On October 25, the National Association for Public Health Statistics and Information Systems (NAPHSIS), the Society for Maternal-Fetal Medicine, and the March of Dimes held a Congressional briefing entitled “Vital Statistics: Vital to Maternal and Child Health.” The briefing featured Shawna Webster, Executive Director of NAPHSIS; Devin George, State Registrar and Director for the Louisiana Bureau of Vital Records and Statistics; Rebecca Russell, Senior Director of Applied Research for the March of Dimes; Judette Louis, Associate Professor of Obstetrics and Gynecology at the University of South Florida; and Elizabeth Saadi, State Registrar in the Kansas Office of Vital Statistics.
The speakers discussed the problems that exist around collecting maternal mortality data, and how vital statistics could be used to help lower maternal mortality rates, which are currently on the rise in the United States. Webster offered introductory remarks and noted that while states were sending their information to the National Center for Health Statistics (NCHS) more reliably, there were still problems with the integrity of the data.
George explained that while physicians are supposed to check a box on a death certificate to indicate if the patient was pregnant at the time of death or within a year of her death, they don’t always check this box or check it incorrectly. Sometimes, this can be caught by the Bureau of Vital Records and Statistics if they notice a fetal death certificate filed in short proximity.
Louis discussed her role as a maternal fetal medicine physician, which is a more specialized obstetrician, and noted the rising maternal mortality rate and the disparity in maternal deaths within races and ethnicities. She highlighted two initiatives created by the Florida Department of Health’s Pregnancy-Associated Mortality Review (PAMR), the Obstetric Hemorrhage Initiative (OHI) and the Hypertension in Pregnancy Project (HIP),which sought to lower hemorrhage and hypertension rates, the two leading causes of maternal death in the state of Florida, and treat these diseases more effectively with better preventative care, screening and post-discharge education. These initiatives would not have been possible without this important vital data, as the data allowed them to target specific causes of maternal mortality in Florida.
Russell‘s remarks focused on the issue of “maternity care deserts,” areas where maternity care is not available within the county, which are a high contributor to maternal deaths in rural areas. She also discussed the barriers preventing women from accessing care, particularly lack of health insurance, a problem for one-fifth of pregnant women.
Saadi concluded by highlighting the use of vital statistics and explained why they are important. She mentioned that the introduction of Electronic Death Reporting Systems has made a big difference in many states, including her own state of Kansas. This data led to the regulation of home daycares in Kansas after a disturbing number of young children died. However, the data could be further improved by including more specific information on cause of death. For instance, an indication that “cardiac arrest” was the cause of death is not helpful to determine whether or not the death was related to pregnancy and delivery-related heart disease.
This article was contributed by COSSA’s fall intern, Victoria Deck of Emerson College.