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On the heels of several global initiatives, Merck for Mothers has announced that the US is one of five target countries where it is focusing its maternal health resources – both human and financial. Here, as in the other four countries – Brazil, India, Uganda and Zambia – their focus is on the two leading causes of death – preeclampsia and postpartum hemorrhage (uncontrolled bleeding). In the US, the other leading cause of maternal death is embolism (the sudden obstruction of a blood vessel by a blood clot or air bubble).
Dr. Mary D’Alton, chair of obstetrics at Columbia University (and also a recipient of the Preeclampsia Foundation’s Outstanding Physician Award in 2011), has been a leading voice for putting the “M” back in maternal-fetal medicine. Her assessment of the situation in the US: “We are lacking an organized national response. There’s a chasm between knowing and doing.”
Merck for Mothers’ funding will focus on state-level, facility-level and community-level programs, as well as supporting advocacy and awareness across all systems.
Twelve states will receive support via the Association of Maternal & Child Health Programs to build out their maternal mortality review boards – some of which don’t even have such initiatives in place to routinely and consistently review maternal deaths, identify what went wrong, and use those findings to take action. The first six states to be supported are Ohio, Delaware, Colorado, New York, North Carolina and Georgia.
Recognizing the role that specific facility practices have on quality improvements, M4M will work with three professional organizations to implement pilot programs in five states to improve providers’ ability to react to obstetric emergencies, setting the stage for national adoption. The recent practice guidelines that the Preeclampsia Foundation helped the American College of Obstetricians & Gynecologists develop will prove very helpful to ensure that a basic level of quality care is provided to every woman, everywhere.
Finally, at a community level, four programs in New Jersey, Baltimore, Philadelphia, and Manhattan will be supported to link women with chronic conditions to prenatal and primary health care, including capitalizing on provisions build into the Affordable Care Act (ACA), so that women move into their pregnancies healthier, decreasing the likelihood of childbirth complications.
Why the focus on US maternal mortality and morbidity?
Approximately 880 women die from complications of pregnancy and childbirth each year in the US. And this is just the tip of the iceberg – approximately 52,000 women per year suffer severe complications that may have lasting effects on their health (“severe maternal morbidity”).
Lauren Ward Larsen of Boulder, CO, is one such woman. Suffering a near-fatal case of preeclampsia and HELLP Syndrome during her first – and last – pregnancy in 2000, Lauren's health never returned to its previous level despite years of physical therapy. Today, her doctors attribute the severe osteo-arthritis in her shoulders, hips, knees and ankles to the massive internal hemorrhaging (DIC) that accompanied her preeclampsia experience.
"At times, the long-term effects of preeclampsia are frustrating – not being able to engage in many physical activities with my husband and daughter," said Larsen. "But 13 years later, I continue to seek out different therapies and surgical procedures in hopes of regaining the full use of my body and living pain-free. What can I say: I'm an optimist."
Despite the $111 billion spent annually in the US on hospital care related to childbirth, our country still ranks 47th globally in maternal mortality – behind countries including Bosnia and Turkey. This death rate has nearly doubled since 1990, due in part to the rising epidemic of obesity, diabetes and chronic hypertension amongst women of childbearing age, but even without those influencing factors, experts have estimated that 40-50% of maternal deaths are preventable.
“We applaud this investment by Merck for Mothers,” said Preeclampsia Foundation executive director Eleni Tsigas. “As a member of the initial expert task force that advocated for Merck to invest in preeclampsia as an important maternal issue, often overlooked, but needing significant attention, we’re thrilled to see their commitment take shape.”
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