According to health and policy experts, there are many reasons for both the Louisiana rates and the national crisis.
“Race is a social construct, it is not a biological state,” said Veronica Gilispie-Bell, medical director of the Perinatal Analysis of the Quality of Collaborative Work and Pregnancy-Related Mortality and obstetrician at Ochsner Health. “To say that ‘because we have a lot of black people in Louisiana, so our results are bad’ is taken out of context.”
Cassidy, one of four Senate doctors, admitted in an interview that several causes of high maternal mortality rates in his state, including racial bias in care, higher levels of preeclampsia among American black women, are a serious disease. high blood pressure, which is the leading cause of maternal death worldwide – and a difficulty for women, especially in rural areas, to get medical care easily and quickly.
Proposed by him the Law on the Bound Mother, S. 801 (117)sponsored by Sen. Maggie Hassan (DN.H.) will address some access issues by requiring Medicare and Medicaid recommendations for mothers to remotely monitor their blood pressure, glucose and other health indicators. Cassidy also co-authored a bill named after the late MP John Lewis, S. 320 (117)signed in March this year, to study racial differences in health.
Cassidy also argued that the state’s definition of maternal death plays a factor in its consistently high performance.
“Sometimes maternal mortality includes up to a year after birth and includes killing her boyfriend,” Cassidy said. “In my opinion, it’s best to limit your definition to what is perinatal, if you will – sometimes before and after the birth.”
Louisiana uses a broad definition of maternal mortality, which states have gradually adopted in recent years as the CDC has expanded its own analysis with a pregnancy monitoring system. The states, the federal government, and the World Health Organization have traditionally defined maternal mortality as any death caused or related to pregnancy or childbirth up to 42 days after the end of the pregnancy. Louisiana has extended this to one year after pregnancy or childbirth and includes what she calls “pregnancy-related deaths” that are not actually caused or unrelated to pregnancy.
Most states have actually switched to monitoring deaths within a year and are beginning to include broader definitions of pregnancy-related mortality, said Ellen Pliska, senior director of family and child health at the Association of State and Territorial Health Officials.
“It’s more than just health,” Pliska said. “Until recently, much of what was considered was health problems such as sepsis, infection, cardiovascular problems … or bleeding. We are beginning to see – and we have been observing this for quite some time – that there are things that are not exclusively medical that often cause a large number of these premature deaths. ”
This could mean that states continue to report higher mortality rates. Since the CDC introduced its surveillance system, the maternal mortality rate in the country has been steadily rising from 7.2 deaths per 100,000 in 1987 to 17.3 deaths in 2017. But the agency said the reasons for the growth are unclear, and at least part of the trend is related to better data.
Louisiana was an early adoptive parent in this transition. Thirty-six states and the District of Columbia require officials to investigate deaths related to pregnancy, but only nine states and the District of Columbia require officials to consider racial differences and fairness in their reviews. Analysis of the Gutmacher Institute. Louisiana is one of them.
This means that deaths from shots during the year of pregnancy are counted as maternal mortality as well as overdoses, car accidents and deaths by suicide. Maternal health experts, such as government official Gilispie-Bell, advocate this broad definition as a holistic approach that takes into account factors such as food insecurity, workplace conditions, economic stability and family dynamics. The report, co-authored with Gilispie Bell, between 2018 and 2019, the number of homicides of pregnant women was 16 percent higher than among non-pregnant people.
“We always think about pregnancy, because this time when someone is pregnant, and then six weeks later, it seems to turn into a pumpkin,” said Gilispie-Bell. “This period of time before pregnancy and the period after pregnancy is really a time when we have time so we can intervene and do something to help have a healthier pregnancy or reproductive planning to rule out pregnancy.”
Louisiana began counting broader causes of death during the year of pregnancy in 2016, when the CDC and the American College of Obstetricians and Gynecologists recommended a broader definition of what constitutes maternal death. In data before the change Louisiana still ranks relatively low among states across the country. These deaths do not significantly change the picture of maternal mortality trends in Louisiana, but give health officials a “broader picture” of the problems new or future mothers face, Gilispie-Bell said. “It’s less about what’s going on with the patient sitting in my office, and more about what’s going on in their environment,” she said.
Answering the question of how the maternal mortality rate could be affected by the high probability of the abolition of the Supreme Court Rowe vs. Wadeabolishing federal protection against abortion, Cassidy dismissed the risk.
“If we use abortion to limit maternal death, it’s some weird way to approach the problem,” the senator said.
A more holistic definition of maternal mortality does not mean that health care problems are not a major factor in premature maternal death in Louisiana and the country, Gilispie-Bell said.
“There are two things that will always stimulate disparities. It will be systemic racism – historical processes and policies that have been put in place that disenfranchise black and brown people – and the other part of that will be apparent bias, “said Gilispie-Bell.” Black and brown people don’t always get that the same quality of care in the health care system as their white counterparts ”.