State Health Commissioner Urges Stepped-Up Fight Against Maternal Mortality

Cites Higher Risk for African American Women

ALBANY, N.Y. (Sept. 27, 2007) – Citing New York's higher-than-average rate of maternal mortality, New York State Health Commissioner Richard F. Daines, M.D., today challenged the state's health-care community to work together to reduce pregnancy-related deaths.

"While maternal deaths are a rare occurrence, in 2004 at least 51 women lost their lives in New York as a result of pregnancy-related conditions," said Commissioner Daines. "That's 51 deaths too many."

Maternal deaths are defined as the death of a woman while pregnant or within one year of the end of a pregnancy from causes related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The Centers for Disease Control and Prevention (CDC) reports that, over the past 20 years, an average of two to three women died of pregnancy-related complications each day in the U.S.

Noting that the prevention of deaths attributable to pregnancy is a public health priority of the state, Dr. Daines issued a challenge to New York's hospital and health-care community to "work together to reduce maternal deaths and help us meet the national Healthy People 2010 goal." Meeting that goal of 3.3 maternal deaths per 100,000 live births will be challenging, he said. New York State had a maternal mortality rate of 20.5 deaths per 100,000 live births in 2004, the most recent data available. New York City's rate was 24.4. The national rate for 2004 was 13.1.

A CDC interim progress report on Healthy People 2010 noted that "movement in the wrong direction" had occurred regarding the maternal mortality goal. "In New York State, let's turn this around and get movement going in the right direction," said Dr. Daines.

Experts believe maternal deaths are under-reported in other states, and New York's higher rate may partially reflect better reporting. Studies in other states have shown that physicians completing death certificates after a maternal death often fail to report that the woman was pregnant or had a recent pregnancy.

Dr. Daines expressed concern that African American women are three times more likely to die from pregnancy-related complications than non-Hispanic White women. The causes of the disparity are not completely understood in the medical community. "Our efforts to reduce maternal mortality must include increased pre-conception counseling, risk assessment and monitoring of the health of pregnant African American women," Dr. Daines said.

The leading causes of pregnancy-related deaths are hemorrhage, embolism, infection, and pregnancy-induced hypertension. The majority of deaths occur in hospitals and hospital emergency rooms. "We know that pregnancy-related deaths can be reduced," said Dr. Daines. "Studies indicate that as many as half of all pregnancy-related deaths could be prevented if women had better access to health care, received higher quality care, and made changes in their health and lifestyle habits."

Chronic disease has been identified as an underlying factor in many maternal deaths, with obesity occurring in two thirds of the cases. "Once again, we are reminded of the heavy toll obesity is taking on public health and the need to prevent obesity on many fronts," said Dr. Daines.

Dr. Daines made his remarks at a "Safe Motherhood" conference in New York City jointly sponsored by the State Health Department and the American College of Obstetricians and Gynecologists (ACOG). "While dramatic declines in maternal mortality occurred during the 20th century, any pregnancy-related death is one too many," said Donna Williams, Executive Director of ACOG District ll in New York. "ACOG looks forward to continuing to work with the State Health Department and the provider community to identify causes of maternal deaths and implement strategies to prevent them."

Dr. Daines thanked ACOG for its long-standing commitment to reducing maternal mortality through better surveillance and education in the health-care community. In collaboration with the State Health Department, ACOG conducts maternal mortality reviews of hospital-based maternal deaths in New York State. These reviews have enabled ACOG and the state to develop and distribute educational materials targeted to health care professionals to improve the quality of perinatal health including prenatal care, delivery, and postnatal care.

Future activities to reduce maternal deaths should include better surveillance and systematic reporting of maternal deaths, assessment of the causes of deaths, education, and implementation of medical best practices, Dr. Daines said.