Physical Health May Be one of the Biggest Impediments for Maternal Health in Southeastern Michigan

The Michigan maternal mortality rate was 16.4 per 100,000 live births in 2018, according to the National Center for Health Statistics. At the national level in 2017 the maternal mortality rate was 17.4 per 100,000 live births. While Michigan’s numbers were slightly less than the national average, they are still concerning, especially considering the United States has among the highest maternal mortality rates across amongst other nations.

Maternal deaths include deaths of women while pregnant or within 42 days of termination of pregnancy irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Understanding, and improving, maternal mortality is important because it helps highlight the effectiveness of the country’s health care system as it relates to general, obstetric and infant care, and is also a human rights issue, as everyone deserves quality and equal care.

In the graphs below we show what factors impact maternal mortality rates and maternal health in general. Several factors, based off maternal health and community data, were combined by Surgo Ventures, a privately funded action tank, to create the Maternal Vulnerability Index (MVI). This index represents six categories, or sub-indexes, in total: Reproductive Healthcare, Physical Health, Mental Health and Substance Abuse, General Healthcare, Socioeconomic Detriments and Physical Environment. In Southeastern Michigan, and throughout the country, each county and states ranks differently in each category, with the higher number meaning there is an increased vulnerability. This report does not have a national index for the sub-indexes or the MVI as a whole for comparison. The highest level for comparison is at the state level.

The Reproductive Healthcare factor in the MVI is based off a woman’s access to family planning and reproductive services, as well as availability of skilled attendants. As with all the data discussed in this post, the vulnerability level varies greatly by location (again, higher numbers refer to higher vulnerability). In Southeastern Michigan, St. Clair County has the highest Reproductive Healthcare MVI Sub-Index at 50, while nationally there are counties in the Dakotas, Texas, Arkansas, Missouri,  Nebraska and several other states where the Reproductive Healthcare Sub-Index is above 85. The State of Michigan has a Reproductive Healthcare Sub-Index factor of 68. Texas has the highest Reproductive Healthcare Sub-Index of 100 of all 50 states.

For the Physical Health index there is a much wider range of vulnerability in Southeastern Michigan, with Livingston County having a vulnerability level of 0 while Wayne County has a vulnerability level of 88. The State of Michigan has a Physical Health Sub-Index of 66 and comparatively Texas has the highest at 100. The factors that play into the Physical Health vulnerability status include prevalence of noncommunicable diseases and sexually transmitted disease and the percent of females with hypertension, obesity and diabetes. All of these factor can increase the risk of complications and/or death during and after pregnancy.

The Mental Health and Substance Abuse Sub-Index is among one of the higher ones for counties in Michigan, with five of the seven in Southeastern Michigan having a vulnerability index above 50. Macomb County has the highest vulnerability index in the region at 77, followed by Wayne County with an index of 76 and St. Clair County with an index of 74. Michigan has a Mental Health and Substance Abuse Sub-Index of 62 and the State with the highest sub-index is West Virginia at 100. The indicators that play into this index include stress, access to mental health and substance abuse institutions and the overall mental health of mothers in the area.

General Healthcare Sub-Index measures the accessibility, affordability and utilization of healthcare, including insurance coverage and the state’s Medicaid expansion status. Some of the factors of this vulnerability measurement include access to quality medical care, the percent of women of reproductive age who are uninsured, and the postpartum extension status.

St. Clair County has the highest vulnerability index at 45 while Washtenaw County has an index of 0, meaning there is ease in access to and affordability of healthcare for reproductive age women. Michigan has a General Healthcare Sub-Index of 29, and comparatively, the two states with the highest sub-index are Mississippi and Alabama at 100.
General Healthcare Sub-Index measures the accessibility, affordability and utilization of healthcare, including insurance coverage and the state’s Medicaid expansion status. Some of the factors of this vulnerability measurement include access to quality medical care, the percent of women of reproductive age who are uninsured, and the postpartum extension status.
St. Clair County has the highest vulnerability index at 45 while Washtenaw County has an index of 0, meaning there is ease in access to and affordability of healthcare for reproductive age women. Michigan has a General Healthcare Sub-Index of 29, and comparatively, the two states with the highest sub-index are Mississippi and Alabama at 100.
The final sub-index in the overall MVI is Physical Health, of which Wayne County has the highest rate at 95, both in Southeastern Michigan and in the State of Michigan. Michigan has a Physical Health Sub-Index of 82 and of all 50 states Alabama has the highest sub-index at 98. Environmental factors that influence maternal health outcomes include violent crime rates, housing conditions, pollution and access to transportation.

Overall, Wayne County has the highest MVI in Southeastern Michigan, and the State, at 77. Regionally, the county with the second highest MVI is St. Clair County with a rate of 55. At the state level, Michigan’s MVI is 66 and Alabama has the highest MVI of 100. While we know several factors play into the health of a mother and child, this index allows us to examine how all these factors are connected and provide more definitive answers as to why the US’s maternal mortality rate is so poor.

In examining the factors above, it should go without saying that race, socioeconomic status and location are all overarching factors into the MVI. This is examined on a deeper level through the index though and will be further discussed in an upcoming post.

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