By Katie Schubert
Board, Coalition for Health Funding
Chief Advocacy Officer, Society for Maternal Fetal Medicine
Serena Williams. Kelly Clarkson. Beyonce. Kim Kardashian. Amy Schumer. These famous new moms had complicated pregnancies and/or births. Serena Williams is likely the most “famous” case of a woman advocating for her own health yet not totally being heard until it was almost too late. Kim Kardashian had severe preeclampsia. Amy Schumer recently took to Instagram, saying “Amy is still pregnant and puking because money rarely goes to medical studies for women such as hyperemesis or endometriosis. . .” The rest of this quote is not entirely appropriate for print, but suffice to say, she describes her strong feelings about the prioritization of other types of research. Schumer has suffered from hyperemesis (severe nausea and vomiting) her entire pregnancy, a condition that made headlines due to Duchess Catherine Middleton’s struggle with it through her pregnancies.
Although six million women in the United States get pregnant each year, there is so much we do not know about pregnancy and birth. Research on pregnant women was long thought to be unethical and as a result, there is very little knowledge about what medications and therapies are safe during pregnancy. In the past few years, medical ethicists have made a 180-degree change and researchers are encouraged to include pregnant women, as possible, in their work.
Even more troubling is that the United States has the highest rate of maternal death among industrialized countries. For women of color, the likelihood of pregnancy complications or death is even higher. The CDC this week released a report that provided some sobering statistics: about 700 women die from pregnancy-related complications in the U.S. annually; about 3 in 5 pregnancy-related deaths could be prevented; about 1 in 3 pregnancy-related deaths occur 1 week to 1 year after delivery; and that Black and American Indian/Alaska Native women were about 3 times as likely to die from a pregnancy-related cause as White women. We can do better, and our nation’s moms and their families deserve better.
Once a woman delivers her bundle of joy, the focus is often on the health of the baby first, and the health of the mother comes second. Unfortunately, there are far too many American mothers dying due to pregnancy-related complications following childbirth because we, as a nation, have not always prioritized maternal health. But that is beginning to change. Last year, Congress passed the Preventing Maternal Deaths Act into law. This legislation is critical to tackling our rising maternal death rates. Congress paired that legislative win with $12 million for maternal mortality review committees – almost double what the community was asking for. This support for maternal health has been reinforced just this week when the fiscal year 2020 House Labor-HHS report included an additional $12 million for that work, plus increases for the Alliance for Innovation on Maternal Health and the Safe Motherhood Initiative.
There are also several proposals in the 116th Congress aimed at authorizing public health programs to address maternal health and progress is being made at the state level, as well. SMFM has created a map that includes state-level fact sheets on the public health initiatives that are critical to reducing maternal mortality.
Still, far too little has been done on the research side. Relative to investments in research for other specific diseases and populations, investments for research in pregnant women and breastfeeding women are small. Unlike other medical fields such as oncology, cardiology, and psychiatry, which rely heavily on industry for research and clinical trials, much of the evidence that guides obstetric and postpartum practice is generated from studies that are funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes for Health (NIH). In fact, the NIH acknowledged this during the Task Force Specific to Pregnant Women and Lactating Women (PRGLAC) meetings in 2017 and 2018, finding that “many of the clinical practice guidelines of the American College of Obstetricians and Gynecologists are rooted in NIH-funded studies.”
Some of the most impactful NICHD-supported research related to pregnancy in the last decades has originated within research networks supported by NICHD, such as the Stillbirth Collaborative Research Network, the Obstetric-Fetal Pharmacology Research Unit Network, and the Maternal- Fetal Medicine Units Network (MFMU). The MFMU specifically has been conducting critical research in the field of obstetrics since 1986. Studies out of the MFMU directly impact the clinical practice of obstetrics – they have actively reduced the pre-term birth rates in the U.S., improved outcomes in both mothers and their babies, and have reduced health care waste. There is no better investment that can be made than in clinical trials related to obstetrics – for healthy moms bring healthy babies, improving the health of our nation.
SMFM is calling on Congress to prioritize research in pregnant and breastfeeding women. This imperative is particularly important given the continued rise in maternal mortality and severe morbidity. Evidence from clinical studies is desperately needed to guide prediction, prevention and management of the various pregnancy complications that lead to these dire outcomes.
This Mother’s Day, SMFM is calling on YOU to help us honor mothers and their role in society. While the support for public health programs related to maternal health is long overdue, we can educate policy makers to prioritize investments in research in pregnant and breastfeeding women. Let’s work together to make it happen.