Looking Outward to Look Within: The Health Resources and Services Administration Maternal Mortality Summit, and What It Means for Women Everywhere
Authors: Doris Chou
Journal: Annals of Internal Medicine (2020)

Supplement1 December 2020Looking Outward to Look Within: The Health Resources and Services Administration Maternal Mortality Summit, and What It Means for Women EverywhereFREEDoris Chou, MDDoris Chou, MDUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland (D.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3259 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2015, when world leaders approved and became signatories to the Sustainable Development Goals 2015–2030 (SDG) Framework, a critical nuance was noted (1). Unlike the Millennium Development Goals, which focused on improving the status of lower-resourced countries between 1990 and 2015, this global pact intends for all countries, regardless of resource level, to collectively contribute to the global agenda. High-, middle-, and low-income countries alike are expected to report on and improve their populations' and countries' status across 17 goals as measured by targets with more than 200 indicators (2).In that framework, SDG 3.1/3.2 assesses the state of maternal and child health services and outcomes (2). As a vital barometer of any health system, SDG 3.1/3.2 asks whether a country can sustain itself by ensuring its future: the lives of women and their newborns. Unfortunately, the promise of the future often goes unfulfilled. In the United States, it is estimated that 2 women die every 3 days because of pregnancy (3–5). The absolute numbers may appear to be small, but any maternal death is unacceptable.To address this issue, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services convened the HRSA Maternal Mortality Summit in June 2018. The purpose of the summit was to "discuss evidence-based approaches and identify innovative solutions to decreasing maternal mortality and morbidity rates in the U.S. and globally" (6). Participants included U.S. domestic experts as well as those from Brazil, Canada, Finland, India, Rwanda, and the United Kingdom.Although at first glance the experiences of Canada, Finland, and the United Kingdom are natural comparisons, U.S.-based practitioners readily found commonalities among all the shared experiences in the root causes of ill maternal health. Before the summit, it is unlikely that the general U.S. public would spontaneously identify with maternal health experiences from Brazil, India, and Rwanda. However, many of the participants found resonance in the discourse around the effects of nutrition, education, and social and cultural forces that shape care-seeking and implementation of medical advice (issues of access, accessibility, and acceptance). Above all, constructs of ethnicity, race, social status, and "women's agency and autonomy" amplified throughout the country-led discussions. The same themes could be found both between countries and across U.S. states.During the summit, countries shared openly on the challenges of measuring and documenting maternal deaths. All countries discussed the limitations of any one measurement system to accurately capture all the maternal deaths as it directly affects the ability of programs and efforts made by countries to address the causes of maternal death (and morbidity). The discussants shared how shifting demographics, social determinants, and risk factors could result in inequities, which often contributed to maternal morbidity and deaths.Nevertheless, maternal ill health is preventable. A positive pregnancy brings benefits not only to the individual, but also to her community, society, and country. Sweeping and long-standing changes do not come easily; there is no single "magic bullet." Concerted and transparent efforts are needed to change the rhetoric from "It's not my/our problem" to asking the difficult questions of "Why does maternal ill health occur?" and "How can we move forward?" by focusing on what can be done rather than focusing on what cannot.The World Health Organization (WHO) works worldwide to promote health, keep the world safe, and serve vulnerable persons. With partners, the WHO developed the Ending Preventable Maternal Mortality (EPMM) initiative to support countries as they determine the processes to assure appropriate resource allocation to strengthen health systems and enable them to move toward universal health coverage for all who are in need, with the aim of improving maternal and newborn health (7). Integrating EPMM principles and strategies enables countries to realize improved maternal health by prioritizing country leadership and supportive legal, regulatory, and financial mechanisms and integrating maternal and newborn health care to preserve the mother–baby dyad (7). The EPMM initiative calls for a human rights framework to ensure that high-quality sexual, reproductive, maternal, and newborn health care is accessible and available to all who need it and for the empowerment of women, girls, families, and communities (7).Focusing the EPMM lens on the United States, the HRSA summit highlighted essential areas to address. These include general health among women and the effects of inequities and disparities. Additional concerns are the availability of a robust health workforce and the relevant policies and financial implications that drive the overall U.S. health agenda. Readers of this supplement will find thoughtful consideration of these themes and articulation of some of the efforts undertaken to address American maternal mortality and morbidity.The first article provides a narrative landscape review of U.S. maternal health epidemiology (8). The robust series of papers that follow distill the U.S context of racial/ethnic, socioeconomic, and geographic disparities in the care and health