In California, African-American women are dying of pregnancy related-causes at rates seen in some developing countries, and at four times the rate of white women and other ethnic groups in the state.
A new report from the California Department of Public Health reveals the stark disparity: the mortality rate for black women was 46 deaths for every 100,000 live births from 2006 to 2008, while the rates for Asian, white and Hispanic women in the same period ranged from 9 to 13 deaths per 100,000 births.
“African-American people generally have worse health outcomes than Caucasian people…but not to this degree, not four-fold,” said Conrad Chao, a clinical professor of obstetrics and gynecology at the University of California, San Francisco, who worked on the report. “What surprised me when we got through the numbers was the magnitude of the disparity.”
A 2007 Centers for Disease Control national breakdown showed a similar — but smaller– race gap, with black women at about three times the risk for maternal death as white women.
Taken as a community, African-American women in California have a maternal mortality risk comparable to rates in Kazakhstan and Syria, according to World Health Organization data.
The report was authored by a panel of experts investigating the rising rates of maternal death in the California over the last decade. Across the country, maternal mortality rates have increased from 8.5 in 100,000 live births in 1996 to 12.7 in 100,000 in 2007.
Experts have suggested a number of possible contributing factors, including improved data collecting and reporting, women delaying pregnancy to a later age, higher rates of preexisting health conditions such as hypertension, and higher rates of Caesarian deliveries.
Obesity is considered a major risk factor for pregnancy, since it can contribute to other health issues that cause complications. An in-depth look at 2002-2003 data in the report found that black women who died of maternal causes in California were more likely to be overweight or obese, and to have other medical risk factors.
The disparity data should be a wake-up call to other states, said Susan Wood, executive director of the Jacobs Institute of Women’s Health at George Washington University.
“This is not an isolated situation, California is a huge state. It shares many of the same health trends as other states, and this definitely raises critical issues,” she said, particularly for regions with high obesity rates. Southern states especially are known to have some of the largest health disparities and some of the worst health outcomes in the country. Access to prenatal services and outreach in California is also considered relatively strong among the states.
Chao emphasized it is unlikely that one factor is to blame for the rates, noting that the Hispanic population has seen a marked rise in obesity that has yet to be matched with a spike in maternal deaths.
Education level does appear to play a role. 11 percent of all births in California were to women without a high school diploma, but accounted for 31 percent of mothers who died from 2002-2003.
Michael Lu, an associate professor of obstetrics and gynecology at UCLA who was not involved in the analysis, studies race and socioeconomic disparities in maternal and infant health. He called the findings a landmark report, and a call to action across the country.
“The magnitude of this black-white gap in maternal mortality is the greatest among all health disparities…and that gap is growing,” Lu said. “It’s unacceptable.”
Lu pointed to two major factors that doctors have known impact maternal health for a long time, both the mother’s health status before pregnancy and the quality of health care she received during pregnancy at birth.
Chao said the analysis could not draw any concrete conclusions about quality of care, but that further exploration of the issue is a must. The committee determined that more than one-third of the maternal deaths had a good chance of being prevented, especially in cases of hemorrhage or infection.