Americans often think of high childbirth mortality rates as a problem plaguing low-income countries, but U.S. maternal mortality rates, particularly for African American and Native women, are high. Merck for Mothers’ “Safer Childbirth Cities” initiative is combating this trend, and its latest call for proposals is expanding its efforts beyond its initial ten-city cohort.
While the U.S. maternal mortality rate is substantially lower than most countries of the Global South, according to the World Health Organization, the U.S. maternal death rate of 19 deaths per 100,000 live births it is substantially higher than Canada (10 per 100,000), the United Kingdom (7), Japan (5), Spain (4) and Italy (2). Countries comparable to the U.S. include Russia (17), Turkey (17) and Romania (19). Moreover, the U.S. is the only high-income country with a rising level of maternal mortality.
Not surprisingly, there is a significant racial disparity in U.S. death rates; the CDC reports that Black and Indigenous women are two to three times more likely to die in childbirth than their White counterparts. The COVID-19 pandemic has further exacerbated these disparities.
In 2019 the CDC noted:
Most pregnancy-related deaths are preventable. Racial and ethnic disparities in pregnancy-related deaths have persisted over time.
Pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR) for black and AI/AN [American Indian/Alaskan Native] women older than 30 was four to five times as high as it was for white women. Even in states with the lowest PRMRs and among women with higher levels of education, significant differences persist. These findings suggest that the disparity observed in pregnancy-related death for black and AI/AN women is a complex national problem.
Merck for Mothers is a $500 million global initiative that aims to eradicate maternal mortality. Between 2011 and 2019, its maternal health programs and partnerships have served over 10 million women in 48 countries. Merck & Co., a global pharmaceutical company, has its U.S. headquarters in Kenilworth, New Jersey.
The Safer Childbirth Cities initiative currently operates in 10 U.S. cities: Baltimore, MD; Atlanta, GA; Camden, NJ; Chicago, IL; Columbus, OH; Jackson, MI; Newark, NJ; New Orleans, LA; Philadelphia, PA; and Pittsburgh, PA. In all of these cities, Merck has partnered with local non-profits, government organizations, healthcare providers, and public health agencies to improve healthcare for pregnant women, particularly those in poor, under-served, and high-risk communities. Philanthropic organizations, including the Burke Foundation, The Nicholson Foundation, the Community Health Acceleration Partnership, the W. K. Kellogg Foundation, Rhia Ventures co-founded the initial cohort.
Poor maternal health outcomes are deeply embedded in the conditions where people live and work. The Safer Childbirth Cities project was launched in 2018, and “supports community-based organizations in U.S. cities with a high burden of maternal mortality and morbidity to implement locally responsive, evidence-based interventions and test innovative approaches to help their cities become safer – and more equitable – places to give birth.”
Call for Proposals for Grant Funds
Merck is currently inviting organizations to apply for funding as part of the second cohort of Safer Childbirth Cities. Funded projects will “establish specific goals to improve maternal health based on identified community needs, advance evidence-informed solutions to meet these goals, and track progress by demonstrating impact with their population.” The deadline is August 24, 2020, and the grants—worth up to one million dollars over two to three years—will be announced in late 2020.
In the ten cities which have already received grants, community-based coalitions are leading multi-pronged efforts to improve maternal health. Julie L. Gerberding, M.D., MPH, Executive Vice President and Chief Patient Officer at Merck (and former director of the CDC), notes, “Community organizations form the frontline of women’s health, but all too often struggle to find the support they need. Our first grantees have already demonstrated that strong local leadership, a woman-centered approach and coordinated action can translate promising ideas about how to reduce maternal health disparities into meaningful patient impact.”
The COVID-19 pandemic has further laid bare the influence of income, race and host of social factors on healthcare outcomes; African Americans have been particularly hard hit by COVID-19. The pandemic has also compounded challenges for expectant mothers—from worries about contracting the virus, to less access to their scheduled prenatal visits and the prohibition of visitors in maternity wards. So far, Merck has contributed more than $30 million to COVID-19 relief; one third of which has gone to disparately impacted communities in the U.S. and abroad. In addition, three million dollars of assistance has has helped pregnant women before, during and following childbirth.
“Through Safer Childbirth Cities, our aim continues to be to fuel broad-based action that improves health equity by addressing the effects of systemic racism and ensuring all women have access to respectful, high quality maternal care and support,” notes Mary-Ann Etiebet, M.D., M.B.A., Merck for Mothers Lead and Executive Director.
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