Hawaiʻi attempts to mitigate infant, maternal mortality as numbers rise globally

HONOLULU (KHON2) — In Hawaiʻi, the health of mothers and infants presents a serious issue that is also a rising problem around the globe.

Despite our islands’ natural beauty, many Native Hawaiian and Pacific Islander families grapple with troubling statistics related to maternal and infant mortality.

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Dr. Rebecca Delafield, a researcher at the Department of Native Hawaiian Health at the University of Hawaiʻi John A. Burns School of Medicine, has dedicated her career to exploring these issues.

Her work sheds light on the disparities and challenges faced by these communities.

Dr. Delafield’s journey

Dr. Delafield shared her personal journey into the world of public health.

“I got into this research through my work kind of early on in my life,” she said. Her studies centered around social determinants of health with a focus on the lived experiences of wāhine (women) and keiki (children).

“I did my undergrad looking at gender studies and kind of differences in the actual lived experiences of women and children,” she explained. Her path led her to work in domestic violence programs and to intern for international organizations.

“I knew that I wanted to work in an area of maternal and child health for my graduate work,” Dr. Delafield said.

Eventually, she pursued her doctoral program with a focus on Native Hawaiian and Pacific Islander communities, emphasizing her dedication to those she aimed to serve.

The importance of data

Dr. Delafield quickly pointed out the lack of data surrounding maternal and infant mortality rates, especially for Native Hawaiian wāhine.

“We don’t have a lot of data out there,” she stressed. “For Native Hawaiian and Pacific Islanders, the population is relatively small compared to other groups.”

This scarcity of data makes it challenging to understand the full scope of the problem.

“Maternal mortality is really the tip of the iceberg,” Dr. Delafield noted as she pointed out that it is essential to look beyond mortality rates and examine the broader context of maternal health. “There are things happening before that can support women,” she emphasized.

Gathering more data is crucial for understanding these issues and helping those in need.

Disaggregating data for better understanding

Recently, Ryan Hiroshi Keliʻi Shontella , a JABSOM student researcher, developed a method to separate Pacific Islander data from larger Asian datasets. This discovery is significant for Dr. Delafield’s work.

“This work around disaggregation is really important,” she affirmed. By breaking down data into smaller groups, researchers can gain clearer insights into specific communities.

Dr. Delafield is currently working on a grant that aims to collect better data.

“I think we can see more information and have a bigger dataset to understand what’s happening with our populations,” she explained.

This initiative aims to address severe maternal morbidity, the conditions that can lead to complications during pregnancy and childbirth.

“The CDC put out a report that combined three years of data and showed rates of pregnancy-related maternal deaths,” she noted. Such information is vital for researchers focusing on disparities.

A 2023 report from the CDC that combined three years of data to show rates of pregnancy-related maternal deaths. The report was significant for those working in disparities research because it provided much-needed maternal mortality data.

Dr. Delafield also noted that another study from Hawaii examined maternal deaths reviewed by the Maternal Mortality Review Committee. It revealed disturbing disparities which highlights the importance of having robust data to understand and address these issues effectively.

Support after delivery

While Dr. Delafield highlighted the importance of prenatal care, she also pointed out the critical need for postpartum support.

“I’ve heard from communities that we need a lot of support for women in this area,” she said, emphasizing that care should continue after the baby is born.

Dr. Delafield revealed that many women do not receive adequate prenatal care. “Native Hawaiian and Pacific Islander women often start their care later and have fewer visits than women from other racial groups,” she said.

This trend raises concerns about access to healthcare. “For our communities, there seems to be something going on around access,” she remarked.

Language barriers also play a role, particularly for Pacific Islander communities. Dr. Delafield pointed out that how wāhine are treated during healthcare visits can significantly affect their experiences.

“I heard some things that were troubling, especially regarding how women from Micronesia were treated,” she said. Many women reported feeling judged and not taken seriously, which can deter them from seeking the care they need.

