NOTE: This article by State Senator Carolyn Comitta, “We’re Making Progress in Addressing Maternal Mortality: But There’s Still Much More Work to Do,” was featured in the Chester County Medicine (Summer 2023), published by the Chester County Medical Society. You can also view it here.
The birth of a child should be a special time – a joyous occasion for mothers and families. Tragically, too many mothers in Pennsylvania and America face serious and sometimes fatal health consequences due to pregnancy and childbirth-related complications.
We already know that among affluent nations, the U.S. is one of the least-safe countries to have a baby. Sadly, and shamefully, maternal mortality rates continue to trend upward. According to the Centers for Disease Control and Prevention, there were 32.9 deaths per 100,000 live births in 2021, the highest rate in the nation since 1965. Overall, in 2021, 1,205 women died during childbirth or in the six weeks afterward, an increase from 861 in 2020 and 754 in 2019.
Furthermore, this growing crisis is disproportionally impacting women and communities of color. A new study published in the Journal of the American Medical Association shows that the maternal mortality rate in the U.S. more than doubled between 1999 and 2019, with Black mothers consistently bearing the highest burden. Nationally, the maternal mortality rate is two to four times higher for Black mothers than their white counterparts.
While Pennsylvania fared better than some of our neighbors, we still showed a more than 30 percent increase in Black mortality rates during those two decades. A 2022 report from the Pennsylvania Maternal Mortality Review Committee, which reviews all maternal deaths in the Commonwealth, found that Pennsylvania had an overall pregnancy-associated mortality ratio (PAMR) of 82 deaths per 100,000 live births. Non-Hispanic Blacks had the highest PAMR of 163 per 100,000 live births. In addition, recent national studies are showing significant increases – as much as 44 percent – in maternal mortality for Hispanic women.
In Pennsylvania, we continue to take steps to save lives, provide enhanced care, and support all healthy mothers, babies, and families:
- This summer, the governor signed Act 5 into law, requiring more detailed tracking of the health issues that mothers experience during pregnancy and birth. In addition, Philadelphia is taking steps to require hospitals to share detailed information about pregnancy, delivery, and the parent’s health for patients who experience serious childbirth complications. Knowledge is power and with more information and enhanced data gathering we will be better equipped to save lives.
- In Septiembre 2021, I was joined by my friends on the Pennsylvania Women’s Health Caucus and doctors from Chester County Hospital in kicking off our campaign to extend Medicaid coverage from 60 days to one year postpartum for all Pennsylvanians. We succeeded and thanks to federal funding from the American Rescue Plan Act, all mothers in Pennsylvania can now access coverage for up to one year following the birth of a baby. This is especially important because more than half of the cases of maternal death between 2013 and 2018 impacted mothers enrolled in Medical Assistance when they delivered. And nearly 60 percent of maternal mortality deaths occurred between 42 and 365 days of delivery, many well beyond the standard 60 days of Medical Assistance coverage for pregnant women.
- And this year’s budget spending plan allocates $2.3 million to expand maternal health programming, including implementing prevention strategies to reduce maternal mortality and morbidity.
Still, we have much more work to do. In a nation and region where medical technology and professionals are world-renowned, we can lead the way in providing exceptional care for new moms and newborns.
A big part of that challenge is bridging the gap in access to resources, accurate information, and quality care. According to CDC data, about 84 percent of pregnancy-related deaths in the U.S. are preventable. Improving wellness services, access to nutritional support, counseling and exercise, increased screenings for behavioral health and postpartum depression, more home-based and visiting services, breastfeeding support, substance use disorder treatment, childcare service, and access to family planning can greatly improve maternal health outcomes.
In addition, it’s important to meet expectant mothers where they are – literally and figuratively – in terms of prepartum and postpartum services. More than 193,000 Pennsylvanians live in maternity care deserts where a lack of obstetricians, hospitals with delivery units, or birth centers raise the risk of poor maternal and infant health outcomes.
I am a co-sponsor of Senate Bill 335, legislation introduced by state Senator Judy Schwank, that calls for extending Medicaid coverage to doulas. While not clinicians, doulas are trained professionals who can provide emotional, physical and educational support during pregnancy, birth, and postpartum. And there is strong evidence that they can reduce childbirth complications and improve care coordination. Furthermore, community-integrated doulas can be effective in helping reduce racial disparities and bridge cultural gaps in communities of color. At a time when we’re facing a shortage of doctors and nurses, empowering doulas may be an effective strategy for reducing maternal mortality.
Finally, I must emphasize that ongoing attacks on reproductive freedom only threaten to roll back and limit access to reproductive care. While abortion remains safe and legal in Pennsylvania, states that heavily restrict access to abortion have some of the highest maternal mortality rates. Some of the very same procedures outlawed through abortion bans include safe treatment of those who experience ectopic pregnancies, safe and legal fertility treatment, safe procedures for those who suffer miscarriages, and safe and accessible postpartum and birthing care. The bottom line is reproductive health and maternal health are deeply connected with reproductive choice. Like all healthcare choices, these must remain between patients and healthcare professionals. Doctors must be free to do their jobs effectively and all Pennsylvanians must feel safe accessing the full scope of reproductive, perinatal, and maternal health care.
Recently, my family was blessed with another grandchild – a beautiful, healthy baby girl. We were fortunate that my daughter and granddaughter had access to quality prepartum and postpartum care, as well as a strong family support structure. As I watched them bond over their first days together, I was filled with gratitude for the care they received and the doctors, nurses, and medical workers who all helped ensure a safe and healthy delivery and follow-up care.
And yet, at the same time, I was also painfully aware that for too many Pennsylvanians and Americans those moments are consumed by grief in the loss of a mother – a loss that can echo through an entire family and community.
In Pennsylvania, we can do better and we are working to support healthy mothers, babies, and families. I thank all the doctors, nurses, and medical staff who are vital to that effort. And I look forward to continuing to work with you and all our healthcare professionals to develop innovative strategies and solutions to reduce maternal mortality and save lives.