A report by the Philadelphia Maternal Mortality Review Committee of the Philadelphia Board of Health has found that non-Hispanic Black women made up 43% of births in Philadelphia from 2013 to 2018 but accounted for 73% of the pregnancy-related deaths.
The Improving Outcomes: Maternal Mortality in Philadelphia report indicates pregnancy-related deaths in the city from 2013 to 2018 was approximately 20 per 100,000 live births, which is higher than the 2018 national rate of 17.4 per 100,000 live births.
Accidental drug overdoses increased from 25% of Philadelphia’s pregnancy-associated deaths (from 2010 to 2016) to 39% (from 2017 to 2018) according to the report. The Review Committee cautioned that the pregnancy-associated deaths described in this report are just the tip of the iceberg when looking at the overall state of maternal health in Philadelphia.
“In order to meaningfully reduce maternal mortality, it is necessary to work collectively, think outside the box and develop innovative solutions,” Dr. Aasta D. Mehta, medical officer of Women’s Health at the Philadelphia Department of Public Health and director of the Philadelphia Maternal Mortality Program said in a news release.
“Significant racial disparities in maternal health outcomes demand attention to the underlying issues, which should be accomplished by addressing implicit bias and systemic racism. Devoting resources to address social determinants of health and integrating community voices into policies and programs is key to improving the maternal health outcomes for the women of Philadelphia and across Pennsylvania.”
Sara Jann, public policy director for the Maternity Care Coalition, said she was horrified by the report findings.
“Those of us who work in this space keep going back to is your ZIP code should not determine your birth outcomes or your baby’s birth outcomes,” she said in an interview with The Philadelphia Tribune.
Jann works with the PA Prenatal-to-Three Collaborative, which advocates for doula reimbursement, comprehensive behavioral health services and Medicaid coverage expansion.
“We need certain policy changes on the state level to help moms here in Philadelphia,” she said.
“The first thing that we are advocating for is the extension of pregnancy Medicaid. Currently moms have to reassess at 60 days and we are pushing for 12 months of coverage.”
Jann noted that the $1.9 trillion American Rescue Plan Act of 2021 gives states a new option to extend Medicaid postpartum coverage from 60 days to 12 months.
“We are advocating extremely hard on the state level to get Pennsylvania to take up this new option,” she said.
Jann also highlighted the important role that doulas play in providing education and helping women advocate for themselves when they are having a baby.
A doula is a person who provides emotional and physical support to women during pregnancy and childbirth — and some provide postpartum help. Though certified, doulas are not medical professionals and don't deliver babies or provide medical care.
“There is a ton of evidence that doulas can support positive birth outcomes for both mom and baby,” she explained. “Specifically for Black women, doulas can be an incredible resource when you are interacting with a health care system that has the effects of institutional racism. For folks who use Medicaid for their health insurance, improving birth outcomes for those women is a win-win for everyone."
However, Jann said the issue is that doulas are not covered for most women who have Medicaid.
The review committee collected recommendations developed during each of their meetings in response to each case. These recommendations fit into seven broad themes that are presented in the "Improving Outcomes: Maternal Mortality in Philadelphia" report as overarching recommendations to help improve maternal mortality in Philadelphia. The recommendations are:
1. Address root causes of health inequity in the health care system
2. Tailor behavioral and mental health services to meet the specific needs of pregnant and postpartum women
3. Improve access to preventive, preconception and prenatal care
4. Direct more attention to the postpartum period
5. Heighten awareness of high-risk pregnancy and postpartum complications in non-obstetric care settings
6. Strengthen coordination of services between health care and social service settings
7. Build infrastructure to identify and support women with history of intimate partner violence
The report was developed using aggregated data from 110 pregnancy-associated and pregnancy-related deaths in Philadelphia between 2013 and 2018.
The Philadelphia Maternal Mortality Review Committee gathers multidisciplinary stakeholders from across the city in order to better understand the causes of maternal mortality and to provide recommendations for policy and programmatic change. Comprising representatives from the five labor-and-delivery hospitals in the city, along with members from city agencies and non-governmental organizations, in order to identify, track and review its pregnancy-associated deaths.
Photo: Center for Disease Control