Recently the U.S. Department of Health and Human Services (HHS) announced a landmark Maternal Health Initiative.  The initiative incorporates a comprehensive HHS Action Plan to significantly reduce maternal deaths and disparities that put women at risk before, during and after pregnancy. In addition the U.S. Surgeon General issued a corresponding Call to Action to Improve Maternal Health, which puts forth the critical roles healthcare providers can do to improve maternal health, which should include mobile medical.

Remarkable as it may seem, though the United States has one of the most technologically advanced healthcare systems in the world, we have a maternal mortality rate that is higher than comparable countries. The barriers placed on racial and ethnic groups, geographic location, and age disparities are particularly alarming. For instance pregnancy-related mortality for African American, Native American and Alaska Native women is alarming at nearly triple that of white, Hispanic, and Asian/Pacific Islander women. Since 2010 hospital obstetric services in rural counties decreased significantly, leaving pregnant women in these areas with few options for care. Plus women over 35 years of age are one and a half times more likely to experience complications during pregnancy than a decade ago. Every year thousands of women experience severe maternal morbidity with unexpected difficulties in labor and delivery that ultimately have a significant effect on their short- or long-term health. These disparities and outcomes are unacceptable anywhere, but most particularly in an otherwise advanced country such as ours. The impact of these disparities can create lasting problems which make it extremely difficult for many mothers to deliver healthy babies and live healthy lives themselves.  That’s where mobile clinics can be of significant value to reach the underserved.

According to the National Center for Biotechnology Information “almost one fourth of stillbirths are potentially preventable. Given the predominance of placental insufficiency among stillbirths, identification and management of placental insufficiency may have the most immediate effect on stillbirth reduction.”  With far too many preventable still births and miscarriages, and the dangers of postpartum emotional and physical health issues this new call to action by the HHS is committed to reducing disparities and improving care for all of our nation’s mothers.  And we can accomplish even more if Congress acts on the maternal health proposals contained in the 2021 Fiscal Year Budget.  With public and private sector partners working together these actions can once again make the United States one of the safest places in the world for women to give birth.  The HHS Action Plan provides a clear roadmap to address the risk factors before, during and after pregnancy by improving the quality of services and providing more access to maternity and postpartum care.

Maternal Mortality and Morbidity in the United States

According to the World Health Organization (WHO) maternal morbidity is defined as “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing”.  This includes the death of a woman while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy.  Approximately 700 women die each year in the United States from pregnancy-related causes.   The U.S. experiences rates of morbidity and mortality that are significantly higher than in other countries of similar income and population size.  Though thousands of women experience and survive severe maternal morbidity (SMM) each year, many still have significant short or long term consequences to their health.  In 2017, there were over 25,000 hospital deliveries with an SMM which does not include those who only received a blood transfusion.  The results of these SMMs included bleeding disorders, infection, and emergency hysterectomies.  And when we include those that required blood transfusions there where over 50,000 hospital deliveries with an SMM.  And as suggested above there are considerable ethnic, racial, and geographic disparities in the rates of severe maternal morbidity and pregnancy-related mortality.