Black Women More Likely to Die in Childbirth than Whites or Latinas

A probing 90-question review promises to unravel the stubborn knot of questions about why as many as 139 women died from pregnancy-related complications in New York state between 2003 and 2005 and why New York City continues to be a leader in maternal mortality.

For more than two years, a voluntary maternal mortality review conducted in the state has been struggling with its own life-and-death problem: the disappearance of New York City hospital participation.

The New York City Health and Hospitals Corporation -- a coalition of city-owned care and treatment facilities that represent a large portion of the city's maternal deaths along with the largest population of African- American patients -- has backed out of the review process.

As a result Donna Montalto, who heads the New York state review, says a report due out in 2009 won't have enough hospitals participating to a make a meaningful analysis of maternal deaths in the state.

The Health and Hospitals Corporation, a public hospital system that includes 11 acute-care hospitals and several home care, diagnostic and treatment facilities, withdrew from the review in 2006. Two years before, 13 maternal deaths occurred in its hospitals, representing nearly half of all the maternal deaths in the city that year, state health department data indicate. Three years later in 2007, the number of deaths fell to six.

"We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives," Pamela McDonnell, a spokesperson for the Health and Hospitals Corporation, replied via e-mail.

'Damaging' Departure of Data

The fact that the city's hospitals with the largest number of black patients will be missing is especially damaging to the study, says Montalto, director of New York's American College of Obstetricians and Gynecologists, which launched the Safe Motherhood Initiative in 2001 in conjunction with the New York State Department of Health. In addition to conducting the review, the team of medical specialists that run the initiative also train physicians volunteering to study curriculums on averting maternal mortality.

Montalto is now working with the Healthcare Association of New York State, an association of the state's hospitals, to educate and encourage all hospitals to participate. In 2004, black women were nearly four times as likely to die in childbirth as white women nationwide, and had a maternal death rate of 34.7 per 100,000 live births compared to 9.3 deaths per 100,000 live births for white women.

These types of reviews are path-breaking analyses of maternal death causes and recommendations are active in at least nine states, including New York state for now.

Designed to discover and interpret major risk factors, Montalto's State Maternal Mortality Review surveys -- among many data -- the deceased woman's occupation, primary language, education, insurance coverage, prenatal care, method of delivery and history of sexually transmitted diseases. It asks if the pregnancy was intended or unintended. It might also help explain why African-American women represent a disproportionate amount of maternal deaths.

While all hospitals are required to report maternal deaths to state agencies, this voluntary review effort strives to present a detailed account of the life of the woman and her care in the ward and make recommendations on enhancing quality of care in obstetrics and gynecology.

New York Leads Cities in Maternal Deaths

New York City leads all other U.S. cities in the number of maternal mortalities, and between 1989 and 1998, the state had the highest rate of maternal mortalities per 100,000 live births -- 28.7 -- in the nation, the Atlanta-based Centers for Disease Control and Prevention reported in 1999.