The most common indicator of maternal health used internationally is maternal mortality, usually measured as the ratio of deaths to women while pregnant or within forty-two days of termination of pregnancy per 100,000 live births. Deaths are usually included only if the cause is related to or aggravated by the pregnancy or its management. Maternal mortality is a rare event in the United States. However, the 1998 ratio of 7.1 deaths per 100,000 live births was higher than the ratio in many other industrialized countries. No progress was observed in the United States in the 1990s, and disturbing differences persist in the incidence of maternal death among ethnic groups. African-American women have three times the risk of maternal mortality compared with white women, and the risk of death for Latinas or Hispanic women also appears to be significantly higher than the risk for white women.
In order to prevent maternal mortality and eliminate disparities, researchers must determine the fundamental causes of pregnancy-related deaths. Defining and measuring maternal morbidity is also critical because illnesses and complications of pregnancy are far more common than maternal deaths. While it is not easy to obtain an accurate count of all of the deaths that might be precipitated by pregnancy or childbirth, the legal requirement for registering deaths and filing death certificates assures a fairly high level of completeness. Measuring the morbidity that accompanies women's reproductive lives is much more difficult.
The U.S. Department of Health and Human Services, Office of Disease Prevention and Health Pro motion, developed an initiative called Healthy People, which establishes new health objectives for the nation every ten years. The overall goals of Healthy People 2010 are to increase longevity and quality of life and to eliminate health disparities in the population. One aim is to reduce maternal mortality by more than 50 percent, to an overall ratio of 3.3 deaths per 100,000 live births by the year 2010.
A similar objective for maternal morbidity cannot be set because severe complications throughout pregnancy are too difficult to measure reliably with existing data. Instead, Healthy People 2010 focused its attention on problems that occur during labor and delivery. Most women in the U.S. deliver their babies in hospitals with trained providers who record any complications to the mother and the newborn. In 1998, hospital discharge data indicated that women experienced complications of labor and delivery in nearly one-third (31.2) of every 100 deliveries. The objective for improving this rate is a target of twenty-four complications per 100 deliveries by the year 2010.
Two other maternal health outcomes were targeted for improvement in the Healthy People 2010 objectives, even though data that is gathered will not facilitate adequate monitoring of these events. The first is ectopic pregnancies, sometimes called tubal pregnancies, that result from the implantation and development of a fertilized egg in a woman's fallopian tubes or elsewhere outside the uterus. This condition, which can pose extreme danger to women and sometimes causes death if not detected and treated in a timely fashion, appears to be on the rise in the U.S. The second concern is postpartum complications, including depression as well as physical problems such as hemorrhage and infection.
Since reproductive health, according to the ICPD definition, encompasses positive aspects beyond the absence of disease or disability, many other indicators would be required to monitor maternal wellness. For example, women's psychological health, quality of life, level of satisfaction in intimate relationships, and overall physical condition would need to be measured. Indicators that track threats to women's reproductive health, such as domestic violence, toxic environmental exposures, and hazards in the workplace, should also be taken into account. Accessibility and quality of gynecology, family planning, abortion, preconception, prenatal delivery, and postpartum services are important issues to monitor. Since most women spend many more years raising children than they do bearing children, maternal well-being should encompass the experience of childrearing as well as women's development throughout the life cycle. Older women are often ignored in the realm of repro ductive health, although menopause has become a topic of public discussion and reproductive cancers are receiving new attention.
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