Maternal Mortality

Maternal Mortality Rates Are Increasing

Maternal mortality rates in the state of California have nearly tripled from 1996-2006 and are 4.5 times higher than the Health People 2010 benchmark.  No one is sure of all the reasons for this rapid and troubling increase.  In the 1990s California's rates ranged from 5.6 to 10.7 deaths per 100,000 live births, which is consistent with the overall US rate.  Beginning in 2000 the rate climbed to 10.9, then to 14.6 and in the last  reported year it is nearly 17.  Also concerning is a similar rise in the entire US rate.  Definitions are critically important and are reviewed on a related page. 

Note: This slide has been updated from previous versions (prior to 6/1/2009) to ensure that the maternal mortality rate for California is shown for 1999-2006.  Previous slides showed the pregnancy-related mortality rate for CA 1999-2006 which was incorrectly compared to the HP 2010 objective. 

 

Racial Disparity

For over the past 5 decades, African American women in the US have consistently experienced a 3 to 4 times greater risk of death from pregnancy complications than  white women. (Tucker, AJPH, Feb 2007)  This increase appears to be independent of age, parity or education (OB/GYN, 2003 and MMWR 1995).  In addition, for five conditions with known rates of high pregnancy-related mortality, African American women did not have a higher prevalence, but did have a higher case-fatality rate than white women (Tucker, AJPH, Feb 2007).  In 1940, African-American women were 2.3 times more likely than White women to die from pregnancy-related causes, while in 2004-2006, African-Americans were 3.3 times more likely to die from these causes.  The African-American racial disparity is seen in other states and has had limited research.


PREGNANCY-RELATED MORTALITY DEFINITION:

    Pregnancy-Related Mortality Rate   
     Death from obstetric causes within one year postpartum, per 100,000 live births
   
    Numerator:      Underlying cause of death on the death certificate:
             ICD-10 codes A34, O00-O96, O98-O99 for 1999-present
    Denominator:    Live Births in California per, year

A major project within CMQCC is the first state-wide chart review of maternal deaths to identify the reasons for this increase and to discover opportunities for improvement in medical care (California Pregnancy-Associated Mortality Review (CA-PAMR).  Pregnancy associated and related deaths are being reviewed to ensure correct classification of cases.  CA-PAMR began with 2002 as that was the closest year that had birth-certificate and death-certificate matched cases.