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John Hoffmire: Maternal mortality rates rising in US, stunting global maternal health progress

The overall global maternal mortality rate (MMR) may be dropping, but the decline is slowed in part by a surprising rise in rates in the developed world. In the United States, the rate of mothers dying from complications in pregnancy and birth is increasing. The rate seems inconsistent with modern medical and technological advances. Maternal mortality rates should be steadily dropping, especially in the developed world, yet the statistics suggest that something is wrong with current models of public health.

According to the Centers for Disease Control and Prevention, the United States’ MMR went from 7.2 per 100,000 births in 1987 to 17.8 in 2011, more than doubling the rate of maternal mortality. The United States’ MMR increased to 28 per 100,000 births in 2013, according to the World Bank’s estimates.

Why are these rates rising despite more developed research and technological advancements?

In a 2014 comprehensive study published by The Lancet on “Global Causes of Maternal Death,” it was shown that one in four maternal deaths are caused primarily by pre-existing health conditions like HIV, malaria, diabetes or obesity, and this fraction is increasing globally. What’s more, one-third of maternal deaths in the United States show a link to cardiovascular disease.

In the United States, African-American women are shown to be more at risk for dying in childbirth than white women. This correlates with research showing that 40 percent of black women in the United States qualify as obese, compared with 22 percent of white women. This may be heavily influenced by poverty levels. According to a report published by the Urban Institute, in 2010, the average income for whites was twice that of blacks. While it is encouraging that progress has been made around malnutrition in the U.S., it is sad to note that the largest nutrition problem in low-income America is about what people eat, rather than whether there is enough to eat.

There is also other evidence showing that poverty contributes to the global maternal mortality rate because of the lack of medical resources available to the poor. Not only are impoverished women more likely to suffer from chronic illness prior to getting pregnant, they are also more likely to lack sufficient access to proper medical care, especially before becoming pregnant. This is apparent when looking at the recent surge in migrant, impoverished women in Western Europe. The chances for women from countries with substandard medical or war ravaged societies are dismal. They are twice as likely to die in childbirth as the general population.

One successful approach to reducing the MMR is contraception. Since the 1980s, the distribution of contraception in developing countries has cut the number of maternal deaths by 40 percent. Contraception helps prevent unwanted pregnancies experienced by women with health concerns or other burdens, and also reduces the rate at which women die from abortions done without proper medical care (which make up 13 percent of maternal deaths).

Another necessary step is to prevent chronic health conditions like obesity, diabetes and cardiovascular disease from developing. This could include free annual checkups, affordable health insurance and giving people the tools they need to make healthy lifestyle choices. Reducing the incidence of chronic disease would significantly reduce the number of maternal deaths.

While the theoretical answers for reducing the MMR are clear, it is always the execution that is most difficult. Needs and applications will differ from country to country, thus the most successful strategies and tactics to decrease the global maternal mortality rate will require a world-wide collaborated effort. There are ways that you can help.

John Hoffmire is director of the Impact Bond Fund at Saïd Business School at Oxford University and directs the Center on Business and Poverty at the Wisconsin School of Business at UW-Madison. He runs Progress Through Business, a nonprofit group promoting economic development. Laura Steele, Hoffmire’s colleague at Progress Through Business, did the research for this article.