High Rate for Deaths of Pregnant Women in New York State

By Anemona Hartcollis

The New York Times, June 19, 2010

More mothers die during pregnancy or soon after in New York than in almost every other state, and according to reports released on Friday by the New York Academy of Medicine and the city’s health department, social factors like poverty, obesity and lack of insurance may be responsible.

While the total number of maternal deaths are small — an average of about 40 a year across the state — city health officials said their analysis showed that maternal mortality was being driven by environmental factors like poor nutrition that could be changed through public policy.

New York City's analysis, billed as one of the most sophisticated looks at maternal mortality in the country, studied 161 women who died of pregnancy-related causes in the city from 2001 to 2005.

It found that 49 percent of the women who died were obese. Black women, who were more likely to be obese, were seven times as likely to die in pregnancy as white women. Hispanic and Asian women were twice as likely to die as white women.

The death rate was highest in the Bronx and Brooklyn, which have large poor and minority populations. The neighborhoods with the highest death rates were Bedford-Stuyvesant and Crown Heights in Brooklyn and Jamaica in Queens. Those with the lowest death rates — actually zero — were Chelsea and Greenwich Village in Manhattan, Bensonhurst in Brooklyn and Flushing in Queens.

Women without health insurance — who may receive less preventive care — were four times as likely to die as women with such coverage, but women covered by Medicaid, the government insurance program for the poor, fared as well as women with private insurance, the city found.

"Black women are more likely to be obese, and they are more likely to be uninsured, and they are more likely to live in communities where the environment does not promote healthy decisions," Deborah Kaplan, the assistant commissioner of the city's bureau of maternal health, said as the city's data was presented at the Academy of Medicine headquarters in Manhattan.

The city's report acknowledged, however, that while factors like obesity, poverty and race were strongly correlated with maternal mortality, it was not possible to say that those factors actually caused the deaths.

The study did not look beyond the statistics to the particular circumstances of each death, which might reveal whether the hospitals that treated the women or decisions made by doctors had contributed to their deaths. "I think we can see this as an issue that needs more clarity," the academy’s president, Dr. Jo Ivey Boufford, said.

Of the women who died during childbirth, 79 percent were delivered by Caesarean section, which carries all the risks of any other surgery, like hemorrhaging and infection. The top four causes of death were blood clots, hemorrhage, pregnancy-induced high blood pressure, and infection, which together accounted for 63 percent of all pregnancy-related deaths, according to the city’s report. Half of the pregnancy-related deaths occurred within a week of delivery.

Prenatal care, or the lack of it, however, did not seem to play a strong role in the deaths. The study found that half the women who died received care that was considered adequate or better in their first trimester.

Women 40 or older were 2.6 times as likely to die as those under 40.

In 2007, the most recent year cited in the academy’s report, New York State’s rate was about 16 maternal deaths per 100,000 live births. It ranks as the fourth worst rate in the country, followed by Maryland, New Mexico, Georgia and the District of Columbia, according to a multiyear analysis by the National Women's Law Center.

The national rate in 2006 was 13.3 maternal deaths per 100,000, three times as high as the federal government's target for 2010 of 4.3 deaths, and ranking the United States below more than 30 other nations.

New York City has fared even worse. The average maternal mortality rate from 2001 to 2005 in New York City was 23.1, nearly twice the national average of 11.8 during that period, according to the city's report.

In addition to the 161 women whose deaths were directly related to pregnancy, the city looked at another 105 women whose deaths were indirectly related to their pregnancies. Homicide accounted for more than a fifth of these deaths, suggesting that the stress of pregnancy may be related to domestic violence. Black women were five times as likely to be murdered as white women, and Hispanic women were more than twice as likely to be killed as white women.

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