Brief introduction to Maternal Mortality Rates (MMR) and the solutions
Source
Throughout time, there have been many imperative public health issues that transpired in the U.S. Shedding light on these public adversities would allow medical health professionals, as well as the general public, to become one step closer towards resolving societal tribulations. One of the public health afflictions that should be deliberated upon is the rate of maternal mortality that occurs due to childbirth. Maternal mortality rates (MMR) during delivery is a deeply alarming public health issue that should be discussed due to the amount of mothers and families it affects each year. This public health concern also raises apprehension because of the alarming increase in MMR that occurs throughout different races, which is displayed through statistical trends (Hoyert). Additionally, since different demographics are affected by this public health issue in distinctive ways, the resolutions that help to alleviate it will vary amongst these demographics. Ultimately, it is imperative to mitigate the MMR during childbirth in all demographics as well as aim to figure out the appropriate solutions for reducing disparities that disproportionately affect MMR in African American women; implementing accessible obstetric care services in rural areas, having more doula services available to mothers/families, and breaking systematic barriers can be some potential solutions to lowering MMR.
Causes of MMR in rural areas
Firstly, research shows that rural areas are more subject to MMR than urban areas. For example, the MMR for larger urban areas is 7.5 per 100,000 live births and 11.6 per 100,000 live births in smaller urban areas. In contrast, the MMR for rural areas is 16.6 per 100,000 live births, which is statistically higher. Furthermore, in 2004, over 50% of rural counties in the U.S. did not have obstetrical services, which are services that specialize in treating women before, during, and after pregnancy/childbirth. This revelation signifies that half of the population in rural counties did not have access to medical care that is vital for treating mothers at one point in time. Essentially, the minimal presence of obstetric services is a primary factor as to why MMR occurs more fervently in rural areas (Rossen et al).
Solutions to MMR in rural areas
To reduce the MMR in rural areas, there are solutions currently being worked on and suggested solutions that have been proposed. For example, Wyoming is a rural state that has little to no care centers for pregnant women. Subsequently, they now allow out-of-state health care providers to be Medicaid providers for their state (Health Disparities in Rural Women). This will allow for the necessary obstetric and pediatric treatments to be more available in a rural area. If this is emulated, more rural cities, counties, and states can increase the amount of medical care needed to support women who are expecting. Additionally, 24 family medicine residency programs are designed to have their training and practices located in rural areas. This is a very advantageous approach to decreasing the lack of obstetric care because it makes graduates of family residency programs 2-3 times more likely to practice, train, and potentially stay in rural areas after they graduate. By having more obstetric care services, women can obtain the necessary treatment from health care professionals that is needed to safely deliver their babies and lessen MMR. In rural Arkansas, the Arkansas Medicaid program as well as the University of Arkansas for Medical Sciences are utilizing medical resources and telemedicine to increase the access of maternal and fetal services for the medical community of Arkansas. The telemedicine and medical resources they are utilizing also helps to provide more education for healthcare clinicians in their medical community and overall increases the amount of obstetric care that the people of Arkansas can receive (Health Disparities in Rural Women). All of these implemented approaches are significantly helping to mitigate the adversities that rural civilians face regarding access to essential medical care, and ultimately, the MMR in rural areas as a whole.
There have also been some promising suggested ideas to combat the amount of MMR in rural areas. For instance, the American College of Obstetricians and Gynecologists promote collaborations with rural health cares to acknowledge the deficiencies in medical care that rural women face and the potential solutions to mollify it. They also are a voice of advocacy for increasing obstetric/reproductive care services and encourage financial incentives that would contribute towards the rise of medical care in rural areas (Health Disparities in Rural Women). Essentially, the proposals and steps that are being implemented in rural areas can have a very positive impact on rural women who need the maternal care that will protect their health during pregnancy and childbirth.
