REPRODUCTIVE JUSTICE: NOT JUST ABORTION, NOT JUST WOMEN

**NOTE**  Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

MATERNAL MORTALITY

WHAT DOES THE LITERATURE SAY?

2023

Hoyer, D. (2023). Maternal Mortality Rates in the United States, 2021.  Accessed 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)

• The maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019.   In 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6) (Figure 1 and Table). Rates for Black women were significantly higher than rates for White and Hispanic women. The increases from 2020 to 2021 for all race and Hispanic-origin groups were significant

Illinois Department of Public Health (2023).  Maternal Morbidity and Mortality. Accessed https://dph.illinois.gov/topics-services/life-stages-populations/maternal-child-family-health-services/maternal-health/mmmr.html

• Site has links to several reports from the Maternal Mortality committee

Tennessee Department of Health (2023). Maternal Mortality review.  Accessed https://www.tn.gov/health/health-program-areas/fhw/maternal-mortality-review.html

• Caring for Motherhood, maternal mental health support, a journey through postpartum depression and anxiety, birth trauma, and trauma-informed care. TIPQC’s new project is the Promotion of Vaginal Deliveries. The project aim is to promote safe vaginal delivery for all in the birthing population presenting with a nulliparous, term, singleton, vertex pregnancy and thus decrease NTSV cesarean delivery rates to < 23.6% (Health People Goal 2030) in all participating Tennessee birthing facilities by Summer of 2024.

2022

Gunja, M., Gumas, E. and Williams, R. (2022).  The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison.  Accessed  https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison

• The maternal mortality rate in the United States has for many years exceeded that of other high-income countries. Data from the Organisation for Economic Co-operation and Development and the Centers for Disease Control and Prevention show rates worsening around the world in recent years, as well as a widening gap between the U.S. and its peer nations

2021

American College of Obstetricians and Gynecologists Alliance for Innovation on Maternal Health (2021) Safe Reduction of Primary Cesarean Birth.  Accessed https://saferbirth.org/psbs/safe-reduction-of-primary-cesarean-birth/

• Goals include guidelines for promotion of vaginal delivery and decreased cesarean section delivery through education of healthcare teams on approaches which maximize the likelihood of vaginal delivery

New York State Department of Health (2021). Taskforce on Maternal Mortality and Disparate Racial Outcomes. Accessed https://www.health.ny.gov/community/adults/women/task_force_maternal_mortality/

• The multi-pronged initiative includes efforts to review and better address maternal death and morbidity with a focus on racial disparities, expanding community outreach, and taking new actions to increase access to prenatal and perinatal care, including establishing a pilot expansion of Medicaid coverage for doulas.

U.S. Department of Health and Human Services (2021). Health People 2030 - Reduce Maternal Deaths  Accessed https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-maternal-deaths-mich-04

2020

North Carolina Institute of Medicine (2020). Healthy Moms, Health Babies.  Accessed https://nciom.org/wp-content/uploads/2020/04/Perinatal-Report-FINAL.pdf

• Rates of SMM have been on the rise, likely due to increases in maternal age, pre-pregnancy obesity, preexisting medical conditions, and cesarean deliveries

Tikkanen, R., Gunja, M., Fitzgerald, M. and Zephryn, L. (2020).  Maternal Mortality and Maternal Care in the United States Compared to 10 Other Developed Countries.  Accessed https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries 

• The U.S. has the highest maternal mortality rate among developed countries. Obstetrician-gynecologists (ob-gyns) are overrepresented in its maternity care workforce relative to midwives, and there is an overall shortage of maternity care providers (both ob-gyns and midwives) relative to births. In most other countries, midwives outnumber ob-gyns by severalfold, and primary care plays a central role in the health system. Although a large share of its maternal deaths occur postbirth, the U.S. is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.

New York State Department of Health  (2018) New York State Pregnancy - Associated Mortality Review. Accesed https://www.scnylegislature.us/DocumentCenter/View/89293/2018-NYS-Pregnancy-Associated-Mortality-Review-PDF  AND  https://www.health.ny.gov/community/adults/women/docs/maternal_mortality_review_2018.pdf   

• Hospitals should implement the Alliance for Innovation on Maternal Health (AIM) bundle3 to reduce cesarean delivery rates. The pregnancy-related mortality rate for cesarean delivery was 1.7 times that of vaginal delivery (15.8 vs 9.4 deaths per 100,000 live births).  Women with cesarean deliveries comprised 42.9% of deliveries among pregnancy-related deaths, while accounting for 33.8% of all NYS live births. Women with vaginal deliveries comprised 50.0% of deliveries among pregnancy related deaths, while accounting for 66.0% of all NYS live births.  It was determined that 78.0% of pregnancy-related deaths were preventable.

2015

Wilson Center (2015). What explains the United States' dismal maternal mortality rates?  Accessed https://www.wilsoncenter.org/event/what-explains-the-united-states-dismal-maternal-mortality-rates

• Despite spending two and half times more per person on health than the OECD average, the maternal mortality rate in the U.S. increased from 12 to 14 deaths per 100,000 live births from 1990 to 2015, putting the United States at 46th in the world.

Last updated: June 2024