Here in California, we have seen the maternal mortality rate more than double for all women, and like the national data, pregnancy-related deaths among African-American women in California were 3.3 times higher than rates for whites or Latinas (37.6 deaths per 100,000 live births versus 12.0 and 11.9 respectively). The causes of pregnancy-related mortality in the U.S. cluster into four main categories—hemorrhage, embolism, hypertensive complications and cardiovascular disease. Each of these has a significantly higher condition-specific mortality rate and greater severity of disease for African American women than for other groups (Harper 2007).

An important study by Tucker et al from the CDC examined the prevalence of five conditions considered major causes of mortality occurring during hospitalization for labor, birth and postpartum. She found that African-American women did not have a higher prevalence of these conditions compared to other racial/ethnic groups, but were more likely to die from them, suggesting either a possible difference in the severity of the disease or the quality of care provided during hospitalization. [Tucker MJ, Berg CJ, Callaghan WM. The black-white disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. American Journal of Public Health. 2007;97(2):247-251.] African-American women have consistently had an approximately 40% higher rate of antepartum hospitalization which may represent a greater burden of disease, more severe disease, less access to preventive prenatal or preconception care or a combination of all of these.

Also, my colleague, sociologist Louise Roth at the University of Arizona has examined the issue of ‘elective ceserean’, and the hype in the media surrounding ‘maternal request’. As you know in the last ten years, the cesarean rate has increased up to over 30% nationally, and cesarean is a major risk factor for babies and mothers. Roth found that Black and Hispanic/Latina mothers are more likely to have a cesarean delivery than white or Asian non-Hispanic mothers, and unmarried and less educated mothers (who are more likely to be low-income) are more likely to have cesarean deliveries than otherwise similar married and more educated women. Maternal request is unlikely to motivate these disparities in cesareans because the most vulnerable mothers, who tend to have the fewest choices, have higher odds of cesarean delivery. In contrast, structural inequality in provider-client relationships may play a significant role in the likelihood of cesarean delivery, with significant health implications for vulnerable populations.

While the issue of infant mortality and morbidity is critical, it’s striking to me that so much more attention has been paid to infant outcomes while hardly any research has looked at what is happening to the women. Yet we know that a leading cause of fetal/infant death is maternal illness/mortality. Of course, babies are a lot more ‘sympathetic’ characters than mothers, which we as a society are quick to judge for all sorts of things.

Thanks.
Christine
Christine H. Morton, PhD
Program Manager/Research Sociologist
California Maternal Quality Care Collaborative

cmorton@stanford.edu http://www.cmqcc.org

Its was my fault and guess that I should have read the whole thing before commenting on this.

Jessica, I am not sure I am understanding you. Caucasians are included in this. They are the “normal” or standard. They are listed above as “Non-Latino Whites”. African Americans have more than 2 times the infant mortality rates as Caucasians. I know in Florida maternal mortality rates show similar trends.

Hope I made sense here.