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Running head: PHILADELPHIA MATERNAL HEALTH INDICATORS

Maternal Child Health Indicators in Philadelphia County

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PHILADELPHIA MATERNAL HEALTH INDICATORS
Maternal child health indicators in Philadelphia County

Philadelphia County is located in Pennsylvania, a state in the United States of America that has a

population of about 1.553 million and has increased by 0.29 percent in the previous years

(Babay, 2014, para. 2). The city has recorded 23247 resident births of which 16.5 % of the births

were Hispanic, 49.5% blacks, 26.9% whites and other ethnic groups were 23.9%. Low birth

weights in Philadelphia are associated with infants with fewer than 2500g (Babay, 2014). It has

remained higher than the national average over the past six years. The pre-term births, which are

births less than 37 completed weeks of gestation, have remained similar to the national average.

Fetal-infant deaths and maternal mortality can be attributed to lifestyle behaviors (cigarette

smoking, alcoholism, and poor nutrition) and diseases (hypertension, diabetes). A high

percentage of births occur under close supervision by medical doctors.

There are several birth options in Philadelphia County including over 30 hospitals, about 5 birth

centers and mothers also have the option of delivering their babies at home which is usually

attended by a certified practice midwife (CPM), a doctor or a licensed/certified midwives

(Pennsylvania Department of Health, 2015). However, a majority of the births are usually

performed in the area's hospitals with physicians and nurses being the primary care givers (PDH,

2015). There is not substantial data that indicate the number of deliveries that have been attended

by CM and CNMs. In addition, the city does not have tangible data to refer to that can help in

identifying the number of practicing CNMs in Penn state. However, there are numerous local

midwifery schools and programs in Philadelphia County and they are their numbers are

increasing steadily. The State Board of Nursing recognizes CNMs and CMs as being eligible to

practice midwifery in Pennsylvania.

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This is an important analysis since pregnancy and childbirth have a considerable impact on the

physical, emotional, mental and socioeconomic health of women as well as their families.

Suitable prenatal care optimizes the possibility of a full-term pregnancy and also the delivery of

healthy babies, postpartum care optimizes an infant's chances for healthy childhood and

adulthood. Philadelphia's growth last year mainly stemmed from births as well as foreign

immigrants. Currently, Philadelphia's birth rate per 1000 people is 14.8, and the number of births

was 23,247 in the year 2014 (Babay, 2014, para. 5). However, records show that the number of

births has remained constant for the last three years thereby consistently boosting the county's

population (Babay, 2014, para. 6). The major concern in Philadelphia is that a huge proportion of

babies dies on their first day of life (Gaestel, 2013, para. 1).

Maternal Mortality

It is defined as the death of a woman while pregnant or within 42 days of termination of

pregnancy from any cause aggravated by the pregnancy or by its management. However,

accidental or incidental causes of death are not included. It is a irrespective of the duration and

the site of pregnancy. More so, it is a ratio of the number of estimated maternal deaths during a

given period per 1000 live births during the same period (WHO, 2014). Maternal mortality is a

key measure of the strength of the health system and an indicator of access to quality care. It also

shows the extent of coverage of the health system and available interventions aimed to prevent

maternal deaths.

The Philadelphia MMR (Maternal Mortality Review) usually identifies and reviews all

Philadelphia inhabitants who have died annually at the end of pregnancy, despite if a pregnancy

leads to a live birth, fetal demise or miscarriage. According to the Philadelphia Department of

Public Health, Philadelphia's rate of maternal mortality is more than 50% above the nation's
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average (George, 2015, para. 1). In the last three years (2010 to 2012) when approximately

69,000 live births occurred in the county, 55 women died within or during one year of the end of

their pregnancy (MMR, 2012) (Tanenbaum, 2015, para. 1). A huge portion of women in the

County is arriving at pregnancy sicker and also with more chronic conditions such as

hypertension, diabetes and obesity (George, 2015, para. 3). What's more, the Philadelphia MMR

found that among the thirty-one medical or natural deaths, nineteen of them were concluded to

be linked to pregnancy, childbirth or pregnancy management.

Another shocking finding was the disproportion in which African American women were

affected. Of the 55 deaths noted above, 31 of these women were women of color, 17 were white,

6 were Hispanic, and one was Asian. According to the Philadelphia MMR report, 14 of the 19

pregnancy connected deaths were women of color (George, 2015, para. 10). These stark figures

display a poor image for Philadelphia mothers, where pregnancy-related rates of mortality are

27.4 per 100,000 live births over the last three years of the MMR report (Otterbein, 2015, para.

