Despite having one of the lowest poverty rates and highest median incomes in the U.S., New Jersey has the fourth-highest maternal mortality rate and one of the highest maternal morbidity rates in the nation. One of the most diverse states in the country, New Jersey has significant maternal health disparities by county, race, and ethnicity, yet few studies have investigated the extent or the underlying causes of these geographic and racial/ethnic disparities.
Non-Hispanic Black women, in particular, have a troublingly high rate of severe maternal morbidity (potentially life-threatening or near-miss events that would have resulted in a maternal death during pregnancy, childbirth, or within 42 days of termination of pregnancy if not for significant medical intervention) at 31.2 per 1,000 deliveries, which is more than double that of non-Hispanic White women (13.4 per 1,000 deliveries). This racial gap is larger than that observed nationally, yet the cause remains elusive.
Geographic disparities are also apparent, but it is unclear whether the geographic disparities remain after controlling for poverty rate or other economic characteristics of the counties, or to what extent the geographic disparities are due of the health care resources in the counties (e.g., availability of obstetricians).
In this project, the research team will use 10 years of New Jersey birth records and other data to:
- identify high-incidence and low-incidence localities—municipalities and areas in NJ that have worse or better maternal health outcomes than state-level rates—overall and by race and ethnicity, and;
- identify high-risk and low-risk localities—municipalities and areas in NJ that have worse or better maternal health outcomes than expected, given the socioeconomic status and healthcare resources of the community—overall and by race and ethnicity.
Additionally, the team will seek out local policy solutions that help ensure safe, healthy motherhood by examining the differences in local laws and regulations in the domains of land use (zoning), transportation, housing, buildings, public safety, social and health services, parks and recreation, smoking, alcohol, drug-free zones, and pollution.
Severe maternal morbidity (SMM)—defined by the Centers for Disease Control and Prevention as unintended outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health—is a major determinant of maternal mortality. Each year 15 of every 1,000 people hospitalized for a delivery experience SMM. In addition to adverse health outcomes, SMM can lead to disruptions in mother-infant bonding, which can compromise children’s social and emotional development, and confers substantial economic costs to families, communities, and insurers including Medicaid.