User:KatherineModrall/Maternal Health

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Group Members: Katherine, Jo, and Lauren

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Race and Ethnicity Section : Add subsections & Update content

MMR in Developing Countries : Add subsections & Update content

Article body: Original Version
 Race and ethnicity 

 Added Subsection Title: "Statistics" 

The pregnancy related mortality ratio (PRMR) represents the number of deaths per 100,000 live births resulting from pregnancy or pregnancy related causes. Analysis of the Pregnancy Mortality Surveillance System, conducted by the Center for Disease Control and Prevention (CDC), indicates significant racial and ethnic disparities in pregnancy related deaths. The pregnancy related mortality ratio (PRMR) represents the number of deaths per 100,000 live births resulting from pregnancy or pregnancy related causes. Specifically, A 2019 report from the CDC shows that the PRMRs of Black women and American Indian women in the United States are 3-4 times higher than that of W white women. For White women during 2019, White women had a PRMR of approximately there were an approximate 13 maternal deaths per 100,000 live births. For While Black and American Indian Indigenous women, there were had PRMRs of 41 and 30 maternal deaths per 100,000 live births respectively. The majority of these deaths were due to preventable diseases associated with pregnancy related mortality, such as hypertension. While the fatality rate of these diseases was higher among Black and American Indian Indigenous women, the initial prevalence was generally the same across all races. Although lower than that of Black and American Indian women, the PRMR for Asian and Pacific Islander women was found to be higher than that of White women (with a disparity ratio of 1.1) Although lower than that of Black and Indigenous women, the PRMR for Asian and Pacific Islander women was still slightly higher than that of the white women at 13.5. The PRMR for Hispanic women has shown a decline in recent years. However, state specific reports show that Hispanic women still face high rates of maternal morbidity, or health problems that arise from pregnancy and birth.

 Added Subsection Title: "Contributing Factors" 

The CDC cites multiple possible causes for the racial gap in maternal mortality. They say that most pregnancy related deaths are the combined result of 3-4 contributing factors. Some of these factors include higher rates of chronic conditions in minor communities, lower rates of prenatal care, and lower rates of insurance coverage. Furthermore, teen pregnancy rates are higher in minority communities, which is a risk factor for pregnancy or birth complications. For Black and American Indian Indigenous women, this can also encounter include issues of implicit racial bias held by healthcare providers, which affects the quality of care given to treat or prevent a fatal disease. For example, an NIH report states that Black women are two to three times more likely to die of hemorrhage or embolisms during pregnancy or the postpartum period. '''Outside of provider-patient interactions, structural factors can contribute to the racial gap in maternal mortality. This includes the gap in access to primary and preventative care as well as other social determinants of health such as education and community support.''' These factors can also be more structural (e.g. the gap in access to primary and preventative care in minority communities). In the CDC report, economic status is not cited as a leading cause of maternal mortality. While economic status and education level is a possible contributing factors to maternal mortality, the racial gap is shown to persist across all economic and education levels.

MMR in developing countries Low and Low-Middle Income Countries
Add Subtitle: "Statistics"

Decreasing the rates of maternal mortality and morbidity in developing countries is important because poor maternal health is both an indicator and a cause of extreme poverty. According to Tamar Manuelyan Atinc, Vice President for Human Development at the World Bank: "Maternal deaths are both caused by poverty and are a cause of it. The costs of childbirth can quickly exhaust a family's income, bringing with it even more financial hardship." Maternal mortality rates are impermissibly high across the globe. However, most women who die during or after pregnancy live in low and lower-middle income countries. Specifically, in 2017, 94% of all maternal deaths occurred in low and lower-middle income countries. The MMR in low-income countries was 462 in 2017 signifying that 462 mothers passed away during childbirth for every 100,000 live births. I n many developing countries, low and lower-middle income countries complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. A woman dies from complications from childbirth approximately every minute. According to the World Health Organization, in its World Health Report 2005, poor maternal conditions account for the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. In low-income countries, most maternal deaths and injuries during pregnancy and labor are due to preventative issues that have been largely eradicated in higher income countries including postpartum hemorrhaging, hypertensive disease, and maternal infections. are caused by biological processes, not from disease, which can be prevented and have been largely eradicated in the developed world—such as postpartum hemorrhaging, which causes 34% of maternal deaths in the developing world but only 13% of maternal deaths in developed countries. For example, postpartum hemorrhaging is the leading cause of maternal death globally; however, 99% of postpartum hemorrhages occur in low and lower-middle income countries. Therefore, addressing postpartum hemorrhaging is crucial in improving maternal mortality rates in low and low-middle income countries.

Add Subtitle: "Decline in MMR in Low and Lower-Middle Income Countries"

The MMR has drastically declined in low-income countries since 2010. Accessible health care has made maternal death a less common outcome a rare event in developed high-incomer countries, where only 1% of all maternal deaths occur. In low and lower-middle income countries, the average decline rate of the MMR is about 2.9% since 2000.   This improvement was caused by lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled birth attendants"—people with training in basic and emergency obstetric care—to help women give birth. Despite this immense progress, there is still lots of work that must be done in order for low-income countries to meet the goal of the WHO organization of an MMR of less than 130 by 2030. Additionally, t he vast majority of the maternal mortality rates today are still occurring in low and lower-middle income countries. These complications can often be fatal in the developing world low and lower-middle income countries because single most important intervention for safe motherhood is to make sure that a trained provider with midwifery skills is present at every birth, that transport is available to referral services, and that quality emergency obstetric care is available. In 2008 342,900 women died while pregnant or from childbirth worldwide. Although a high number, this was a significant drop from 1980, when 526,300 women died from the same causes. The situation was especially led by improvements in large countries like India and China, which helped to drive down the overall death rates. In India, the government started paying for prenatal and delivery care to ensure access, and saw successes in reducing maternal mortality, so much so that India is cited as the major reason for the decreasing global rates of maternal mortality. (Not relevant to low and lower-middle income countries)

MMR in Low and Low-Middle Income Countries
Statistics:

Maternal mortality rates are extremely high worldwide. However, most women who die during or after pregnancy live in low and lower-middle income countries. Specifically, in 2017, 94% of all maternal deaths occurred in low and lower-middle income countries. The MMR in low-income countries was 462 in 2017 signifying that 462 mothers passed away during childbirth for every 100,000 live births. In many low and lower-middle income countries complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. According to the World Health Organization, in its World Health Report 2005, poor maternal conditions account for the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis. In low-income countries, most maternal deaths and injuries during pregnancy and labor are due to preventative issues that have been largely eradicated in higher income countries including postpartum hemorrhaging, hypertensive disease, and maternal infections. For example, postpartum hemorrhaging is the leading cause of maternal death globally; however, 99% of postpartum hemorrhages occur in low and lower-middle income countries..

Decline in MMR Over Time:

The MMR is extremely high in low-income countries; however, it is necessary to acknowledge the reduction in MMR that has occurred over the past two decades. The MMR has drastically declined in low-income countries since 2010. In low and lower-middle income countries, the average decline rate of the MMR is about 2.9% since 2000. This improvement was caused by lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled birth attendants"—people with training in basic and emergency obstetric care—to help women give birth. Despite this immense progress, there is still lots of work that must be done in order for low-income countries to meet the goal of the WHO organization of an MMR of less than 130 by 2030. Looking forward, the MMR in low and lower-income countries must  continue to decline through improving access to skilled birth attendants to perform cesarean sections and other necessary procedures, increased access to family planning, and increased access to hospital facilities.