New York’s American College of Obstetricians and Gynecologists, in
conjunction with the New York State Department of Health, launched the
Safe Motherhood Initiative in 2001. The Initiative was established to
conduct reviews that facilitate responses to pregnancy-related
deaths and eliminate racial disparities in maternal mortality in New
York State. However, HHC's refusal to participate will lead to a great deal of information,
particularly information on racial disparities among pregnant women in
the hospitals, being left out of the review.
The first Safe Motherhood Initiative review that came out in 2005
interpreted 33 deaths over the course of 2 years – it found that 60% of those women who
died were African American. The review examined the deaths of these
women in detail and sought to determine what the cause of the racial disparity was. According to Women’s eNews:
In 2004, black
women were nearly four times as likely to die in childbirth as white
women nationwide, and had a maternal death rate of 34.7 per 100,000
live births compared to 9.3 deaths per 100,000 live births for white
women...Designed to discover and interpret major risk factors, [director of New York’s American College of Obstetricians and Gynecologists Donna] Montalto's State
Maternal Mortality Review surveys--among many data--the deceased
woman's occupation, primary language, education, insurance coverage,
prenatal care, method of delivery and history of sexually transmitted
diseases. It asks if the pregnancy was intended or unintended. It might
also help explain why African American women represent a
disproportionate amount of maternal deaths.
The Opportunity Agenda’s report on New York City’s health care system,
Dangerous and Unlawful: Why Our Health Care System Is Failing New York Communities and How To Fix It, showed the unequal and inadequate access to health care that many
communities, particularly communities of color, are faced with. This
lack of access and poor quality was most evident in the absence of
primary care for many New Yorkers. Incidentally, the last Safe Motherhood Initiative review found
that inadequate prenatal care was one of the main causes of the racial
disparity in maternal deaths in New York State. Prenatal care is
something that many women get through their gynecologist as part of
their primary care; thus, the lack of decent primary care can lead to many
women in communities of color having at-risk pregnancies.
The problems in the city’s health care system was exemplified by last
month’s disaster at Kings County Hospital. It is to the detriment of
all New Yorkers that HHC is refusing
to participate in the Safe Motherhood Initiative’s review – it is
crucial that we address health disparities and find real solutions to the problems in the state’s health care
system, but the city has to play a role in doing this. HHC says its mission is:
To extend equally to all New Yorkers, regardless of their ability to
pay, comprehensive health services of the highest quality in an
atmosphere of humane care, dignity and respect.
The death of Esmin Green
last month showed that HHC is not succeeding in its mission. Its
decision not to participate in the Safe Motherhood Initiative review is
another one that could lead to an unnecessary, preventable death at a
city hospital. The city needs to work to address these problems - until it does, our communities will suffer.
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