What's making maternal mortality worse?

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Mar 24, 2023 View in browser   By Sophie Gardner POLITICO illustration/Photos by iStock Hi Rulers! I’m back as your guest host today. Feedback? Story ideas? Book recs? sgardner@politico.com or @sophie_gardnerj! In mid-March, the CDC released data that confirmed what many health professionals suspected: COVID-19 had devastating effects on the U.S. maternal mortality rate. The 2021 stats show the rate spiking by a whopping 40 percent, meaning that there were 32.9 deaths per 100,000 live births in 2021, up from 23.8 in 2020 and 20.1 in 2019. The 2021 rate was especially dire for non-hispanic Black people, at a shocking 69.9 deaths per 100,000. The CDC hasn’t released data that details the causes yet, which makes it hard to tell exactly how much of the spike can be attributed to COVID. But Donna L. Hoyert, the lead author on the CDC’s report, is already looking into it. One way to gauge the virus’ impact is through death certificates, she said, which mention when a patient had COVID-19. Hoyert also looked at the pattern of COVID-19 deaths, which matches up with the changes in the maternal mortality rate: “Comparing 2021 to 2020, the total number of COVID-19 deaths increased and the age group it’s affecting shifted somewhat to younger age groups,” which means that the virus was affecting more pregnant people, Hoyert told Women Rule. Because COVID-19 is a disease that medical professionals can test for, its link to maternal mortality rates is fairly easy to find. But since the 2021 data was recorded, there’s a new possible threat to the health of pregnant people: abortion restrictions. That story might not be as clear. In the summer of 2022, after the Roe V. Wade draft decision was published, a slew of articles detailed potential risks that abortion restrictions could pose to pregnant people, but few explained just how difficult the effects could be to document. “It's going to depend on the state, whether anybody goes to the trouble of identifying the fact that [a person who died from pregnancy-related causes] wanted to get an abortion and couldn't,” said Eugene Declercq, a professor of Community Health Sciences at the Boston University School of Public Health, who studies maternal mortality. “That’s going to be very difficult to systematically document.” That type of information won’t show up on a death certificate-based report like Hoyert’s. And looking specifically at the maternal mortality rate of states with strict anti-abortion laws comes with its own complications. “The states that have put in the restrictions already had significantly worse women's health outcomes” pre Dobbs v. Jackson decision, Declercq said. “It's going to be harder to pull that out because they are already doing so poorly.” The best bet is Maternal Mortality Review Committees, according to Declercq, which work on the state level to thoroughly review individual pregnancy-related deaths. “If anybody is going to start identifying cases where abortion restrictions might apply, might have had an impact, It's going to be in those maternal mortality reviews,” Declercq told Women Rule. Karen Sheffield-Abdullah is a certified nurse-midwife with a doctorate in nursing who served on the North Carolina MMRC until 2020. She investigated the medical records of individuals who had pregnancy-related deaths, sometimes plowing through 5,000 pages of information. “Looking for information that tells us whether or not the care that was received or not received contributed to the death of the individual … is part of doing our due diligence as scientists,” Sheffield-Abdullah told Women Rule. There is little post-Dobb’s data available yet, so it’s difficult to say exactly what those reports will look like when they do come out. Hoyert expects it will be about a year before the CDC releases their 2022 maternal mortality rates in the same series. “It will take a lot of different types of analysis of data, and it's going to take many years to be able to pin this trend on Dobbs,” said Katie McHugh, an Indiana-based OB/GYN and abortion care provider. But even pre-Dobbs and pre-COVID-19, the maternal mortality rate was on the rise. The CDC has documented a steady increase since 2018. And the U.S. rate is much higher than in other wealthy countries. “Maternal mortality and infant mortality are examples of how we treat the most vulnerable of our