The state of Pennsylvania’s Mothers and Babies

Montia Brock (left) and Carissa Ashby (right) spend time with Ashby’s daughter on the front porch of Ashby’s Swissvale home. Brock, a community health worker and perinatal health policy specialist from Healthy Start, conducts home visits to Ashby. Healthy Start Pittsburgh is a local nonprofit that works to reduce infant mortality by strengthening maternal health. (Photo by Kat Procyk/PublicSource)

The path to optimal health for all Pennsylvanians leads to and through women. Maternal and infant health outcomes are critical measures by which the health of states and nations is measured and compared. While the Pennsylvania Department of Health (PA DOH) works hard to address the health needs of all moms and babies, we must place special focus on those experiencing significant disparities in maternal and infant health outcomes—our African-American and Latinx moms and infants. These Pennsylvanians are dying at higher rates every year. It is time we reverse this terrible trend in the commonwealth.
Loren Robinson, MD, MSHP

The maternal mortality rate, as defined by a governmental initiative Healthy People 2020 (HP 2020), is the number of birthing parent deaths due to complications around pregnancy and labor within 42 days of a pregnancy per 100,000 live births. In 2016, Pennsylvania’s mortality rate was 11.4 maternal deaths per 100,000 live births. While the HP 2020 goal is to reduce maternal mortality rate across the country to 11.4, a goal that Pennsylvania has met, there is so much more left to do. A closer look at Pennsylvania’s data reveals a much more concerning story. Much like what has been reflected in national headlines over the past year, Pennsylvania maternal mortality rates among white and African American women differ greatly. In 2016, White women had a maternal mortality rate of 8.7. African American women were dying at a rate triple than that of White women at 27.2 deaths per 100,000 live births. Similarly, infant mortality statistics in Pennsylvania mirror that of maternal mortality. In 2016, the rate of infant mortality among white infants was 4.6 per 1,000 live births, while Latinx and African American infants were dying at significantly higher rates (7.4 and 14.6, respectively). Just a few weeks ago, the March of Dimes’ Premature Birth Report Card was released. Pennsylvania was given a grade of “C,” with an average of 9.4 babies born preterm out of all babies born in the state. We know that preterm birth is one of the biggest risk factors for infant mortality. In Pennsylvania, the preterm birth rate among African American women is 46 percent higher than that of any other group of women.
Carolyn Byrnes, MPH

What we know from these mortality and preterm birth statistics is that they are just the tip of the iceberg. For every woman and infant who dies, there are even more who just barely survived. Since the late 1980s, the United States has seen an increase in maternal mortality rates. Across the country, states are scrambling to respond to this data. Health officials are continually evaluating the data and working to make pregnancy and delivery experiences much safer for our nation’s women. A first step in better understanding this crisis is a clearer, more accurate picture of what is happening in the lives of these mothers. Each woman’s medical history and clinical care, as well as the environment and social factors affecting her well-being, need to be carefully collected and used in care plans before, during and after pregnancy. The better we understand what is and what is not working well for mothers and their families, the better equipped we are to respond.
Pulling this information together and making recommendations to prevent maternal deaths is exactly what the newly established Pennsylvania Maternal Mortality Review Committee (MMRC) aims to do. The committee was created by Act 24 and signed into law by Governor Wolf on May 9, 2018. The committee’s role is to review cases of maternal mortality in Pennsylvania and make recommendations on how to prevent deaths in the future. MMRC is made up of a diverse group of experts representing various disciplines from across the commonwealth. Each is donating his or her time and expertise to make a difference in the lives of Pennsylvania mothers.
With the formation of MMRC, as well as PA DOH’s continuous efforts to care for the state’s maternal and child health populations, we hope that we can help change the way health care is delivered to moms and infants. We need to close the racial gap that is killing our most vulnerable populations.
Carolyn Byrnes, MPH is special advisor to the secretary of health, and Loren Robinson, MD, MSHP is deputy secretary for health promotion and disease prevention, Pennsylvania Department of Health
 
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