1). These numbers are shocking especially when it's compared to the nationals average that was

18.5 deaths per 100,000 births, which is already exceedingly high for a developed country

(Otterbein, 2015, para. 2).

These high rates might be attributed to the lack of integration among all health care providers -

including those who specialize in mental health services, obstetrical care, and substance abuse -

and social services institutions that handle issues like birth control, domestic violence and

addiction (Otterbein, 2015, para. 1). Social determinants such as poverty, addiction, living

conditions, and violence are important aspects of maternal health (Tanenbaum, 2015, para. 3),

and as such they should be addressed if Philadelphia maternal mortality rates are to be lowered.

Also, most maternal deaths in the past years have been because of accidents including motor
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vehicle crashes, drug intoxication, or fire; 6 of the deaths were as a result of homicide; and two

were suicide cases (George, 2015, para. 5). So, there is the need to address these issues if Philly

is to stand a chance of reducing the high maternal mortality rates it's currently experiencing.

These numbers are frightening, especially given that Philadelphia is home to some of the best

healthcare facilities and medical professionals in the US. How will Philadelphia's rate of

maternal mortality look like in the future if it lacked these tremendous opportunities? It is

important that these "gaps or shortfalls in Philadelphia's health systems, community resources,

and social services systems" (Golden, 2015, para. 2). Accordingly, the local government should

look into increasing access to required services as well as home-based care for pregnant women

coordinated with social and medical services.

Maternal mortality is an important indicator for three main reasons: it reflects Philadelphia's

overall health-care system; it's an unimaginable tragedy and if maternal mortality can be

prevented - everyone agrees - it ought to be prevented; and it rates are intimately and directly

associated with severe rates of morbidity for fetus/infant and mothers. Maternal mortality is

measured by considering all maternal deaths occurring in a reference period multiplied by

100000 divided by the total of live births occurring within the reference period.

As well, maternal mortality is a key measure of the strength of the health system and an indicator

of access to quality care, the extent of the coverage of the health system and available

interventions aimed to prevent maternal deaths. The maternal mortality ratio is indicative of the

risk associated with every pregnancy and the best drawing board of socio-economic conditions

such as girl child access to education, position in the political arena, equality in healthcare

provision and overall development. Maternal mortality rate is important for the Philadelphia to
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device and analyze the most common cause of maternal deaths and come up with preventable

measures.

Infant Mortality

It is an estimate of the number of child deaths less than one year for every 1,000 live births.

Infant mortality rate can be viewed as an indicator of general population health and overall heath

and well being of the child due to its focus on health policy (WHO, 2014). It can be considered

as a weight scale on which the health status of the population is balanced on that of the rate of

death of infants. Infant mortality rate is also an indicator of the overall well-being of maternal

health in the population - a reflection of the quality of primary health care and the availability of

supportive services in the community. Infant mortality rate can be viewed as an indicator of

general population health and overall heath and well being of a child and the mother. Infant

mortality rate is also an indicator of overall well being of maternal health in the population, a

reflection of quality primary health care and availability of supportive services in the community.

All these append to its importance.

In Philadelphia, the rate of mortality rate is 10.7 per 1000 live births (PHD, 2015). According to

the nation's data, Philadelphia records the highest infant mortality rate of the eleven largest US

counties, more than 50 percent higher than the next highest rates. The mortality rates among

infants have remained relatively consistent (Gaestel, 2013, para. 13), rising only 4 percent

between the year 2000 and 2010. However, it has been shown that infant mortality in

Philadelphia is highest among non-Hispanic blacks and also in the Upper North and North

planning districts.

Mathis (2013, para. 1) points out that the rate of deaths for infants in Philadelphia is

approximately the same as that of Indonesia - a third world country. Indonesia has the worst
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infant mortality rate (eighth) in the world and this only compiles more to the all extremely sad

news. Philadelphia women have been said to share a common factor with women in the

developing nations, that is, the poorer they are, the greater possibility they have of losing their

child either before they come to term or on the first day of life. A review of 487 infant deaths in

less than one year by a Medical Examiner's Office in Philadelphia showed that most of these

deaths were due to prematurity (54%) (Mathis, 2013, para. 4).

