to answer,” Mayes said. “In individual cases, there may be access issues related to the appropriate level of care. But research shows that even higher-income, higher-educated African-American women have higher risks of mortality, compared with White women with lower income and less education.”

Mayes said theories about the high rate of Black maternal mortality tend to focus on the stress that African Americans face. She pointed to research by Arline Geronimus and by Michael Lu and Neal Halfon.

At the University of Michigan, Arline Geronimus in 1993 proposed a “weathering” hypothesis and said that the health of Blacks deteriorates in early life because of repeated social and economic adversities and political marginalization. Coping with persistent stress in a race-conscious society can so greatly affect health that a Black person’s morbidity and mortality can be similar to that of a much older white. The health of African-American women can start to decline in early adulthood. For Blacks in poor health at earlier ages than whites, deterioration grows, producing ever-greater inequalities.

Over the years, Michael Lu and Neal Halfon at UCLA in California have proposed that disparities in birth outcomes between racial and ethnic groups result from different developmental trajectories begun early in life and by cumulative allostatic loads over time. Allostatic loads are the physical wear and tear that accumulates as individuals are exposed to repeated stress.

Among all mothers nationally, pregnancy-related mortality has risen statistically in the last 30 years but the reasons for that aren’t clear, Mayes said. “The use of computerized data linkages by the states, changes in the way causes of death are coded, and the addition of a pregnancy check box to death certificates in many states have most likely improved the identification of pregnancy-related deaths over time,” she said.

“Whether the actual risk of a woman dying from pregnancy-related causes has increased is unclear,” Mayes said. “But many studies show that an increasing number of pregnant women in the United States have chronic health conditions, such as hypertension, diabetes and heart disease,” making them more susceptible to pregnancy complications.

Nationally, the CDC’s Pregnancy Mortality Surveillance System reported that deaths related to child bearing, occurring during or in one year of pregnancy, rose from 7.2 per 100,000 births in 1987 to 17.3 per 100,000 births in 2013, the most recent year with full data.

“Louisiana’s data demonstrates a concerning increase in pregnancy-related deaths over time,” according to the state’s Department of Health. Maternal mortality in Louisiana rose from 17 deaths per 100,000 live births in 2004-2006 to 63.5 per 100,000 in 2014-2016, but that may be partly because of the increased reporting or data collection observed nationally, the agency said.

Through the Louisiana Pregnancy-Associated Mortality Review Committee or LA-PAMR, the state tries to review all pregnancy-associated deaths among residents, according to information provided by Johannessen. After years of surveillance in Louisiana, LA-PAMR was authorized by the state’s Perinatal Care Commission and was formed in 2010 by the state’s Department of Health and its Bureau of Family Health. In 2018, LA-PAMR became a multidisciplinary committee with enhanced expertise to address causes of maternal mortality and to monitor communities most at risk.

Last year, LA-PAMR reviewed pregnancy-related deaths from 2011 to 2016 and examined causes. That review uncovered a need to address reproductive planning among mothers suffering from chronic disease, partner violence, substance use and emotional health issues. In the future, the review committee plans to collaborate with members from communities with high maternal mortality.

Partnerships with obstetric leaders and birth facilities led to last year’s launch of the Louisiana Perinatal Quality Collaborative or LaPQC, joining clinicians, hospitals, policy makers and public health professionals to improve birth outcomes.

“We’re definitely aware of the state’s maternal mortality rate and race-related discrepancies,” Dr. Alfred G. Robichaux III, with the Department of Maternal Fetal Medicine at Ochsner Baptist Medical Center in New Orleans, said last week. “The LaPQC is working with the LA-PAMR and the Perinatal Commission to investigate every event and to look for opportunities to improve future care.”

The LaPQC is also liaising with obstetrical hospitals to implement evidence-based guidelines to upgrade the care of patients with hemorrhage and hypertension, two of the main causes of maternal mortality, Robichaux said.

Last week, Shauna Sanford, spokeswoman for John Bel Edwards, said that a state legislator is expected to introduce a bill in April, supported by the Governor and aimed at forming an advisory council to study Louisiana’s increased maternal mortality.

As for Serena Williams, an HBO documentary series, “Being Serena,” begins on May 2 and focuses on the birth of her daughter and Williams’ gradual health recovery and recent return to tennis.

This article originally published in the April 2, 2018 print edition of The Louisiana Weekly newspaper.