Maternal mortality in America: lessons from the developing world.
In separate but related articles, Drs. Tsu and Goodburn outline strategies for confronting the staggering number of maternal deaths in the developing world: monitoring process indicators and elucidating technologically feasible interventions. American providers face a maternal mortality rate that is only a fraction of that seen in the developing world, but they are challenged by large disparities in perinatal outcomes between African Americans and whites. Strategies similar to those advanced by Tsu and Goodburn might be applicable in the United States. American perinatal health care providers need to look beyond the details of individual adverse events to the structure of care in settings where adverse outcomes are common. Inadequate staffing levels, overcrowded neonatal intensive care units, and provider fatigue are examples of structural problems that have been linked to poor outcomes. Ultimately, improved quality may be achieved only after the relationship between poor-quality health care (medical errors) and inequality is recognized and acted on. Providers should take an active role in identifying and reporting near misses and in developing the skills and technologies with which to implement systems that prevent recurrences.
Minkoff
Howard
H
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA.
D001741:Black or African American; D003906:Developing Countries; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology; D044465:White People