As an OB/GYN who has worked in dozens of developing countries, I have seen firsthand what it’s like to give birth in places where resources are strapped and conditions are bleak. I’ve seen the way women struggle to gather the money needed to give birth at a facility. I’ve seen women walk miles – while in labor no less – to reach the closest health clinic or hospital. I’ve seen women get to a facility only to find that it’s overcrowded, understaffed or lacking in critical medicines and supplies. And for all these reasons, I’ve had the misfortune of seeing women die in pregnancy and childbirth, their deaths often hand tallied on the walls of health facilities, if counted by the system at all.
These are circumstances under which no woman should have to give birth. Yet they persist, day in and day out. But what I’ve found most surprising since I’ve taken on a new role as Executive Director of Merck for Mothers is that these issues are actually not confined to the developing world. Sadly, there are communities in the United States that face challenges not all that different than those facing women in places like sub-Saharan Africa and South Asia.
I recently travelled to some of these communities for the launch of Merck for Mothers’ new programs to reduce maternal mortality here in the U.S. As part of this work, we’ve partnered with organizations in Baltimore, Camden, New York City and Philadelphia, where I had a chance to witness some of the challenges women face in getting the care they need for a safe and healthy pregnancy and childbirth. What I saw and heard was astonishing, revealing three striking parallels.
Our partner in Camden told me that many of the women their program serves interact with the health system for the first time when they become pregnant. Whether it’s because they don’t have the funds (or insurance) to afford preventative care, or don’t have a full understanding of the services available to them, a lot of these women go years or decades without seeing a health provider. Because of this, it is common for women in low-income communities to miss out on things like primary care visits and prenatal check-ups. In fact, only 50% of pregnant women in Camden receive first trimester care, making it much more difficult to identify conditions that could lead to a complicated – and, at times, life-threatening – childbirth.
Transportation is also an issue. I remember one woman in Baltimore telling me that – even if her family could afford public transportation – health care services were located too far away for her to use regularly. And because taxis rarely venture into the poorer communities, she is cut off from the transport services she needs to reach care on a routine basis. Harking back to time I spent in rural parts of Zambia and Uganda, this story sounded all too familiar, and little did I know that it was such a prevalent one in the U.S.
Finally, perhaps the most profound parallel between maternal mortality domestically and abroad is the lack of reliable data. I knew that many maternal deaths in the developing world go undocumented, but I had no idea that more than 1 in 3 of these deaths are unidentified on death certificates in America. This type of information is critical in our effort to save women’s lives during pregnancy and childbirth, as it allows us to spot trends, better understand the problem and create targeted policies and clinical practices to address it.
Considering this range of unexpected realities – and factoring in the escalating rates of chronic health conditions like obesity, high blood pressure and diabetes – it is no wonder that maternal mortality is on the rise in this country. In fact, as an OB/GYN, I fear that these chronic conditions will soon become the fourth major parallel, as these same challenges are beginning to spill into developing countries. The rise of chronic conditions in poor countries has the potential to jeopardize the progress made in bringing down maternal death rates throughout the world, much like they did in the U.S.
In view of these common and emerging similarities in maternal health, Merck for Mothers has launched new partnerships in the U.S. that build on our global portfolio of programs in more than 20 other countries. While the contexts are certainly different, many of the obstacles are the same, and I look forward to the opportunity to help overcome them and ensure safer and healthier pregnancies and childbirths for all women – at home and abroad.