Disparities In Maternal Mortality Research Articles

Stakeholder Perspectives on Racial Disparities in Maternal Mortality and Morbidity in Alabama

Through interviews with providers and other professionals in maternity health care, our team sought to identify multi-level determinants of maternal health disparities and factors that contribute to sub-optimal maternal outcomes for Black women in Alabama. Black women are three times more likely to die from pregnancy-related causes than White women. AL has the third worst maternal mortality ratio in the US.

A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality

SummaryBackgroundEthnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care.MethodsNational surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009 and 18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received. The care of a stratified random sample of 54 women who died during or up to a year after the end of pregnancy between 2009 and 18, (18 from the aggregated group of Black women, 19 from the Asian aggregated group and 17 from the White aggregated group) was re-examined specifically to describe any structural or cultural biases or discrimination identified.FindingsThere were no major differences causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups).InterpretationThis confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted.FundingThis research is funded by the 10.13039/501100000272National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217–21,202. MK is an NIHR Senior Investigator. SK is part funded and FCS fully funded by the 10.13039/501100000272National Institute for Health Research (NIHR) Applied Research Centre (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania.

BackgroundMaternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania.MethodsThis study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation.ResultsDirect disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders’ engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor.ConclusionOverall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.

State Capacity and Public Provision in a Socially Fragmented Nation

Much research has demonstrated that progress in socioeconomic development and health infrastructure is instrumental in reducing maternal mortality. However, the effects on the maternal mortality ratio of state capacity and social fragmentation, which might change socioeconomic and health factors, are still under-studied. This study examines the extent to which state capacity (at the local level) and social fragmentation affect maternal mortality disparities across districts in Indonesia. By using district-level data and a separate analysis of old and new districts resulting from the proliferation of local government after decentralization, I find that local state capacity does matter for public health care provision. Districts that have stronger state capacity are more likely to have less maternal mortality. Also, variations in local state capacity are responsible for the prevalence of inter-regional disparities in maternal mortality in the country, in particular between old and new districts. Therefore, improvements in local state capacity, especially for new districts, will be necessary for the country to minimize the inter-regional gaps in health outcomes like maternal mortality. Unexpectedly, I do not find a significant link between social fragmentation and maternal mortality.

A National Cohort Study and Confidential Enquiry to Investigate Ethnic Disparities in Maternal Mortality

Background: Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care. Methods: National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009-18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received, and describe any structural or cultural biases or discrimination identified. Findings: There were no major differences in assessed quality of care, nor in causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups). Interpretation: This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted. Funding: NIHR Policy Research Programme Declaration of Interests: All authors have completed the ICMJE disclosure form and declare: Marian Knight, Sara Kenyon and Jennifer Kurinczuk received grants from the NIHR PRP in relation to the submitted work. Kathryn Bunch, Nicola Vousden, Anita Banerjee, Philippa Cox, Fiona Cross-Sudworth, Mandish K. Dhanjal, Jenny Douglas, Joanna Girling, Rohit Kotnis, Roshni R. Patel, Judy Shakespeare, Derek Tuffnell and Meg Wilkinson have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. No authors have other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: Identifiable MBRRACE-UK data were collected in England and Wales without consent with approval of the Secretary of State for Health and Social Care under Section 251 of the NHS Act 2006 (15/CAG/0119). Data were collected in Scotland without consent with approval from the Public Benefit and Privacy Panel for Health and Social Care (1920-0131). Identifiable information was not provided from Northern Ireland. The legal basis for this activity is Article 6 (1)(e) and Article 9 (2)(i) under the General Data Protection Regulation.

A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health.

Our objective was to review the role of maternal health disparities and mental health in the maternal mortality crisis in the USA, and discuss how perinatal care quality improvement in these areas is a critical lever for reducing maternal death. This paper summarizes content from a plenary talk delivered at the 2020 Biennial Meeting of the International Marcé Society for Perinatal Mental Health, in commemoration of the Society's 40th anniversary. The talk synthesized literature on two characteristics of the maternal mortality crisis in the US: (1) wide racial and ethnic disparities in maternal mortality and severe morbidity and (2) the impact of mental health and substance use disorders on maternal death, and introduced a framework for how health care quality gaps contribute to both of these issues. The US remains an outlier among similar nations in its alarmingly high rates of maternal mortality. Achieving significant progress on this measure will require confronting longstanding racial and ethnic disparities that exist throughout the pregnancy-postpartum continuum, as well as addressing the under-reported issue of maternal self-harm. Suicide and overdose are leading but under-recognized causes of death among pregnant and postpartum women in some states. Health care delivery failures, including inadequate risk assessment, care coordination, and communication, are identified in the literature on drivers of maternal health disparities and self-harm. Many of the same steps to improve quality of perinatal care can help to reduce health disparities and address the essential role of mental health in maternal well-being.

