In maternal mortality, causes vary significantly by race

Not only are black women three times more likely than white women to suffer a pregnancy-associated death, the cause and manner of their deaths also varies widely.

During a presentation to the Joint Commission on Health Care on Monday, Melanie Rouse, maternal mortality projects coordinator with the Virginia Department of Health, expounded on the various disparities within maternal mortality based on race.

Pregnancy-associated deaths are a wide category that include deaths that occur when a woman is pregnant or within a year of termination of a pregnancy, regardless of the cause of death or outcome of the pregnancy, according to the Centers for Medicare and Medicaid Services. The category includes deaths from medical conditions as well as from car crashes, drug overdoses and homicides.

From 2009 to 2013, the most recent year data was available, 66 percent of pregnancy-related deaths for black women were due to natural causes, compared to 45 percent for white women.

The leading causes of death for white women were accidental overdoses, motor vehicle accidents, cancer, infection and suicide. For black women, the leading causes were cardiac disorder, homicide, exacerbation of a chronic illness, pulmonary embolism and motor vehicle accidents.

The racial disparities, Rouse explained, “have been found to extend beyond all socioeconomic and educational backgrounds.”

Virginia’s Maternal Mortality Review Team, which is preparing to release a report on its most recent findings, also found that the most prevalent risk factors for pregnancy-associated death, Rouse said, include mental illness, chronic substance abuse and chronic medical conditions.

“Over 25 percent of maternal decedents in Virginia had been diagnosed with depression and approximately 20 percent had been diagnosed with anxiety at some time in their lives,” Rouse told lawmakers. “Nearly 25 percent of maternal decedents were also found to have chronic substance abuse.”

The team also concluded that there is a “lack of coordination of care with many women not receiving the appropriate screenings, referrals, and/or being able to navigate a complicated health care system on their own.”

But because the data used in the report was from years before Medicaid expansion, increased coverage among women is expected to have a positive effect.

Gena Boyle Berger, deputy secretary of health and human resources, followed Rouse’s presentation to the lawmakers by detailing Gov. Ralph Northam’s recently-announced goal to eliminate the racial disparity in pregnancy-related deaths by 2025.

She said the administration is developing a strategic plan for reaching that goal based on the Maternal Mortality Review Team’s findings, recent literature and best practices from other states.

The Joint Commission also unanimously agreed to have its staff do a thorough analysis of additional data so it can potentially recommend that the General Assembly put additional resources toward addressing maternal mortality in Virginia.