The United States is the most dangerous nation in the developed world in which to give birth, and Louisiana is among the states with the highest maternal death rates.
A researcher with Tulane University aims to figure out why.
Maeve Wallace, a reproductive and perinatal epidemiologist at Tulane's School of Public Health and Tropical Medicine, has received two grants totaling $2.4 million to study pregnancy-associated mortality, university officials announced Tuesday.
The grants, which come from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, also will examine state-level policies that could be contributing to the higher death rates.
Wallace's studies come amid increased concern about rising maternal mortality in Louisiana and nationwide.
According to a 2018 report by the United Health Foundation, Louisiana ranked second only to Georgia in maternal mortality, with 44.8 deaths of mothers, out of every 100,000 live births, that are related to or aggravated by pregnancy or its management. That's more than double the national average of 20.7 deaths per 100,000 births.
The report used data from the Centers for Disease Control for the years 2011 to 2015.
In September, the Louisiana Department of Health also released a report on maternal mortality, summarizing data accumulated by the Louisiana Pregnancy-Associated Mortality Review, which tries to understand pregnancy-associated deaths to prevent future ones.
Researchers for that report found that the number of maternal deaths, defined by the World Health Organization as happening during or within 42 days of the end of a pregnancy, increased exponentially in Louisiana between 2011 and 2016.
Not only did maternal deaths increase at a substantially higher rate in Louisiana than elsewhere in the country, but the researchers found that during that time, a whopping 45 percent of pregnancy-related deaths were deemed preventable.
Race and age, researchers have found, are huge factors in the deaths.
The state's experts found that black women were four times more likely than white women to experience pregnancy-related death, consistent with national trends. Women over age 35 were almost three times more likely to die pregnancy-related deaths.
In Louisiana, the most common causes of pregnancy-related death were hemorrhage, cardiomyopathy and cardiovascular disease, and almost half the deaths happened between 24 hours and 42 days after delivery.
According to the state's Health Department, the most common contributing factor among all deaths was a lack of access to health care providers or facilities.
Many women failed to undergo screenings or get assessed for pregnancy-related risks, even when they suffered chronic diseases, state officials said.
Now, the Tulane study will also examine why black women are more likely than white women to die during pregnancy or post-partum periods.
Wallace and her team will look at how factors including income inequality, structural racism and residential segregation play a role, and hope to discover ways to reduce the racial disparity.
The team will also look at how state-level policies play a role, Tulane officials said.
Tulane researchers believe policies such as expanded Medicaid eligibility, mandated provision of reasonable accommodations for pregnant women and paid family leave all have a positive influence on maternal health, the university said in a release.
The study also will examine whether state restrictions on abortion have an impact on maternal mortality.
Wallace will use data from every state with a special focus on Louisiana.
“State legislatures are passing women’s health and social policies at an unprecedented rate, often without any information about potential impacts on maternal and child health," Wallace said in the Tulane release.
"It is critical that we understand how policies can support or harm the health of the population so that we can hold policymakers accountable for addressing the maternal mortality crisis in this country.”
Meanwhile, in September, the state Health Department said it would seek to reduce maternal deaths in three ways.
The Louisiana Perinatal Quality Collaborative, consisting of 32 birth facilities in the state, launched an initiative called Reducing Maternal Morbidity, vowing to better address hemorrhage and hypertension. It also will focus on reducing racial disparities in life-threatening complications, officials said.
The Health Department also launched the Healthy Moms, Healthy Babies Advisory Council, made up of experts and stakeholders determined to better inform communities on how to prevent maternal mortality and morbidity.
Finally, Louisiana’s Medicaid expansion under Gov. John Bel Edwards allows for better access to the kind of care that can prevent these deaths, according to Dr. Rebekah Gee, the state health secretary. The expansion allows for home visits and other reforms that can address maternal health outside of hospital settings, she said.
“No woman should die because they want to be a mother,” Gee said earlier this year. “The governor and the Louisiana Department of Health are doing everything we can to prevent pregnancy-related deaths by working with hospitals, doctors and community partners.”