Kanitra Patterson, with her son Robert Jr., age 6, giving a pedicure at Highland Nails in Highland Park. Kanitra Patterson developed a serious heart condition while pregnant with Robert. Doctors said she faces a 50 percent risk of death if she developed that same condition during her current pregnancy. (David Coates / The Detroit News)
Detroit women are dying from pregnancy-related causes at a rate three times greater than for the nation.
Experts blame the same combination of medical conditions and social toxins that kills Detroit babies at a frequency that is the worst of America’s big cities, and even some Third World countries.
Data from the state Department of Community Health show at least six Detroit moms died yearly, on average, as a direct result of pregnancy or childbirth from 2008-11 — a total of 26 maternal deaths in that period. That translates to a maternal death rate of 58.7 per 100,000 babies — higher than in Libya, Uruguay or Vietnam.
While it’s widely assumed that death in pregnancy or childbirth is an anachronism in a highly developed country, the national and local rates are actually creeping upward.
Americans “don’t think women are dying (from pregnancy) in the U.S., let alone that the rate is going up,” said Dr. Priya Agrawal, executive director of Merck for Mothers, a 10-year, $500 million initiative launched by drug-maker Merck in the United States in 2011 to reduce maternal mortality.
“It’s always surprising to me that we focus on the infant and forget about the mother.”
Experts attribute increased maternal death rates to uncontrolled chronic health conditions, which are more common in African-Americans, and to poverty that deprives low-income women of health insurance and access to health care. Detroit fits squarely within those perimeters: 83 percent of residents are black, and Detroit has more people living under the poverty line — 42 percent — than any major city in America,according to an analysis of U.S. Census data by the Annie E. Casey Foundation.
“Clearly, this is one of those examples where there is a glaring health care disparity,” said Dr. Gregory L. Goyert, division head for maternal fetal medicine at Henry Ford Health System.
“... it always comes down to African-American women having a three to four times greater risk of maternal mortality than Caucasian women. When you have a population with large numbers of African-American women, you are going to have a higher rate of maternal mortality.”
Health conditions that factor into maternal deaths include obesity, diabetes and high blood pressure. Untreated, they can lead to excessive bleeding, blood clots, strokes and other deadly complications.
These ailments also can result in preterm delivery — the No. 1 killer of babies in Detroit, which has the highest infant mortality rate among major U.S. cities, according to a special report published by The Detroit News in January. The News also disclosed that children 18 and younger die at a higher rate in Detroit than elsewhere in the U.S. — most often the victims of illnesses and conditions of infancy, and secondly by violence.
“(The maternal death data) speaks to the need for people to be healthy before conception,” said Wayne State University Associate Dean Dr. Sonia Hassan, a leading researcher on preterm delivery.
Noted Vernice Anthony, director of Detroit’s Department of Health and Wellness Promotion: “The risk factors that can impact preterm birth (are the) same risk factors that can increase the risk for maternal death.”
Health act may impact rates
Health care professionals are hopeful that maternal and infant death rates will decline as more women gain health care options through the federal Affordable Care Act or expanded Medicaid, and become more educated about their bodies.
Kanitra Patterson, 27, almost became a statistic, but is learning from her first pregnancy to take better care of herself. She developed pregnancy-induced cardiomyopathy — weakening of the heart muscle — about 24 hours before the birth of her son, Robert, six years ago. Patterson was admitted to DMC Hutzel Women’s Hospital for dangerously high blood pressure when suddenly, she couldn’t breathe. Doctors placed Patterson on oxygen and induced labor, and she and her baby survived.
Patterson is again at risk of the potentially fatal heart condition, now that she’s pregnant with her second child, daughter Kahlia, due Aug. 7. Patterson is watching her diet more carefully this time to control her blood pressure.
“It’s prayer, and I’m laying off the salt,” Patterson said. “When I was pregnant with my son, I was hard-headed. I learned my lesson and listened.
“I went (for prenatal care) a little earlier. And I’m up to the doctor’s office every two weeks since I was five months pregnant.”
Cheryl Larry-Osman,a labor and delivery nurse with Detroit’s Henry Ford Health System, said she once had two laboring patients nearly die in a single day. She recently testified at a congressional briefing in support of the proposed Maternal Health and Accountability Act, which would provide federal funding to assist states in preventing pregnancy-related deaths and reducing racial disparities in maternal health care.
One of the patients, an African-American woman in her mid-30s, stopped breathing in the recovery room.
“She didn’t look OK, her eyes were open … but not really focusing. She didn’t have a pulse so we started CPR on her,” the nurse recalled.
“She survived, the baby survived, but it could have gone easily in another direction.”
Deaths on rise nationally
Statistics paint a sobering picture for the nation, state and city.
The national rate increased from 7.2 pregnancy-related deaths per 100,000 live births in 1987 — the first year the Centers for Disease Control and Prevention analyzed data — to 17.8 in 2009, the most recent year for which CDC data are available.
In a worldwide study of maternal mortality, published in May in the medical journal The Lancet, the U.S. maternal mortality rate ranked 60th in the world, among 188 countries; Iceland had the lowest death rate.
While statistics are incomplete, the frequency of maternal deaths within the U.S. states varies widely.
Michigan ranks eighth highest in all maternal deaths, largely due to the high number of deaths in a few regions, including Detroit and Genesee County, which like the Motor City is a black-majority community with stubborn poverty. Among African-American women in that category, Michigan ranks fourth worst.
The District of Columbia has the highest rate in the nation, and Massachusetts has the lowest. Other states with higher rates than Michigan are Idaho, Arkansas, Oklahoma, Wyoming, Mississippi and Montana.
Officials admit that reliable statistics by which maternal death rates can be compared among cities and states are difficult to come by, because there are no national reporting standards.
Michigan is among 41 states with a question or checkbox on death certificates related to pregnancy status. As states add such a checkbox, their maternal mortality rates increase due to better reporting.
There also is no uniform reporting requirement among Michigan’s 83 counties. To circumvent that lack of data, the Michigan Maternal Mortality Surveillance System — a collaboration of the state health department, Michigan State Medical Society and medical schools — matches death records of women with birth records, and reviews deaths of women who died while pregnant or within one year of termination of pregnancy, irrespective of cause.
This story is part of a collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. The “Surviving through 18 in Detroit” series was made possible through the National Health Journalism Fellowship, a program of the University of Southern California’s Annenberg School of Journalism.