Maternal Sepsis and Health Inequities

“This is a hard truth: women in our nation are dying before, during, and after childbirth,” said Vice President Kamala Harris at the Maternal Day of Action Summit in 2021. “And we know that, for some women, the risk is much higher.”

Vice President Harris was referring to health inequities – or differences in health levels – which can occur based on a person’s wealth, their race or ethnicity, and where they live. Because of health inequities, some groups are more likely to get sick, struggle to access medical care, and even have lower life expectancies than others. These groups include racial and ethnic minorities, poorer patients, and rural patients.

Health inequities affect a wide range of pregnancy-related challenges and conditions, and maternal sepsis is no exception. As Vice President Harris said, “When it comes to pregnancy and childbirth, these systemic inequities can be a matter of life and death.” This Maternal Sepsis Week, we are examining the state of maternal sepsis inequities, why these inequities occur, and what can be done to tackle them.

 

The Facts: Maternal Sepsis Inequities

Maternal sepsis, which can progress from any infection that develops during pregnancy, delivery, or the postpartum period, is the second leading cause of pregnancy-related death in the United States. The United States experiences stark pregnancy-related health inequities, including maternal sepsis inequities.

Data shows that Black women in the United States are twice as likely to develop severe maternal sepsis as white women, and over three times more likely to have a fatal complication of pregnancy as white women. Other nonwhite racial groups are also disproportionately affected: American Indian and Alaskan Native women, for example, are 2.5 times more likely to die of pregnancy-related causes than white women. Rural women are 1.5 times more likely to die during pregnancy than non-rural women. What’s more, a 2019 study showed that public insurance or no insurance were risk factors for pregnancy-related sepsis – which means that pregnant patients who cannot afford private insurance are more likely to develop maternal sepsis than those who can.

 

What Causes Inequities?

Maternal sepsis inequities are caused by many complicated and associated factors. One is systemic racism. This can include discriminatory treatment in hospitals, where doctors are more likely to ignore or downplay symptoms raised by nonwhite pregnant patients. Unequal access to healthcare and treatments – including for chronic conditions prior to pregnancy – also makes unequal outcomes from maternal sepsis more likely.

Another major factor is living far from a maternal healthcare facility. Rural patients who face very long drives are at a geographical disadvantage when it comes to getting care, and that means that they are less likely to receive timely treatment when maternal sepsis symptoms occur. As Sepsis Alliance emphasizes, early detection and treatment offer the best chance for survival.

 

What Can We Do?

Maternal sepsis inequities are a complex problem, which means there is no one simple solution. There are, however, several things that can be done to help.

1. Raise patient awareness. With better awareness of maternal sepsis symptoms, patients are more able to recognize dangerous signs during their own pregnancies and know when to seek medical attention. Patients with awareness of maternal sepsis can also better advocate for themselves in healthcare settings. This includes in settings where their symptoms are being downplayed or dismissed.
2. Improve healthcare professional education. Maternal sepsis is not always easy to diagnose. As Dr. Laura Riley, Chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine, said in an interview with Sepsis Alliance, “Most pregnant patients are otherwise young and healthy, and that sometimes catches us, because people can look good for such a long time, and then they fall off a cliff.” When healthcare professionals receive training about what maternal sepsis can look like and how it progresses, they are more likely to catch these cases early, no matter a patient’s background. “Being able to see that that’s happening as early in the process as possible is what is tricky, but absolutely critical for us,” Dr. Riley said.
3. Advocate for policy change. We can push for policies that improve health outcomes for pregnant patients, no matter their race, socioeconomic status, or location. Local, state, and federal governments can do many things to help alleviate maternal sepsis inequities, including: making investments in the social determinants of health that impact maternal health outcomes (such as housing, transportation, and nutrition); providing funding for initiatives and organizations that promote equity; growing the perinatal workforce to ensure that there are enough trained professionals to treat pregnant patients across the U.S.; promoting innovative payment models to incentivize high-quality maternal healthcare; and much more.

 

Together this Maternal Sepsis Week, we can educate, advocate, raise awareness, and begin to tackle the inequities impacting maternal sepsis care and pregnant patients across the United States.

 

To discover more maternal sepsis information and resources, please visit MaternalSepsisWeek.org

To discover Sepsis Alliance’s healthcare professional education offerings, including courses on maternal sepsis, please visit SepsisInstitute.org.

To send a letter to your local newspaper about the maternal sepsis crisis, please visit our Grassroots Action Center.