Why doula services are important in reducing MMR
Source
In the article entitled Birth Empowerment: Integrating Doula Services Into Our Healthcare System, Rebecca Singer-Miller deliberates about the experiences that an African American woman named Khadija had during childbirth and with doula services. To start off, a doula is a person that works to provide emotional comfort and important education for women during pregnancy and childbirth. Doulas are also advocates for their clients and can give them social service referrals if needed. They are not medical health professionals, but are incredibly beneficial for alleviating toiling adversities during pregnancies/childbirth (510). In relation to doula services, Khadija was provided with a doula of the same cultural background that helps to provide patient care for low-income clients named Efe. Khadija expressed how she felt disenfranchised, so Efe made it her priority to be an advocate of Khadija and to do everything she can to protect, coach, educate, and help her through her pregnancy and delivery. The dedication and care of a doula is very important because statistically, black women are more prone to experience bigotry through structural racism (Singer-Miller 500). Doula services are imperative for multiple reasons resonating with the reduction of maternal mortality rates.
Efe stated that as a doula, she understands the adversities black women face in the healthcare system and how they are often dismissed or not treated properly when describing the pain they feel during their pregnancies. The ethnic understanding that a doula provides is undoubtedly one of the ways in which MMR can be attenuated. To elaborate, the dismissal of pain during pregnancy and delivery can cause more MMR because pain can be an indicator of a maternal problem that could have been missed due to the willful lack of consideration by those who are treating them (Singer-Miller 505). Subsequently, having doula services that offer vital understanding about the pain and discomfort women experience during pregnancy can greatly assist black women and women in general with the necessary additional care that may have been absent in other healthcare settings. Essentially, the product of understanding can positively be the reduction of maternal mortality rates.
Moreover, black women with a college education were more likely to experience life-threatening complications compared to white women who did not complete high school (Singer-Miller 505). This demonstrates a racial inequity because there has been research demonstrating that having a good education and more access to education regarding childbirth and pregnancy greatly helps to abate maternal mortality rates. For instance, statistics show that having experiences in school can help to increase more understanding, better social interactions in healthcare, and more positive outcomes in both maternal health and health in children (Mensch). Since higher education has shown to naturally increase better healthcare services that can help to combat MMR, it can be very beneficial for many demographics to become more knowledgeable about pregnancy and childbirth. However, for black women, statistics demonstrate adverse effects due to racial disparities. Luckily, doula services can also help to reduce racial disparities in the healthcare system. For example, from the experience of Khadija’s and others, having a doula with the same cultural background enhanced health and equity for ethnic clients due to the doula’s cultural competence. In addition, providing education about racial disparities in medical schools and healthcare programs can increase awareness and help others to be an advocate for fairness amongst all demographics (Singer-Miller 511-512). This indicates that prioritizing cultural competence and awareness can remarkably help with this issue.
Furthermore, doulas helped to reduce the amount of C-sections of pregnant women by 40% in a 2013 study (Singer-Miller 513). This is an important contribution because C-sections can transpire unexpected health complications by 80% compared to a vaginal birth and result in more MMR. To elaborate, decreasing the probability of having a C-section can tremendously help with lowering MMR because statistically, less C-sections signifies that the probability of having severe complications during delivery is greatly minimized (Singer-Miller 506). Additionally, doula services help to improve patient-provider communication. Doulas encourage patients to ask questions that will improve their clarity and understanding. They help them to express their important “preferences and values” as well (Singer-Miller 511). Gaining a better understanding of delivery and pregnancy through improved patient-provider communication is vital because it can increase the chances of maternal success during delivery due to the enhanced clarity that would be obtained by both parties. Moreover, Singer-Miller specifically states that “doula support also had a 22% lower rate of preterm births when compared to those without doula support” (514). This is important because lowering the rate of preterm births can decrease complications for the mother and baby. Ultimately, doula services have many crucial benefits that can greatly help to allay the amount of MMR that transpires in the U.S.