outcomes of reproductive-aged women (9–11) and consider the availability of timely access to skilled health personnel and high-quality care, which provide opportunities for prevention and intervention (10–12). Finally, changes in care for mothers of the sickest newborns (13) and maternal comorbid conditions (14, 15) provide concrete strategies to improve health outcomes.Within HRSA sits the Maternal and Child Health Bureau, whose mission is to "improve the health of America's mothers, children, and families" (16). With the summit and this supplement, the HRSA and the United States have taken a step toward ensuring that maternal health is a priority both domestically and internationally. The global community welcomes the continuation and development of this initiative from the landmark meeting.Maternal mortality remains a scourge for every country. Although it can strike any woman, anywhere, fundamentally some predictable patterns can be addressed, with the result that fewer women will die during pregnancy and childbirth. Multilateral sharing and learning from mutual experiences provide potential paths forward in order to reach the collective SDG maternal mortality goal of a global maternal mortality ratio of less than 70 deaths per 100 000 live births (2, 7).References1. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. United Nations; 2015. Google Scholar2. United Nations. SDG indicators. Accessed at https://unstats.un.org/sdgs/indicators/indicators-list on 28 March 2019. Google Scholar3. World Health Organization (WHO); United Nations Children's Fund (UNICEF); United Nations Population Fund (UNFPA); World Bank Group; United Nations Population Division. Trends in maternal mortality 1990 to 2015: estimates by WHO, UNICEF, UNFPA, The World Bank Group, United Nations Population Division. World Health Organization; 2015. Google Scholar4. World Health Organization (WHO); United Nations Children's Fund (UNICEF); United Nations Population Fund (UNFPA); World Bank Group; United Nations Population Division. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, The World Bank Group, United Nations Population Division. World Health Organization; 2019. Google Scholar5. Petersen EE, Davis NL, Goodman D, et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019;68:423-429. [PMID: 31071074] doi:10.15585/mmwr.mm6818e1 CrossrefMedlineGoogle Scholar6. Health Resources and Services Administration. HRSA Maternal Mortality Summit: June 19-21, 2018. June 2018. Accessed at www.hrsa.gov/maternal-mortality/2018-summit.html on 28 March 2019. Google Scholar7. World Health Organization. Strategies toward ending preventable maternal mortality (EPMM). World Health Organization; 2015. Google Scholar8. Ahn R, Gonzalez GP, Anderson B, et al. Initiatives to reduce maternal mortality and severe maternal morbidity in the United States. A narrative review. Ann Intern Med. 2020;173:S3-S10. doi:10.7326/M19-3258 LinkGoogle Scholar9. Lee H, Lin CC, Snyder JE. Rural–urban differences in health care access among women of reproductive age: a 10-year pooled analysis. Ann Intern Med. 2020;173:S55-S58. doi:10.7326/M19-3250 LinkGoogle Scholar10. Lin CC, Hirai AH, Li R, et al. Rural–urban differences in delivery hospitalization costs by severe maternal morbidity status. Ann Intern Med. 2020;173:S59-S62. doi:10.7326/M19-3251 LinkGoogle Scholar11. Snyder JE, Stahl AL, Streeter RA, et al. Regional variations in maternal mortality and health workforce availability in the United States. Ann Intern Med. 2020;173:S45-S54. doi:10.7326/M19-3254 LinkGoogle Scholar12. Robbins C, Martocci S. Timing of prenatal care initiation in the Health Resources and Services Administration Health Center Program in 2017. Ann Intern Med. 2020;173:S29-S36. doi:10.7326/M19-3248 LinkGoogle Scholar13. Verbiest S, Ferrari R, Tucker C, et al. Health needs of mothers of infants in a neonatal intensive care unit. A mixed-methods study. Ann Intern Med. 2020;173:S37-S44. doi:10.7326/M19-3252 LinkGoogle Scholar14. Main EK, Leonard SA, Menard MK. Association of maternal comorbidity with severe maternal morbidity: a cohort study of California mothers delivering between 1997 and 2014. Ann Intern Med. 2020;173:S11-S18. doi:10.7326/M19-3253 LinkGoogle Scholar15. Venkatesh KK, Pate V, Boggess KA, et al. Trends in opioid and psychotropic prescription in pregnancy in the United States from 2001 to 2015 in a privately insured population. A cross-sectional study. Ann Intern Med. 2020;173:S19-S28. doi:10.7326/M19-3249 LinkGoogle Scholar16. Health Resources and Services Administration. About the Maternal and Child Health Bureau (MCHB). January 2019. Accessed at https://mchb.hrsa.gov/about-maternal-and-child-health-bureau-mchb on 28 March 2019. Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland (D.C.)Disclaimer: The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the World Health Organization.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3259.Corresponding Author: Doris Chou, MD, World Health Organization, Avenue Appia 20, Geneva, Switzerland 1211; e-mail, [email protected]int.This article is part of the Annals supplement "Maternal Health in the United States: Findings From the Health Resources and Services Administration and Partners." The Health Resources and Services Administration provided funding for publication of this supplement. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byFactors associated with preventive behaviors, anxiety among healthcare workers and response preparedness against COVID-19 outbreak: A one health approach 1 December 2020Volume 173, Issue 11_SupplementPage: S1-S2KeywordsChild healthGlobal healthHealth careHealth services administration and managementHealth systems strengtheningMaternal healthMaternal mortalityMorbidityPregnancy ePublished: 1 December 2020 Issue Published: 1 December 2020 PDF downloadLoading ...