Maternal mortality in the United States: Targeted dissemination can help to address the problem
Year: 2019
Type: editorial
Abstract: In the USA, approximately 700 women die annually from complications related to pregnancy, delivery, or in the first postpartum year. It is estimated that 60% deaths are preventable (Centers for Disease Control & Prevention, 2019). African American mothers have maternal mortality rates approximately three times higher than white mothers (Center for Disease Control & Prevention, 2019), a significant health disparity. These unacceptably high numbers are comparable to—and in some cases worse than—maternal mortality rates in low-resource countries with far fewer healthcare resources than the USA. Numerous professional and government organizations have developed programs to address the high maternal mortality rates in the USA, such as maternal safety bundles implemented by the Alliance for Innovation on Maternal Health and Safety Initiative. A second example is the March for Moms organization, a grassroots advocacy coalition bringing over 50 diverse stakeholders together to advocate for the health and well-being of mothers. Likewise, the Maternal and Child Health Bureau supports preventative services and home visitation to some mothers. However, despite these efforts to reduce maternal mortality, there has not yet been meaningful population-level change. The USA still lacks comprehensive health care services or universal health insurance coverage for mothers from conception to the end of the first postpartum year. Furthermore, data and reporting on maternal mortality in the USA is incomplete and disorganized, with 17 states currently not monitoring or reporting maternal mortality data at all. The American Academy of Nursing (AAN) calls for increased action to reduce maternal mortality. The AAN, a professional nursing organization of international scholars and experts, serves the public and the nursing profession by advancing health policy and clinical practice through the generation, synthesis and dissemination of nursing knowledge. President Karen Cox urged nurse leaders to advocate for changes in health care practices to reduce maternal mortality based on available evidence (Cox, 2018). In addition, maternal mortality has been addressed by the AAN’s Maternal Infant Health Expert Panel. Expert panels advance evidence-based innovations in health care delivery to address the health needs of populations, including diverse, at-risk and disenfranchised populations. Leaders of the Maternal Infant Health Expert Panel published a paper in Nursing Outlook (2018) which provided responses, policy actions and recommendations related to the ongoing problem of maternal mortality (Amankwaa et al., 2018). As nurse leaders, scientists and advocates for maternal and infant health, we recognize an urgent need for faster knowledge dissemination and adoption of evidence into in practice when it comes to reducing maternal mortality. It takes a mean of 17 years for research evidence to reach clinical practice, but this rate is far too slow for the problem at hand (Morris, Wooding, & Grant, 2011). Fortunately, there are many opportunities for sharing and implementing new knowledge. In additional to writing for journals or books on the topic of maternal mortality, nurses can use social media platforms, present at conferences, speak with journalists and healthcare reporters, contact members of the United States Congress or local policymakers, and participate in advocacy events about maternal health to disseminate knowledge faster (Curtis, Fry, Shaban, and Considine (2017)). Successful diffusion and uptake of research evidence requires identifying the appropriate audience and tailoring messages via appropriate mediums. Targeted dissemination activities can include summaries for stakeholders, educational sessions with clinicians and/or policymakers, development and implementation of clinical guidelines, and media engagement (Curtis et al., 2017). At the heart of dissemination of research findings is knowledge translation. Nurses and nurse leaders are in a unique position of public trust. As such, they are in an optimal position to translate knowledge about maternal mortality to a diverse set of stakeholders for maximum public health and policy impact. Causes of maternal mortality are complex. To reduce the unacceptably high maternal mortality and racial disparities in maternal mortality in the United States effectively, action is needed on multiple fronts including attention from federal research funders (McLean, Graham, Tetroe, & Volmink, 2018), universal health care availability for women, mandatory collection of uniform data on the state level so that trends and progress in reducing maternal mortality can be monitored, and media campaigns that impact women's self-care (Amankwaa et al., 2018). As a profession, nurses must recognize the impact of implicit bias and racism in health care in creating disparities, the problematic lack of universal access to maternity care resources, and the need to implement community-based initiatives to achieve better maternal health outcomes. The empowerment of women and better maternal health outcomes are economic drivers. If women have better health, they may achieve higher education levels, and will, in turn, make better health care decisions for themselves and the families, including those about health promotion. Preventing disease and leading healthful lives is far less costly than disease-oriented treatments, and nurse leaders have a responsibility to ensure that these actions occur by translating knowledge on maternal mortality and advocating for solutions.
Source: Journal of Advanced Nursing
DOI: 10.1111/jan.14094
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2950380265