In the United States, maternal mortality has been rising for decades. In this month’s @Health_Affairs, I write about my family’s story. The effects of maternal mortality last for generations, and it’s time to reverse the rise. 1/n healthaffairs.org/doi/10.1377/hl…
From 1990-2013, maternal mortality nearly doubled in the US, while it declined elsewhere across the globe. The US stands shamefully alone, and it’s getting ever more deadly to become a mother in America. 2/n thelancet.com/journals/lance…
Each year, 700-900 moms die. Every death is a deep, searing tragedy that is unspeakably painful. These maternal deaths leave the surviving spouses, parents, children, friends, co-workers, and neighbors with wounds that never heal, or scars that cannot be hidden. 3/n
Now, we know their names. We know their stories. @ByNinaMartin and @NPRMontagne won a @PeabodyAwards for the incredible Lost Mothers series, highlighting the tragedy of the moms we’ve lost. 4/n propublica.org/series/lost-mo…
My own life was profoundly shaped by maternal morbidity and mortality. My grandma Rita nearly died giving birth to my uncle Tom in 1948. Her life was spared in large part because her rural community was close enough to a town with a hospital that could take care of her. 5/n
My own work on rural maternity care grew – in part – out of my family’s struggle to access care when we needed it. @ruralhealth @Unnecesarean 6/n
My grandma’s sister Beatrice (who she called “Beattie”) was an army nurse for years before she took an assignment caring for patients at a tribal clinic on Choctaw lands in Oklaholma. 7/n 
In 1955, my grandma’s sister Beatrice did not survive childbirth, and she left behind 5 children who were estranged from our family for decades. 8/n
Grandma Rita was forever changed by her own near-miss and by the loss of her sister in childbirth. She rarely spoke of it. The pain was overwhelming. 9/n
Maternal mortality is the pain of children crying out for a mother they will never know. Of a husband who longs to be held. Of a sister who longed to share conversations as they grew older. 10/n
It doesn’t need to be this way. We can make change, and we can start now. 11/n
First, we need to establish and fund a national maternal mortality review committee, with attention to systematic, timely data collection across all states. These obstetricians made the case clearly in a 2017 @greenjrnl commentary. 12/n insights.ovid.com/pubmed?pmid=28…
I have served on Minnesota’s maternal mortality review committee since 2012. Here’s the honest truth: We have never publicly released recommendations from our reviews. Also, we have not met since May 2017 because of bureaucratic delays. We must do better. 13/n
Secondly, women deserve access to respectful care. Period. Before, during, after pregnancy…regardless of pregnancy intention or status. Access is impeded by uninsurance and gaps in coverage, and lack of clinicians and facilities in poor, rural, and underserved communities. 14/n
Dr. Michael Lu – former administrator of the federal Maternal and Child Health Bureau - argued compellingly for women’s health across the lifespan as a necessary step to address maternal mortality in this recent @JAMA_current piece 15/n jamanetwork.com/journals/jama/…
Also, last week, @NEJM published a @NJEMPerspec on maternal mortality. It focused almost exclusively on the hospital context. While important, this fails to acknowledge the crucial role of social determinants. It’s necessary, but not sufficient. 16/n nejm.org/doi/10.1056/NE…
Just to highlight exactly how necessary it is to improve maternal safety in hospitals, I want to point to the excellent reporting that @alisonannyoung at @USAToday has done. 17/n usatoday.com/in-depth/news/…
Beyond hospitals, women need full-spectrum reproductive rights. The same communities where there's no place to give birth are places where it's hard to access family planning or abortion care. See this great @voxdotcom piece by @annanorthtweets 18/n vox.com/policy-and-pol…
Third, it is long past time to recognize and directly confront the deadly effects of racism on pregnancy and childbirth. Black moms are 3-4 times as likely as white moms to die around the time of childbirth, and that is just as wrong as a thing can be. 19/n
If you want to learn more about the data (and become appropriately outraged), please read this excellent piece by @KemiDoll and colleagues. 20/n ajph.aphapublications.org/doi/abs/10.210…
If you want to understand the lived experience of birthing while black, please learn about Shalon Irving. 21/n npr.org/2017/12/07/568…
And if you want to read excellent journalism connecting the stories and the data, please read @lindavillarosa from @NYTimes this past spring. 23/n nytimes.com/2018/04/11/mag…
But, most importantly, if you want to know what to do, listen to black women. If you read nothing else, read this by @RJWarrior @Authorbray @IVAPhD @mclemoremr. 24/n blackwomenbirthingjustice.org/single-post/20…
As they note, here’s the real problem at the intersection of racism and maternal health: "assumptions about Black women’s inability to know what they need drive where resources are invested and in whom." 25/n
Fourth, the health care delivery systems that care for mothers and the health plans that finance services need to get crystal clear about what matters. Do what matters, pay for what matters, and listen to mothers. Heed every warning. @neel_shah @CTurlington @Debra_Bingham 26/n
When systems are set up to maximize resources, not to provide care to individuals, people’s voices are ignored. This happens most frequently to black women like @serenawilliams, often with tragic results 27/n nytimes.com/2018/01/11/spo…
We need more states like California, that listened to and learned from @kristenterlizzi story. 28/n vox.com/science-and-he…
In California, led by orgs like @CMQCC and funders like @CHCFNews, they bucked the national trend, making system-wide changes that led to declines in maternal morbidity and mortality, while rates rose in the rest of the US. 29/n healthaffairs.org/doi/10.1377/hl…
There is hope, and that’s important for me and for my family. 30/n
My grandma Rita died in December 2017 at age 94. The last conversation I had with her – just days before she passed away - focused on her sister Beattie, and Beattie’s death during childbirth. 31/n
My own daughter was born in 2010. That year had the highest US maternal mortality rate in recent memory. I would have been statistically safer giving birth in Egypt, Iraq, Latvia, Mongolia, or Uruguay. 32/n
I named my daughter Rita, after her great-grandmother. 33/n
Do we have the will to change the trajectory of maternal mortality in the United States? For the sake of my grandma’s memory and for the sake of my daughter, I hope so. 34/n
Much appreciation to my family for helping me to tell our story, and to my colleagues @RRHDr @EGolberstein @V_V_G for helping me to give voice to these words. (END! Thanks for reading. Let’s demand better for moms.) 35/35 healthaffairs.org/doi/10.1377/hl…
