Report: African-American Women at Higher Risk for Maternal Death in Calif.
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.
Should hysterectomy mean the ovaries come out too?
The report showed that women who had their ovaries taken out had lower rates of ovarian cancer and were not more likely to get heart disease or a hip fracture – which had been a worry in this group because of the quick drop in hormones that happens once the ovaries are gone.
That doesn’t mean that all women who are getting a hysterectomy before menopause should also have their ovaries out.
“I’ve always said to my own patients, this is a woman’s individual decision,” Dr. William Parker, a gynecologist affiliated with the University of California, Los Angeles, told Reuters Health.
“Ovarian cancer is a terrible disease, but an extremely rare disease,” said Parker, who was not involved in the current study. “I think it’s important (to consider the options), and I don’t think there’s a pat answer.”
Led by Dr. Vanessa Jacoby from the University of California, San Francisco, the researchers used data from the Women’s Health Initiative study to compare women who had their uterus and ovaries removed with those who just had their uterus taken out.
Hysterectomies are often performed in women who haven’t hit menopause but have heavy bleeding or are bothered by benign tumors growing in the uterus. More than half a million women have the surgery every year in the U.S.
The current study included more than 25,000 women age 50 to 79. Researchers followed the women for an average of 7 to 8 years to determine how many were diagnosed with ovarian cancer, heart disease, or a hip fracture.
Ovarian cancer was very rare in both groups of women — 1 in 300 women who only had a hysterectomy were diagnosed with the disease, compared to 1 in 5,000 women who had their ovaries removed with the hysterectomy.
The authors calculated that 323 women would have needed to have their ovaries removed to prevent each case of ovarian cancer.
Both groups of women were diagnosed with heart disease and hip fractures at similar rates, and about the same amount of women in both groups died during the study – 8 of every 1,000 women each year.
Those findings differ from a previous study, co-authored by Parker, which found that women who had their ovaries removed were more likely to be diagnosed with heart disease and die than women who didn’t.
Two reasons for the difference, researchers say, may be that Parker’s study followed women for a longer period of time and included women who were younger, on average, than the women in the current study.
That makes the studies difficult to compare, said Lauren Arnold of Washington University in St. Louis, who wrote an editorial accompanying the new research in Archives of Internal Medicine.
“It just underscores that there’s a lot that goes into the decision about whether to remove the ovaries,” Arnold told Reuters Health. “Sometimes the decision is fairly clear cut,” such as for women who have a gene that puts them at a high risk for ovarian cancer.
In that case, most doctors recommend women have their ovaries out because the survival rate for ovarian cancer is so low – most women aren’t diagnosed until the cancer is advanced, and then fewer than one in three will survive another 5 years, the researchers report.
“But if you don’t have an ovarian cancer risk, you have a lot of different factors to weigh,” Arnold said.
Parker said that women should also consider if they or anyone in their family has a history of heart disease – which his study suggested would mean that leaving in the ovaries is a good idea.
Jacoby said the question of whether or not to remove the ovaries can be based on a woman’s personal feelings about ovarian cancer, heart risks, and her own body.
“The main message that I hope women get is this is a very personal decision and they should really talk to their doctor about the risks and benefits of removing their ovaries,” Jacoby told Reuters Health. “There’s no right answer.”
Women’s health at risk this legislative session
Did you know that 97 percent of Planned Parenthood’s work is for preventive services that help women, families and communities stay healthy? If you answered “no,” you may be relying on a few state legislators for your information.
During a Health and Human Services committee hearing last week, Rep. Ron Renuart, R-Ponte Vedra Beach, misstated that almost 37 percent of the total income of Planned Parenthood is from abortions and suggested that our organization opposes anti-choice bills because “they don’t want to lose business.”
Rep. Liz Porter, R-Lake City, during closing remarks on a bill to mandate an ultrasound prior to abortion, also misstated that “the real objections of organizations like Planned Parenthood [to this bill]… is fear of the effect to their bottom line.”
Earlier this month, a member of Congress cited inaccurate statistics about the services Planned Parenthood provides and was lampooned in the press.
The people who are charged with passing laws — including public health policies — seem to be basing their decisions on fiction or outright lies. The fact is that Planned Parenthood is a trusted provider of affordable, quality reproductive health-care services. Yes, it does provide abortions, which account for 3 percent of its services. The other 97 percent of its work is preventive, including life-saving cancer screenings, breast health care, wellness exams, contraceptive services, and prevention and treatment of sexually transmitted infections and diseases.
Planned Parenthood works hard to give women access to the reproductive health services that they need to stay healthy — and to avoid unintended pregnancies. Too many of our legislators are more interested in promoting their extreme anti-choice agenda than they are in the truth or in helping women avoid unintended pregnancies.
Two years ago the Centers for Disease Control and Prevention [CDC] reported studies that showed women in Florida have the least access to reversible contraception, such as the pill, than women in all the rest of the country. Contraceptive use prevents abortions.
During these hard economic times, when Florida families are struggling and the number of uninsured is rising, more women are turning to community health providers like Planned Parenthood for trusted, high-quality affordable health care.
But in this current session of our Legislature, 18 bills that attack women’s health and rights have been introduced. From a mandatory-ultrasound bill — which would force women to undergo an unnecessary and expensive medical procedure before they could get an abortion — to a full ban on abortion, the impact of these bills, if passed into law, would be devastating. Women’s rights would be set back decades. Women’s health would be at risk.
The Florida bills are among the most extreme in the nation — many lack exemptions for women who are facing threats to their health or coping with fetal impairment or rape or incest. What is missing from all of these proposals is an understanding of the complicated and unique circumstances women face when deciding to terminate a pregnancy. As legislators consider these bills, they would do well to examine the facts — not rhetoric and lies.
Our legislators owe it to their constituents to debate these anti-choice bills honestly. Instead, our Legislature has become fodder for late-night comics by censoring the word “uterus” and refusing to proclaim “Birth Control Matters” day — all the while turning their backs on measures that would reduce the number of unintended pregnancies in our state.
Florida needs community health providers like Planned Parenthood for first-rate health care and as an organization willing to fight for women’s reproductive health and rights. Especially during these tough economic times, when Floridians face high unemployment rates and many do not have health insurance, good, economical health care is vital.
Our legislators should stop attacking Planned Parenthood and, instead, join them. We all want to reduce the number of abortions in our state, and family planning and sound, economical health care for women are the paths to follow.