Maternal Mortality on the Rise in California

By Rachel Walden — February 11, 2010

Last week, California Watch, a new project of the Center for Investigative Reporting, released a report describing an increase in maternal mortality in the state over the past decade.

The report shows that the number of California women who died from causes directly related to pregnancy nearly tripled in the past decade.  The report’s authors confirm that this is the most significant spike in pregnancy-related deaths since the 1930s. The findings have prompted enormous concern and many questions about why this is happening.

Dr. Elliott Main, the principal investigator for the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state, acknowledged that only a modest amount of this increase was related to factors such as obesity among mothers, advanced maternal age, and infertility treatments. He said it was hard to ignore the fact that cesarean rate has increased 50 percent in the same decade that maternal mortality increased.

While changes in reporting may be responsible for some of the apparent increase, California Watch explains:

In 1996, the maternal death rate in California was 5.6 per 100,000 live births, not far from the national goal of 4.3 per 100,000. Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.

In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.

The best estimates show that less than 30 percent of the increase is attributable to better reporting on death certificates. Even accounting for these reporting and classification changes, the maternal death rate between 1996 and 2006 has more than doubled, Main said.

Although the number of deaths is relatively small — and pregnancy and birth are safe for the vast majority of women —  it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.

It is difficult to understand all the possible causes for the increasing maternal death rate without more data available. California Watch notes, though, that “The California [California Maternal Quality Care Collaborative] task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions.” (In some hospitals across the country that have already introduced stricter limits on inductions with no medical indication, there is evidence of improved outcomes.)

California Watch notes that the California Department of Public Health has failed to release a report on the trend; initial findings on the increasing maternal mortality rate were presented at a 2007 conference, but a more formal report has been under review since 2008, according to the piece. The Department’s the department’s director of public affairs has responded that “There was no effort to hold that report back. It just needed some more revisions.”

The CA Department of Public Health has released a couple of graphs of basic trend data, one showing an increase in maternal mortality in California over the last 10 years that is greater than the increase in the U.S. overall, and a second showing an increasing rate of maternal mortality for Black women (37.6 per 100,000 live births in 2002-2004) that is much higher than that for Hispanic (11.9), Asian (10.4), and White Non-Hispanic (11.9) women.

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