By Deborah L. Kaplan, DrPH, MPH, R-PA
Assistant Commissioner, Bureau of Maternal, Infant and Reproductive Health, New York City Department of Health and Mental Hygiene
By Sang Hee Won, MPH
Project Director, Severe Maternal Morbidity Surveillance Project, Bureau of Maternal, Infant and Reproductive Health, New York City Of Department of Health and Mental Hygiene
The New York City Health Department, in partnership with the Fund for Public Health in New York, recently released a report titled "Severe Maternal Morbidity, New York City, 2008-2012," which examines life-threatening complications during delivery. This report details findings of the city’s first-ever severe maternal morbidity (SMM) surveillance system based on the Centers for Disease Control and Prevention’s national maternal morbidity surveillance model. It explains how SMM cases are identified; describes the overall trends and leading indicators of SMM; examines SMM by maternal characteristics, place-based indicators and prenatal and delivery characteristics; and estimates direct medical costs associated with SMM. The report is available here.
Key findings of this report include:
– SMM affects approximately 2,500 women each year in New York City.
– The rate of SMM in New York City increased 28.2 percent – up from 197.2 deaths per 10,000 deliveries in 2008 to 252.9 per 10,000 deliveries in 2012 – and was 1.6 times as high as the national estimate from 2008-2009.
– The leading indicators of SMM included blood transfusion, disseminated intravascular coagulation, hysterectomy, ventilation and adult respiratory distress syndrome.
– Women with an underlying chronic condition, such as hypertension, diabetes or heart disease, were three times as likely to have SMM as were women with no chronic conditions.
– There are stark demographic disparities.
• Black non-Latina women were three times as likely to have SMM as were white non-Latina women. Rates were also high among Puerto Rican and other Latina women compared with white non-Latina women.
• Black non-Latina women with at least a college degree had higher SMM rates than did women of other races/ethnicities who never graduated high school.
• SMM rates were highest among women living in high-poverty neighborhoods.
There are likely many contributors to the disparities in SMM, including a woman’s health prior to becoming pregnant, obesity, access to care and factors associated with poverty, including structural racism, inadequate housing, residential segregation and lower educational attainment. The chronic stress of racism also likely plays an important role. Showing these stark disparities through data is key to making injustice visible and reaffirms the Health Department’s commitment to improving maternal health and promoting health equity. These data will inform the agency’s efforts to address this public health concern. For more information, contact Sang Hee Won at email@example.com.
This project was supported by a grant from Merck through its Merck for Mothers Program.