An additional 18% was because of sleep-related causes/issues such as suffocation as a result of

an adult rolling over on their baby in a shared bed; another 11% were congenital (Mathis, 2013,

para. 4). One more issue that has been cited is the lack of access to good care (Babay, 2014;

Gaestel, 2013; George, 2015; Golden, 2015; Mathis, 2013). Fifteen maternity wards have been

closed around Philadelphia city in recent years, and only six remain. Murtha (2013, para. 8)

notes that prenatal care, as well as delivery options, have been consistently shrinking in

Philadelphia County over the last 15 years. As a result, we have witnessed about two-thirds of

the area hospitals that provided maternity care close their doors. Some these facilities cite that

inadequate insurance reimbursement, burdensome staffing requirements, and rising malpractice

insurance premiums as the major causes of dwindling maternity care (Murtha, 2013, para. 8).

Pre-term births

This refers to births that occur less than 37 completed weeks of gestation and it accounts

for 35% of infant deaths every year. It’s a major determinant of neonatal morbidity and mortality

as well as reflective of the state of health. Its analysis points towards preventive interventions

and measures towards improving survival chances of preterm infants. In Philadelphia, there were

1819 late preterm births, representing about 8.2% of the live births. Even though it has been

stated that infants born late pre-term has declined nearly 14 percent, overall premature birth rates
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is on the rise. This is mainly because of the large numbers of manifold births in recent years.

Bastek et al., (2015) analyzed data for eight hundred and seventeen women and found that the

prevalence of pre-term birth (<37 weeks) was 41.5%. This study found that the median GA at

delivery was 25-75% (37 weeks) with deliveries taking place between 24 and 41 weeks.

It's necessary to know the number of premature births because it's associated with infant

complications like breathing issues, feeding problems, developmental delays as well as cerebral

palsy (CDC, 2014).

In 2011, 11.9 percent of births were preterm in Philadelphia (PDH, 2014). The rates of

infant death vary by race. It has been found that women of color are 2 to 3 times more probable

to give birth early. However, the rates of pre-term births have been reported highest among non-

Hispanic black women, with about 14.3 percent of their babies being born prematurely. Overall,

we can say that the rates of premature births have reduced in Philadelphia, especially looking at

the available Pennsylvania data. George (2014) in his review notes that Pennsylvania's premature

birth rates were 10.7% in the year 2013. In this review, the author further notes that the state has

improved tremendously in two major areas: reduced elective deliveries that are not medically

necessary (before 39 weeks) to 7.3% from 7.4% (George, 2014, para. 3); reduced the number of

women who smoke to 22.5% from 26.1%.

Low Birth Weight

Low birth weights rate can be viewed as an indicator of general population health and overall

health of the population. It's an important maternal child indicator because it's strongly linked to

mortality risks during year one and, to a lesser extent, with developmental issues in childhood as

well as the risk of different illnesses in adulthood. As such, it can be used to explain variations in

child mortality and also later morbidity, and is an intermediate health endpoint in itself. Babies
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weighing less than 2500 grams at the time of birth are considered to be low birth weight. 10.9%

of all the live births are low birth weight in Philadelphia (Philadelphia Community Health

Assessment, 2014, p.70). Philadelphia has the highest low birth weight births among the largest

U.S counties. Low birth weight births are most common and high among non-Hispanic black

women.

Very Low Birth Weight

Very low birthweight is a word used to describe babies born weighing less than 1,500 grams.

1.5% of the babies born in Philadelphia are born this tiny, and the number is increasing due to

preterm births (The Children's Hospital of Philadelphia, n.d.). In other words, the babies are born

before 30 weeks of pregnancy. The babies, therefore, have less time in the uterus to gain weight.

Another cause of very low birth weight is when the baby does not grow very well during the

pregnancy periods. This occurs mostly is because there is a problem with the placenta, birth

defects, and mother's fitness. In 2011, 2.5% of all the live births were very low birth weight

(Nutter, Schwarz, Mallya & Feyler, 2014).

Local Outcome Disparities

In Philadelphia, there exist racial/ethical and geographical disparities. Rates of diabetes,

hypertension, child asthma, and hospitalization cases are on the rise in the county since 2000.

The main local disparities in the country include premature deaths, teen births, homicide, breast

cancer and poverty. Philadelphia is the poorest among the ten largest cities in the U.S. the

county has the highest smoking and obesity in the country. In the county, a certain population

subgroup is most likely not to have regular access to health care. The most affected subgroups

are the young adults, men and adults without insurance. In Philadelphia County as age increases

the percentage of adults without a regular access to health care decreases; only 8.8% of the adults
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aged 50-64 years do not have a regular source of health care. North Philadelphia has the poorest

health indicators for unemployment, child obesity, HIV diagnosis and teen births. Philadelphia is

among the counties with the highest mortality rates in U.S even though the figure has since

dropped below ten deaths per 1000 live births. Black infants are more likely to die in first years

of life than white infants. North and lower North Philadelphia have the poorest health outcomes

regarding geographical locations.

