Jessica Pereira, 28, taught English as a second language. Paula Krejci, 26, was a standout athlete in high school. Amy Gillespie, 27, was in jail. All three women led different lives, and each of them died unexpectedly as a complication of being pregnant: Pereira in Syracuse, N.Y., a few weeks ago; Krejci in Cleveland in 2012; and Gillespie in Pittsburgh in 2010.
The tragedies are part of a worrisome trend. Deaths due to pregnancy or complications of childbirth have been slowly rising in the U.S. over the past 25 years. Although the rate, according to the latest U.S. Centers for Disease Control and Prevention data, is relatively low—about 17.8 maternal deaths per 100,000 live births in 2011—it has steadily crept up from 10.0 per 100,000 live births in 1990. So in reality the current rate is high for such a wealthy country. And according to a 2014 study in The Lancet, the U.S. is one of only eight countries in the world (the others include Afghanistan and Chad) to see an increase in its rate in the past quarter century.
—Gates CEO: Let's Shrink Maternal Mortality [Podcast]
No one knows precisely the reasons for the overall increase in maternal deaths in the U.S. or which risk factors play the biggest role. But existing data—of which there is less than you might expect—suggest a few suspects. In general, American women who become pregnant are older, sicker and heavier than they used to be, increasing the risk of stroke, high blood pressure and hemorrhage. Nationwide, poverty, lack of medical insurance, lack of maternal education and fragmented health care contribute to the problem.
Alarmed, certain organizations are fighting hard to reverse the trend. One community health organization on Chicago’s west side, which I visited in 2014, combines several innovative approaches to improving maternal health (see the videos below). For starters, the PCC Community Wellness Center has turned the traditional well-baby visit—with its primary focus on the newborn—into a well-family visit that monitors the new mother’s health as well. "This allows us to follow up on any diabetes issues, weight issues, blood-pressure issues, mental health issues that may have arisen during pregnancy," says Mary Puttmann, a family medicine specialist at the center. Nor are fathers left out. "Dads will come to the child's visit, but dads don't often come in for themselves," Puttmann says. By including fathers in the well-family visit, PCC increases the chances that everyone in the family, including the mother, will thrive.
Such comprehensive medical care is just the beginning. PCC Wellness also provides free transportation cards for poor and working-class parents to make sure they can attend prenatal class, which, among other things, helps them identify signs of a pregnancy in trouble Several PCC locations host farmers' markets that bring fresh produce into the inner city, and last fall the organization broke ground on a community farm designed to give patients "the opportunity to make the types of healthy choices we recommend in the exam room," says Robert Urso, PCC president and CEO. The fresh produce initiative underscores PCC's commitment to improving the health of mothers-to-be (as well as the rest of the family) before they become pregnant as well as between pregnancies.
PCC’s efforts are just one example of efforts to attain a global goal set 15 years ago, when world leaders committed themselves to decreasing the maternal death rate by 75 percent from 1990 to 2015. (The World Health Organization defines a maternal death as one that occurs during pregnancy or within 42 days of its end and that is not accidental but related to the pregnancy itself.) The United Nations Development Programme initiative was number five in a list of eight ambitious objectives called the Millennium Development Goals (or MDGs), for improving health around the world. Other goals include halving the global poverty rate; combatting HIV/AIDS, malaria and other diseases; and achieving universal primary education.
— C-sections Save Kids and Moms in Tanzania [Blog Post]
Although the first goal—extreme poverty—has indeed been halved since 1990, the world will not reach its 75 percent target on maternal mortality by the end of the year. The latest data, for 2013, show that the global maternal mortality rate has dropped about 45 per cent since 1990. It turns out that saving moms' lives is more complicated than helping people to earn at least $1.25 a day or protecting them against polio. "Of all the health-related MDGs, reducing maternal mortality has been the most problematic," WHO Director General Margaret Chan told a meeting of international health leaders on January 26. "Doing so depends not on the delivery of a single intervention, like vaccines, bed nets and cocktails of medicine, but on a well-functioning health system, with access to skilled birth attendants and emergency obstetric care."
As my brief visit with PCC showed me, it also takes a certain amount of creativity to reimagine the ways in which health care is delivered, and to expand the vision of what contributes to a healthy life beyond merely medical interventions.