Examining the Role of Psychosocial Influences on Black Maternal Health During the COVID-19 Pandemic.

IntroductionDue to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities.MethodsWe examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people.ResultsEven prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women.ConclusionWe recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene.

Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017.

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016-2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable.

Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

BackgroundGlobal disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands.MethodsWe conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis.ResultsMaternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks.ConclusionsMany barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

The disproportionate burdens of the mifepristone REMS

Of the people who need abortion care in the United States every year, 75% are poor or living on low-incomes and approximately 60% are Black, Indigenous, and other people of color [1]. Black, Indigenous, and other people of color face profound inequities in accessing essential health care as a result of a long history of systemic racism and discrimination [2]. Accessing abortion is no different. Further, due to the stark racial disparities in maternal mortality and morbidity in the United States, Black and Indigenous people who cannot access the abortion care they need confront unconscionably elevated risks in carrying a pregnancy to term [3–5].

Development of the person-centered prenatal care scale for people of color

Given the stark disparities in maternal mortality and adverse birth outcomes among Black, indigenous, and other people of color, there is a need to better understand and measure how individuals from these communities experience their care during pregnancy. This study aimed to develop and validate a tool that can be used to measure person-centered prenatal care that reflects the experiences of people of color. We followed standard procedures for scale development-integrated with community-based participatory approaches-to adapt a person-centered maternity care scale that was initially developed and validated for intrapartum care in low-resource countries to reflect the needs and prenatal care experiences of people of color in the United States. The adaptation process included expert reviews with a Community Advisory Board, consisting of community members, community-based health workers, and social service providers from San Francisco, Oakland, and Fresno, to assess content validity. We conducted cognitive interviews with potential respondents to assess the clarity, appropriateness, and relevance of the questions, which were then refined and administered in an online survey to people in California who had given birth in the past year. Data from 293 respondents (84% of whom identified as Black) who received prenatal care were used in psychometric analysis to assess construct and criterion validity and reliability. Exploratory factor analysis yielded 3 factors with eigenvalues of >1, but with 1 dominant factor. A 34-item version of the person-centered prenatal care scale was developed based on factor analyses and recommendations from the Community Advisory Board. We also developed a 26-item version using stricter criteria for relevance, factor loadings, and uniqueness. Items were grouped into 3 conceptual domains representing subscales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." The Cronbach alphas for the 34-item and the 26-item versions and for the subscales were >0.8. Scores based on the sum of responses for the 2 person-centered prenatal care scale versions and all subscales were standardized to range from 0 to 100, where higher scores indicate more person-centered prenatal care. These scores were correlated with global measures of prenatal care satisfaction suggesting good criterion validity. We present 2 versions of the person-centered prenatal care scale: a 34-item and a 26-item version. Both versions have high validity and reliability in a sample made up predominantly of Black women. This scale will facilitate measurement to improve person-centered prenatal care for people of color and could contribute to reducing disparities in birth outcomes. The similarity with the original scale also suggests that the person-centered prenatal care may be applicable across different contexts. However, validation with more diverse samples in additional settings is needed.

Innovations in U.S. Health Care Delivery to Reduce Disparities in Maternal Mortality Among African American and American Indian/Alaskan Native Women

Despite spending more on health care than any other country, the United States has the worst maternal mortality rate among all developed nations. African American and American Indian/Alaskan Native women have the worst outcomes by race, representing a stark health disparity within the country. Contributing factors disproportionately experienced by these minority populations include challenges of access to consistent and high-quality prenatal care, prevalence of underlying conditions, toxic stress due to systemic racism, and unconscious bias in health care. While many of these factors lie upstream in the lives of women, and seemingly beyond the scope of the clinical walls, the downstream health care delivery system can serve as a vital part of the solution via innovative practices, community-based collaborations, and by serving as advocates for the communities served. Such alignments between clinicians, community leaders, policymakers, and patients that extend beyond the health system can serve as the missing piece needed within the clinic to reverse the trajectory of maternal mortality for American women, especially those from traditionally underserved populations.

