June 18, 1999
Racial Divide Found in Maternal Mortality
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By SHERYL GAY STOLBERG
ASHINGTON --
Though the nation's infant mortality
rate has steadily declined over the
last decade, the percentage of women who die in childbirth has remained essentially unchanged, and
black women are four times as likely to die as whites, according to a
Government study released Thursday.
Dying while giving birth is still
rare in this country. For every
100,000 women who have babies, the
study found, 7.7 die, a figure that
translates into the death of 1 mother
for every 12,987 giving birth.
But the research, the first to analyze maternal mortality by state,
uncovered huge disparities between
black and white women, and among
the states themselves. And experts
say the differences cannot be explained solely by socioeconomics.
"What we found is that the best
rates for black women were still
higher or in about the same range as
the worst rates for white women,"
said Dr. Lynne S. Wilcox, director of
the division of reproductive health
at the Centers for Disease Control
and Prevention in Atlanta, which
conducted the research.
"There are
ongoing, long-term disparities that
have not been looked at carefully
here."
Of the states, New York had the
highest death rate for black pregnant women. In New York, the study
found, 28.7 black women die for every 100,000 who give birth, the equivalent of 1 death for every 3,484
births. That puts New York well
above the national average of 19.6
deaths per 100,000 black pregnant
women; the maternal death rate
among white women in New York,
7.6 per 100,000, was also higher than
the national average for white pregnant women, 5.3 deaths per 100,000.
In Massachusetts, the state with
the lowest rates for both black and
white women, the rate was 8.7 per
100,000 for black women and 2.7 per
100,000 for whites. Because the numbers for other racial groups were
too small be reliable, the researchers did not include them.
To conduct the study, the centers'
epidemiologists examined birth and
death certificates between 1987 and
1996. Any woman who died in pregnancy or 42 days after giving birth,
from any cause related to or aggravated by pregnancy, was considered
a maternal death.
All told, the centers identified
3,086 pregnant women who died in
the study period. But Dr. Wilcox
said that figure was almost certainly an underestimate; smaller, more
detailed studies have found that the
maternal mortality rate is 1.3 to 3
times higher than is reported on
death certificates.
In addition, the national rate of 7.7
deaths per 100,000 women giving
birth is more than twice the goal set
by the Federal Government for the
year 2000, under its Healthy People
2000 initiative. Only Massachusetts,
Nebraska and Washington have
managed to meet the Healthy People 2000 goal of 3.3 deaths per
100,000, and only for white women.
Scientists do not fully understand
the reasons for the disparities between blacks and whites, and the
study did not provide an explanation. But experts offer a variety of
possible explanations: black women
are less likely to have good prenatal
care than whites; they are more
prone to high blood pressure, a leading cause of death in pregnancy, and
they are in poorer health in general.
At the same time, these experts
say, there may be other reasons that
are being overlooked. Even well-educated and well-off black women
appear to be at greater risk than
whites. And little research is focused on preventing deaths among
black pregnant women, in large part
because most people think dying in
childbirth is no longer an issue.
"As safe motherhood has become
an international issue, people say it
is not a problem here in the developed countries," said Andrea Camp,
a senior fellow at the Institute for
Civil Society, a nonprofit foundation
in Boston. "What this report shows
is, it is a problem in America in
1999."
Part of the problem is that states
no longer examine every single
death of a pregnant woman. Dr.
Jeffrey C. King, who is leading an
examination of maternal mortality
for the American College of Obstetricians and Gynecologists, called
on states to establish maternal mortality review boards that would examine the reasons for each death.
Currently, only 25 states conduct
such reviews.
There are three leading causes of
death in pregnancy: preeclampsia,
or high blood pressure induced by
pregnancy; hemorrhage, including
bleeding associated with ectopic
pregnancy, and embolism, a clot in
the bloodstream. The study found
that black women have a higher risk
than whites of dying from each.
"In spite of the technologies available in the United States, we have
not reached an irreducible number
of maternal deaths," Dr. King said.
"This is a public health issue that
requires action."