How racial disparities contribute to MMR
Racial disparities also contribute to the disproportionate maternal mortality rates in ethnic groups, most frequently in black women. To commence, black women have the highest MMR compared to other demographics caused by racial inequities, which are one of the most harmful ways that black women are affected by MMR. The racial disparities black women experience include but are not limited to: structural, social, and organizational factors. To begin, black women are socially affected in multiple ways. For one, they are socially affected by MMR due to the traumatic experiences they have had because of their race throughout history and time. Black women have also significantly faced disenfranchisement, discriminatory behavior, systemic bigotry, implicit prejudices, and more. These social disparities decrease the chances for proper treatment and mitigate access of reproductive health services, which results in higher MMR. Furthermore, the disparity also increases the trepidation of being uninsured due to the unfair treatment of black women. A mix of both social and economic factors can contribute to more health complications regarding pregnancy as well. Additionally, the historical effects of slavery left jarring impacts such as structural racism that is implicitly and explicitly embedded in different areas of healthcare. This can affect black women physiologically and even genetically. Former legislation also created barriers for equal access and treatment in healthcare for black women and women of color, which tie back to the disproportionate increase in maternal mortality rates throughout history and in the present. The systematic biases and bigotry has organizationally affected black women regarding MMR as well (Njuko et al).
How racial disparities can be reduced to combat MMR
Acknowledging the adversities and problems that cause MMR throughout different demographics can raise awareness on ways to reduce, eliminate, and prevent these issues from its prevalence. There are some possible solutions that can help to diminish these racial disparities, which ultimately will help to decrease MMR. Firstly, making medical staff more inclusive and diverse is a notable approach to alleviating MMR. Although black people comprise 13% of the population, only 5% are involved in the medical field. Having more inclusive staff work towards encouraging others to acknowledge the discrete prejudices that is casted upon those of ethnic backgrounds can help to alleviate racial disparities. Additionally, creating policies to help combat this issue is another solution that can be utilized. For example, allowing insurance to cover doula care services and other services that help to lessen MMR during pregnancy can be a very effective objective (Njuko et al). Essentially, promoting inclusivity and making important services more accessible to everyone can substantially contribute to the vast reduction of MMR.
Conclusion
Ultimately, MMR in the U.S. is a dismaying health issue that immensely affects different demographics in many ways. This public health concern can be combated by acknowledging the causes of heightened MMR and finding effective solutions that can assist all mothers with their reproductive health. Putting a stronger emphasis on obtaining support from doulas, encouraging fairness and equal treatment in healthcare, and increasing availability towards important healthcare services have all proven to be incredibly effective in reducing MMR, as well as protecting the overall well-being of both mothers and children.
Works Cited
“Health Disparities in Rural Women.” The American College of Obstetricians and Gynecologists, Feb. 2014,
Hoyert, Donna L. “Maternal Mortality Rates in the United States, 2021.” Centers for Disease Control and Prevention, 16 Mar. 2023, https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#:~:text=The%20maternal%20mortality%20rate%20for,20.1%20in%202019%20(Table).
Mensch, Barbara S et al. “Evidence for causal links between education and maternal and child health: systematic review.” Tropical medicine & international health: TM & IH vol. 24,5 (2019): 504-522. doi:10.1111/tmi.13218 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519047/
Njoku, Anuli et al. “Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States.” Healthcare (Basel, Switzerland) vol. 11,3 438. 3 Feb. 2023, doi:10.3390/healthcare11030438
Rossen, Lauren et al. “Rural-Urban Differences in Maternal Mortality Trends in the United States, 1999–2017: Accounting for the Impact of the Pregnancy Status Checkbox.” American Journal of Epidemiology, vol. 191, 7 June 2022, pp. 1030–1039
Singer-Miller, Rebecca. “Birth Empowerment: Integrating Doula Services into Our Healthcare System.” Health Matrix: Journal of Law-Medicine, vol. 33, Jan. 2023, pp. 499–535. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=163733024&site=ehost-live&scope=site.