Are we listening? Obstetric anesthesiology and the national call for birth justice and accountability: a perspective from the United States

Despite declining rates of pregnancy-related deaths worldwide, the United States (US) has seen an increase in maternal mortality. It is widely known that this increased risk of mortality impacts unevenly Black people, who are three-fold more likely to die from pregnancy-related causes than white people. This disparity in maternal mortality and morbidity is not unique to the US; countries like Brazil, the Netherlands, South Africa, and the United Kingdom (UK) report similar racial disparities in peripartum health outcomes. It is thought that many factors contribute to this tragic health inequity, including, but not limited to, structural racism, provider implicit bias, and lack of access to high quality, culturally humble reproductive health care. On July 25, 2020, activists for reproductive justice and birth justice published an open call in the New York Times entitled “How many Black, Brown, and Indigenous people have to die giving birth? National call for birth justice and accountability.” It is a powerful statement that uses an intersectional framework to understand reproductive inequities, while making demands for positive healthcare reforms and radically dreaming of a reality where the struggle for reproductive justice has been actualized. Using personal narrative, this paper reflects on the field of obstetric anesthesiology and how clinicians can make meaningful change to address and eventually help solve this health care inequity.

Protecting Black mothers: How the history of midwifery can inform doula activism

AbstractIn response to the crisis of racist disparities in maternal mortality, many activists are pushing for increased access to birth doulas for Black women. As states and municipalities respond by incorporating doulas into hospital settings with increasingly common requirements for doula certification, it is more important than ever to investigate the role of doulas, and how that role might change under the medical model of birth within US hospitals. Will activism for doulas turn into arguments for the “right” to a doula? Without the full privileges of citizenship—will the most marginalized women be left out of that right despite their health and safety being at the origins of the activist struggle? To investigate these questions, we can look to the history of midwives in the United States, and examine how the midwifery model of childbirth changed as activists fought for increased access to midwives to improve birth outcomes.

Black-White disparities in maternal in-hospital mortality according to teaching and Black-serving hospital status

Maternal mortality is higher among Black than White people in the United States. Whether Black-White disparities in maternal in-hospital mortality during the delivery hospitalization vary across hospital types (Black-serving vs nonBlack-serving and teaching vs nonteaching) and whether overall maternal mortality differs across hospital types is not known. The aims of this study were to determine whether risk-adjusted Black-White disparities in maternal mortality during the delivery hospitalization vary by hospital types (this is analysis of disparities in mortality within hospital types) and compare risk-adjusted in-hospital maternal mortality among Black-serving and nonBlack-serving teaching and nonteaching hospitals regardless of race (this is an analysis of overall mortality across hospital types). We performed a population-based, retrospective cohort study of 5,679,044 deliveries among Black (14.2%) and White patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. A hospital discharge disposition of "death" defined maternal in-hospital mortality. Black-serving hospitals had at least 7% Black obstetrical patients (top quartile). We performed risk adjustment by calculating expected death rates using predictions from logistic regression models incorporating sociodemographics, rurality, comorbidities, multiple gestations, gestational age at delivery, year, state, and mode of delivery. We calculated risk-adjusted risk ratios of mortality by comparing observed-to-expected ratios among Black and White patients within hospital types and then examined mortality across hospital types, regardless of patient race. We quantified the proportion of Black-White disparities in mortality attributable to delivering in Black-serving hospitals using causal mediation analysis. There were 330 maternal deaths among 5,679,044 patients (5.8 per 100,000). Black patients died more often (11.5 per 100,000) than White patients (4.8 per 100,000) (relative risk, 2.38; 95% confidence interval, 1.89-2.98). Examination of Black-White disparities revealed that after risk adjustment, Black patients had significantly greater risk of death (adjusted relative risk, 1.44; 95% confidence interval, 1.17-1.79) and that the disparity was similar within each of the hospital types. Comparison of mortality, regardless of race, across hospital types revealed that among teaching hospitals, mortality was similar in Black-serving and nonBlack-serving hospitals. However, among nonteaching hospitals, mortality was significantly higher in Black-serving vs nonBlack-serving hospitals (adjusted relative risk, 1.47; 95% confidence interval, 1.15-1.87). Notably, 53% of Black patients delivered in nonteaching, Black-serving hospitals compared with just 19% of White patients. Among nonteaching hospitals, 47% of Black-White disparities in maternal in-hospital mortality were attributable to delivering at Black-serving hospitals. Maternal in-hospital mortality during the delivery hospitalization among Black patients is more than double that of White patients. Our data suggest this disparity is caused by excess mortality among Black patients within each hospital type, in addition to excess mortality in nonteaching, Black-serving hospitals where most Black patients deliver. Addressing downstream effects of racism to achieve equity in maternal in-hospital mortality will require transparent reporting of quality metrics by race to reduce differential care and outcomes within hospital types, improvements in care delivery at Black-serving hospitals, overcoming barriers to accessing high-quality care among Black patients, and eventually desegregation of healthcare.