Philadelphia County resources

The county state of Philadelphia has several programs that provide the people with assistance.

Philadelphia has five medical schools and over 80 hospitals and health care centers. Individuals

and families with limited income turn to organizations and charities for help. Such organizations

offer food assistance to the people of Philadelphia.

Philadelphia’s setting provides healthy food access with Department of Public Health and its

partners improving access to healthy food through new markets and enhanced supermarket

access and health care promotion. The county’s school system plays an important role in the

development of its citizens. There are more than 500 public schools and private schools. These

schools has offered increased chances for physical activities and improved nutrition values.

Share Food Program distributes food stamps including fresh food and groceries.

The county state of Philadelphia has started a program the groups the pregnant women

based on their due dates. This enables regular check-ups and encourages education and peer

support. The Strong Start for Mothers and Newborns initiative provide grants. The aim of Strong

Start is to lower the costs of medical care throughout pregnancy, delivery and the first stages of

the child life. These programs focus on preterm birth due to the complications from deliveries.
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The Obamacare program has also shown initiatives to support pregnant mothers. The program is

trying to improve the health care, improve health outcomes and reduce health costs.

Summary

Philadelphia County meets the goals set by the Healthy People 2020 of maternal child indicators.

In the last 15 years, Philadelphia County has consistently reduced the risk factors associated with

the maternal child indicators (Golden, 2015). Philadelphia is consistently trying to find new ways

to improve the well-being and health of women, infants, children and their families. The County

is striving to reduce fetal death rates at gestation, during perinatal period, within one year,

neonatal death rates, and postneonatal deaths.

Maternal mortality should receive more attention as its rate is very high compared to the rate of

the nation. Currently, the rates of mortality are 27.4 per 100,000 live births compared to that of

the nation which is 18.5 deaths per 100,000 births.

However, the County has a lot of areas it needs to address, especially that its maternal mortality

has been ranked higher than those of third world countries. A number of these indicators are

highest among Black infants compared to White infants.

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Appendix: Philadelphia County compared with Pennsylvania and the US

Health Philadelphia Pennsylvania National date HP 2020 HP 2020

indicator county Baseline goals
Maternal 27.4 10.1 12.7 11.4 11.4
mortality
Infant 11.2 7.4 6.7 6.0 6.0
mortality
Prematurity 12 11.5 12.7 11.4 11.4
Low birth 11.1 8.0 8.2 17.8 7.8
weight
Very low 1.9 1.4 1.5 1.4 1.4
birth weight
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References

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Retrieved 30 October 2015, from

http://www.philly.com/philly/news/breaking/032714_Census_Philadelphia_population_g

rows_again_but_rate_slows.html

Bastek, J., Sammel, M., Jackson, T., Ryan, M., McShea, M., & Elovitz, M. (2015).

Environmental Variables as Potential Modifiable Risk Factors of Preterm Birth in

Philadelphia, PA. American Journal Of Obstetrics And Gynecology, 212 (2), 236.e1-

236.e10. http://dx.doi.org/10.1016/j.ajog.2014.08.025

Community Health Assessment. (2014) (1st ed.). Philadelphia. Retrieved from

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Gaestel, A. (2013). Despite Doctors’ Efforts, Philadelphia’s Infant Mortality Rate Remains

Among the Worst in the U.S. – Next City. Nextcity.org. Retrieved 30 October 2015, from

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rate-remains-among-t

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mortality-rates-mmr-pregnancy-birth.html

Golden, J. (2015). Maternal mortality: A problem with solutions. Philly.com. Retrieved 30

October 2015, from http://www.philly.com/philly/blogs/public_health/Maternal-

mortality-A-problem-with-solutions.html

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| Philadelphia Magazine. Philadelphia Magazine. Retrieved 30 October 2015, from

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Murtha, T. (2013). Research Shows Philadelphia Failing UN Maternal and Infant Health Goals.

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Otterbein, H. (2015). The Brief: Philly's Maternal Mortality Rate Is Worse Than Libya's -

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Tanenbaum, M. (2015). Study: Philadelphia maternal mortality rate higher than national

average. PhillyVoice. Retrieved 30 October 2015, from

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