society,” McHugh said. “And when we see those numbers rising without equal attention to the causes of those increases, we know that our society does not actually value those vulnerable members.” POLITICO Special Report Pool photo by Jacquelyn Martin. “Jackson dissents in abortion case,” by Josh Gerstein And Alice Miranda Ollstein for POLITICO: “Justice Ketanji Brown Jackson dissented Monday as the Supreme Court wiped out a federal appeals court ruling that upheld the right of a minor to go to court to obtain permission to seek an abortion without parental notification.” “Democrats have a diverse bench waiting in the wings. They just need to pitch it to donors,” by Zach Montellaro for POLITICO Magazine: “The Democratic Lieutenant Governors Association plans to raise $15 million by 2026 and spend $2 million each in a pair of high profile lieutenant governor races in 2024 and 2025. The organization also wants an internal operation to support communication and fundraising efforts for lieutenant governors as they eye reelection — or higher office. … “Of the 25 Democratic second-in-commands, which includes states where the secretary of state fills that role, 14 are women and 12 are people of color.” “Never Don and Never Ron: The rest of the GOP field looks for a third lane,” by Natalie Allison and Adam Wren for POLITICO: “‘Ron DeSantis is copying Donald Trump on Ukraine, entitlement reform, and who knows what’s next?’ [Nikki] Haley adviser Nachama Soloveichik said in a statement to POLITICO, describing the former South Carolina governor as ‘a leader on these serious issues facing our country’s future’ who ‘will continue to note her differences with both Republicans and Democrats who want to bury their heads in the sand.’ “‘Republicans deserve a choice, not a copycat,’ Soloveichik said.” Number of the Week Read more here. MUST READS Spencer Platt/Getty Images “A surprising (and growing) gender gap in the most dangerous jobs,” by Andrew Van Dam for the The Washington Post: “The number of intentional human-caused injuries just keeps rising. … “To understand who is being attacked, we analyzed the largest category — hitting, kicking, beating, shoving — by gender. The gap was alarming. Not only are women far more likely to be attacked and injured so badly that they miss work, but almost all the past decade’s increase in hitting, kicking, beating and shoving in the workplace has been targeted at women.” “Oklahoma court OK’s abortion to preserve mother’s life,” by Ken Miller for the Associated Press. “Jill Biden: It’s time for men to step up for women’s rights,” by Zeke Miller for the Associated Press: “The first lady, speaking ahead of President Joe Biden and Vice President Kamala Harris, didn’t mince words as she lamented that women find themselves relitigating ‘battles that we thought we had won a long time ago.’ “‘We need more men to hold each other accountable when women are being hurt or being left behind,’ she said.” “World Athletics tightens rules on transgender women athletes,” by Ben Morse for CNN. “Women get it done’: Ireti Kingibe, Abuja’s new senator, plans for progressive Nigeria,” by Richard Assheton for the Guardian. “Nancy Pelosi on How Women Can Succeed in Politics, Business,” by Natalie Andrews for The Wall Street Journal. Quote of the Week Read more here. Transitions Stephanie Young is leaving her role as executive director of When We All Vote and senior adviser to Civic Nation. Laura Miller will be interim executive director as When We All Vote conducts a national search for its next leader. … Kasey O’Connor is now director of government and regulatory affairs at Cognizant. She most recently was chief of staff to Equal Employment Opportunity Commissioner Andrea Lucas, and is a Ron DeSantis and Commerce alum. … … Katie Wertheimer is now press secretary at Everytown For Gun Safety. She previously was comms director for Tina Kotek’s Oregon gubernatorial campaign. … Katherine Lehr is now COO of Narrative. She most recently was co-founder of Old Town Media, where she continues as a partner but is stepping away from her day-to-day responsibilities, and is a POLITICO alum. (h/t Playbook.) … Emily Gunston has been promoted to be first assistant attorney general for the D.C. Attorney General. She most recently was deputy attorney general for policy and legislative affairs.   Follow us on Twitter Katelyn Fossett @KatelynFossett   Follow us

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