Mary-Ann Etiebet is originally from Nigeria, a poor African country where a woman dies every 13 minutes — 109 each day — from preventable causes related to pregnancy and childbirth.
But it was in Brooklyn, not Nigeria, that Etiebet got first-hand experience when her husband’s sister-in-law died giving birth about 30 years ago.
“The family never really knew what happened,” recalled Etiebet, a physician and infectious disease specialist. “It was a wake-up call for me, and it reminds me every day that maternal mortality is a universal issue.”
Etiebet is now executive director of Merck for Mothers, the pharmaceutical giant’s $500 million program to “create a world where no woman has to die giving life.” This month, the program announced that Philadelphia, Camden, and seven other cities are the inaugural winners of Safer Childbirth Cities grants.
The U.S. is the only high-income country where the maternal mortality rate has been rising for more than two decades, hitting 24 deaths for every 100,000 births in 2014, according to federal data. That’s more than 700 women a year, and it doesn’t include the 50,000 women who only narrowly survive childbirth.
The rates are far worse for African American women and in many cities. In Philadelphia, 27 women die per 100,000 births, while Camden loses 31 women per 100,000 births.
Safer Cities, cofunded by organizations including the W.K. Kellogg Foundation, is a financially modest investment in public health. Each city will get about $1 million over two to three years. Still, the winning applicants say the funding will underwrite innovative ways to identify and help women at risk of pregnancy-related complications.
For example, the Health Federation of Philadelphia and its partners plan to increase women’s access to childbirth coaches called doulas. Another piece of the plan involves sending new mothers who have cardiovascular disease home with a blood pressure monitor and phone app, called Heart Safe Motherhood, developed at the University of Pennsylvania.
“The highest cause of maternal mortality in Philadelphia is related to cardiovascular conditions,” said obstetrician-gynecologist Aasta Mehta, an adviser to the city Department of Health and a leader of its committee that reviews all pregnancy-related maternal deaths. “With Heart Safe Motherhood, we can monitor them much more rigorously and avoid hospital readmissions.”
The Camden Coalition of Healthcare Providers plans to use its Safer Cities grant to leverage its 9-year-old Health Information Exchange, a database of real-time medical information from many sources. The goal is to flag all pregnant women who visit one of the city’s three hospital emergency departments and make sure they receive prenatal care as early as possible, said Natasha Dravid, the coalition’s director of clinical redesign initiatives.
In addition, the Camden project will try to remove barriers to prenatal and postpartum care by paying for transportation to appointments, scheduling mothers’ checkups to coincide with their babies’ visits to the doctor, and troubleshooting health insurance problems.
“In Camden County, 77% of women get prenatal care in the first trimester. In Camden, only 68% do,” Dravid said. “I think that is a metric we can watch to look for improvement.”
Experts attribute this nation’s disturbing maternal mortality trend to numerous factors, including better reporting of pregnancy-related deaths, more chronic illness among women of childbearing age — and medical errors and ineptitude.
The shameful distinction has led to scrutiny by the media and medical authorities, which has spurred changes. For example, Congress this year enacted a law that supports creating maternal mortality review committees in each state to analyze and, hopefully, reduce pregnancy-related deaths. Pennsylvania this month received a $2.5 million grant to create such a committee.