Did You Know 84% Of Pregnancy Related Deaths Between ‘17-’19 Were Determined To Be Preventable?

Women with untreated depression, high blood pressure or gestational diabetes during pregnancy not only have elevated risk of delivering too early, but are more at risk of early mortality up to 50 years after giving birth.

Out of 996 pregnancy related deaths the CDC studied 2017 through 2019, 839 were preventable.

Many of these and some of this can be tied to a combination of (1) poor screening, (2) insurance gaps and (3) a lack of incentives to head off, coordinate and manage higher risk cases. There’s been some progress to improve insurance coverage since this time, but these issues continue to be magnified in what is perhaps the most vulnerable chapter in a woman’s life. 1 in 3 pregnancy related deaths actually occur between the narrow period after birth – from 6 weeks postpartum up to 1 year, or the “4th trimester." For those who survive, the challenges of childbirth extend throughout a woman’s life. In one poll of 2,019 moms over 45, 74% say they have struggled with their mental and physical health due largely to circumstances linked to the 2 year period from “trying to get pregnant through the child’s 1st birthday.” Part of the issue is a healthcare system that is not set up to handle individual differences:

  • Maternal mortality among black women is 3x the rate for white women
  • OBGYN waitlists have grown +19% since 2017 and average 31.4 days, while lack of reproductive endocrinologists heightens risk for 12% of US women with fertility issues
  • 1 in 5 deaths among women is the result of heart disease but research has shown that less than 60% of women recognize heart disease is a leading cause of death

“Almost a quarter of pregnancy related deaths are associated with mental health conditions yet we’re still using generic screenings and just throwing a list of providers at overwhelmed moms expecting them to navigate it alone.” – OBGYN

One new mom – Candace, 30-years-old – goes to her 6-week postpartum appointment and fills out the generic postpartum depression screening being only partially honest about the extent of her feelings of hopelessness and thoughts of self harm - unsure of the implications being honest might have on her and her baby. Seemingly, to her OB, she looks as though she’s “passed the test” but she goes home and continues to suffer in silence for months as things worsen. At her daughter’s 6-month appointment, Candace is slightly more honest with her answers on the screen. The pediatrician hands her a list of mental health providers in the area but never follows up, and Candace can’t get an appointment for 3 weeks. Her symptoms are unlikely to resolve and she runs the risk of becoming part of the 23% of pregnancy related deaths linked to mental health.


20%

of women were not asked about depression at prenatal visit

50%

of pregnant women have untreated depression

1 in 8

women report symptoms of depression after giving birth

Falling through the cracks of a broken health system during the pre- and postnatal period could have a lasting impact on a woman’s health. Untreated conditions during the pre- and postnatal period can lead to an increased chance of early mortality up to 50 years afte giving birth. A recent study tracking 46k women who gave birth between 1959 and 1966, or those within the 50-year window, found that preterm childbirth due to spontaneous labor was tied to a 7% increase in risk of death. Hypertensive disorders tied to pregnancy increased risk of death by 9% and gestational diabetes or high blood sugar during pregnancy increased risk of death by 14%. These conditions were shown to disproportionally impact black women compared to white women. There’s been effort put into securing Medicaid coverage for women postpartum – especially over the last year – but gaps still exist in funding to elevate how we screen for mental health conditions during the prenatal period and how we follow-up on both mental and physical health conditions created or exacerbated by pregnancy and postpartum.

“Women getting an extension to their Medicaid coverage helps and has been an important step, but it doesn’t stop people from falling through the cracks.” – Local Policy Maker

Since 2021, most states have worked to extend Medicaid coverage from the federally mandated 6 weeks up to 1-year postpartum.

Illinois was the first to extend coverage, New York the most recent to do so. Missouri and Alaska are among states proposing coverage extensions. These are positive steps to improve pregnancy outcomes, but 6 states continue to restrict to 90 days or 6 months and the “coverage” doesn’t fix the lack of care coordination or limited improvements to care overall.

Policy reform and reimbursement models must prioritize both pre- and postnatal maternal care.

Maternity bundles were the first step in doing this, but our survey of OBs and Medicaid MCOs acknowledge they are narrowly focused and not innovative as payment is tied to delivering “standard” clinical practices like achieving a low rate of cesarean births and high rates of HIV or Group B strep screenings. Most of these bundles do not yet promote innovation or reform how maternity care is being delivered, and many still don’t include the time and investment in depression screening and follow-up for moms and families, and often don’t yet incentivize lowering maternal mortality.

An Eye on Healthcare series from BRG and Hugh Lytle

Fairness Factor is a special report from
BRG’s Eye on Healthcare series

AUTHORS

Samantha Kaishian, MPH
Bryan Cote, MA

SUPPORT FOR THE SERIES PROVIDED BY EQUALITY HEALTH

Bryan Cote | bcote@thinkbrg.com
Hugh Lytle | hlytle@equalityhealth.com

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