Pregnancy-related Deaths Decline Sharply in NYC, but Black-White Gap Widens

New York City has seen a dramatic decline in the number of women who die in the year before, during and after childbirth, according to a new Health Department study. But despite progress, the gap between black and white women has grown.

"I think providers are doing a better job, communities are beginning to focus on this problem, and I think our partnerships with many others is what's helping to make a difference," said Dr. Lorraine Boyd, medical director of the Department's Bureau of Maternal, Infant, and Reproductive Health.

In the year 2000, the rate of maternal mortality was more than twice as high in New York City as the national rate, with 33.9 deaths per 100,000 deliveries locally versus 14.7 nationwide. Ten years later, the city rate was almost halved while the national rate had increased slightly, making them almost identical.

But within those figures is a dramatic disparity: at the start of the decade, local black women were seven times more likely to perish than white women. By the end of the decade, the already low rate for whites plummeted, while the very high rates for blacks ticked down only a small amount. By 2010 — the most recent year of the study — black women were 12 times more likely than white women to die as a result of pregnancy, a much wider gap than the nation as a whole.

The actual numbers are relatively low: in the five years of the study, 2005-2010, there were 139 women in New York City who died. In the same period, there were more than 600,000 births. 

But the number of deaths is just the tip of the iceberg of a larger problem, according to Dr. Howard Minkoff, the chair of obstetrics at Maimonides Medical Center.  

 "Disparities in mortality have always been a signal about what's going on more broadly in the disparate healthcare people receive, as well as disparate risk factors," Minkoff said. 

In other words, maternal mortality is considered a statistical proxy: for every one woman who actually dies, experts estimate another 100 suffer severe complications as result of both the quality of medical treatment they receive and the widespread health problems in their communities.

Boyd says poorer women are more susceptible to complications — and many of them in New York are also black.

"They may already have high blood pressure, and many of them already may be pre-diabetic," she said. "Many of them are overweight and morbidly so. They have chronic stress from where they live."

Rita Henley Jensen, founder and editor of the website Women's eNews, was the first to report on the new study. She cites evidence suggesting maternal mortality isn't just about the health of poor women.

"What is happening in the medical care system that these disparities persist?" she said. "And what can the medical system do to alter these outcomes?"

Minkoff said that many hospitals that serve poor communities have relatively small staffs and don't deliver enough babies to have experience dealing with complications, such as hemorrhaging, or excessive bleeding. In contrast, Maimonides, where he works, has one of the busiest delivery wards in the country, and the obstetric teams frequently conduct hemorrhaging drills.

"It's not something people are uncomfortable with, because they see it a lot," Minkoff said.

Minkoff and others have been trying to improve the response of hospitals across New York to hemorrhaging and other conditions, and to identify in advance women who are at high risk for life-threatening complications.

Dr. Jo Boufford, head of the New York Academy of Medicine, said a consortium of local and state maternity care leaders have been developing and disseminating protocols for dealing with hemorrhaging and other conditions. She's optimistic that when more recent figures emerge they will show fewer pregnant women whose lives are in jeopardy.

"Hopefully we're going to see a significant improvement in maternal mortality from these crises," Boufford said, "because they'll be managed better and avoided in the first place."