The Integration of Doulas into the Pregnancy Care Teams of Women of Color in the United States

The United States has one of the highest maternal mortality ratios of any country in the Organization for Economic Cooperation and Development (OECD) at 17.4 per 100,000 live births as of 2017, far more than Canada, Sweden, Australia, or Germany (OECD.Stat, 2021). A primary reason for this considerable difference between the U.S. and other OECD countries is the racial disparity in maternal mortality. One intervention aimed at addressing this racial disparity is the integration of a doula, a professionally trained companion who provides birth support, into a woman’s biomedical care team (Gilliland, 2002). The doula works with their client throughout pregnancy, through delivery, and in the postnatal period, providing guidance and encouragement to the mother while also working within the healthcare system to advocate for, and in some cases to protect, her. This paper will provide a general background on maternal death in the United States, highlighting the historical and modern instances of racism and its impact on maternal health; examining the use of doulas as an intervention for reducing maternal death, using New York City as a case study; and discussing the potential implications of a national expansion of Medicaid reimbursed doula programs aimed at improving maternal outcomes countrywide.

Dissenting Statement and Rebuttal of Commissioner Gail L. Heriot in U.S. Commission on Civil Right Report: Racial Disparities on Maternal Health

On September 15, 2021, the U.S. Commission on Civil Rights published a report entitled Racial Disparities in Maternal Health (the “Report”). This Dissenting Statement and Rebuttal (the “Statement”) is a part of that report. Among other things, the Statement points out several errors in Report. For example, the Report incorrectly states that maternal mortality has increased 50% over the last generation. What has actually happened is that changes in death certificates have caused more deaths to be classified as maternal in nature. The Report also emphasizes the theory that racism plays a prominent role in causing racial disparities in maternal mortality. The Statement points out in response that maternal mortality rates for Hispanic and Asian American mothers are lower than the rate for white mothers. This tends to detract from the theory that racism is what’s causing the disparities.

Trends and Racial/Ethnic, Socioeconomic, and Geographic Disparities in Maternal Mortality from Indirect Obstetric Causes in the United States, 1999-2017.

Background:This study examines trends and inequalities in US maternal mortality from indirect obstetric causes (ICD-10 codes: O98-O99) and specific chronic conditions by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, place and region of residence, and cause of death.Methods:National vital statistics data from 1999 to 2017 were used to compute maternal mortality rates by sociodemographic factors. Rate ratios and log-linear regression were used to model mortality trends and differentials.Results:During 1999-2017, maternal mortality from indirect causes showed an upward trend; the annual rates increased by 11.2% for the overall population, 12.9% for non-Hispanic Whites, and 9.4% for non-Hispanic Blacks. The proportion of all maternal deaths due to indirect causes increased from 12.0% in 1999 to 26.9% in 2017. Maternal mortality from CVD increased sharply over time, from 0.40/100,000 live births in 1999 to 1.82 in 2017. During 2013-2017, compared to non-Hispanic Whites, non-Hispanic Blacks had 83% higher, Hispanics 51% lower, and Asian/Pacific Islanders 55% lower mortality from indirect causes. Non-Hispanic White women with <12 years of education had 4.4 times higher mortality than those with a college degree. Unmarried, US-born, and women living in rural areas and deprived areas had 90%, 80%, 60%, and 97% higher maternal mortality risks than married, immigrant, and women in urban areas and affluent areas, respectively. Maternal mortality from infectious diseases, including HIV, was 4.1 times greater and from respiratory diseases 2.9 greater among non-Hispanic Black women compared to non-Hispanic White women.Conclusions and Global Health Implications:While maternal mortality from direct obstetric causes has declined during the past two decades, maternal deaths due to indirect causes, particularly from pre-existing medical conditions, including CVD and metabolic disorders, have increased. Understanding complex interactions among social determinants, indirect causes, and proximate/direct causes is important to reducing maternal mortality and improving maternal health.

Gender Equality, Women’s Political Representation, and Maternal Mortality: Lessons from Indonesia

Abstract Many studies have shown that gender equality and women’s political representation lead to better health outcomes, including a lower rate of maternal mortality. Nevertheless, we still lack a clear understanding of the causal mechanism linking gender equality and politics to maternal health. Besides, most of the studies on this subject suffer from a whole nation bias as they focus on the national level. Using a structural equation model (SEM) analysis, this article examines the effect of gender equality and women’s political representation on disparities in maternal mortality across regions in Indonesia. Compared to districts with a lower level of gender equality, the results reveal that districts with a higher level of gender equality were more likely to have a lower rate of maternal mortality. The effect was mediated by increases in the utilization of maternal health care services made possible by higher rates of gender equality. However, our findings show no strong evidence in support of women’s political representation effects on reducing maternal mortality. Thus, the findings of this study suggest the primacy of gender equality in improving maternal health.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.