Creating a welcoming environment

Dr. Delafield’s research found that wāhine experiences in healthcare are significantly impacted by the relationships they build with their caregivers.

“The way that women were treated could have been a problem,” she observed. Wāhine who received compassionate care from healthcare providers often felt more comfortable during their visits. “Making them feel welcome really changed their experience,” Dr. Delafield noted.

She emphasized that positive interactions with healthcare staff, including nurses and administrative personnel, were crucial.

“Women talked about feeling judged, not being taken seriously and lacking support for their cultural needs,” she said. “We need to understand that in healthcare, there is a culture, too; and those can really conflict.”

Historical context and cultural support

Dr. Delafield discussed the importance of community support during childbirth. “People come in with cultural values and practices that really support pregnancy,” she said.

Many indigenous traditions involve family and community members providing support during childbirth, which can significantly affect wāhine experiences.

However, modern healthcare often isolates women during this critical time. “Coming into these healthcare spaces can hinder support,” she explained.

She stressed that healthcare policies should allow wāhine to have their support persons present during childbirth to ensure they feel supported. “It’s essential to foster that sense of community,” she added.

A way forward

Despite the challenges, Dr. Delafield remains optimistic about addressing these issues. “There are so many things we can do within the hospital systems, communities and state and social policies,” she said. She emphasized that it’s crucial to take action.

“Some things that came up in recent reports were paid family leave,” she noted. Currently, the United States does not have federally mandated paid family leave, but Hawaiʻi has been discussing this issue. “That could significantly help families during and after the pregnancy,” she remarked.

Collaborative efforts, such as the Maternal and Infant Health Collaborative, aim to improve data collection and support for women and infants.

“We need to improve globally, but certain communities have experienced heavier burdens,” Dr. Delafield pointed out as she highlighted the need for focused efforts.

Raising awareness and advocacy

The movement for improved maternal and infant health is gaining momentum. Dr. Delafield believes that advocacy and awareness are becoming more prominent.

“The advocacy and the priority haven’t been on women’s health generally for a long time,” she said. She acknowledged the efforts of various communities, particularly Black women, who have been vocal about their experiences and needs.

“We’ve benefited from the advocacy of women who have shared their stories,” Dr. Delafield stated. “Without that, this issue might not have reached the national agenda.”

She emphasized the importance of sharing experiences and data to create a broader awareness of these issues.

“I feel like there’s a little bit more momentum now, and we can really tackle some of these things,” she said with hope.

Addressing systemic issues

When asked about the systemic barriers that contribute to these health disparities, Dr. Delafield was candid.

“There are frameworks that trace the historical determinants of health through the lens of racism and sexism,” she explained. She highlighted the intersectionality of these issues and how they impact health outcomes for wāhine, especially those from marginalized communities.

“Many women come into the healthcare system with low expectations due to past experiences,” Dr. Delafield shared.

“That can shape their interactions with providers and affect their care.” She noted that improving these experiences requires a conscious effort from healthcare providers to understand and respect cultural values.

Building community support

Dr. Delafield emphasized that building community support is essential for improving maternal and infant health outcomes.

“We need to create a welcoming environment where women feel safe and supported,” she said. Encouraging families to participate in prenatal and postnatal care can make a significant difference.

“There are traditions that promote health during pregnancy, and we should draw on those,” she noted. By integrating cultural practices into healthcare, providers can help wāhine feel more comfortable.

“We have to ensure that our healthcare systems support those cultural values,” Dr. Delafield urged.

The issue of maternal and infant mortality in Hawaiʻi, particularly among Native Hawaiian and Pacific Islander communities, is complex and deeply rooted in historical and cultural factors.

What the data tells us

According to the World Health Organization , “during the height of the pandemic in 2020–21, maternal death rates increased in four of the nine countries shown in the chart above — Australia, Japan, the Netherlands, and the United States.

Unicef has found similar issues: “Every day, 6,300 babies die in the first month of life. In 2022, an estimated 2.3 million newborns died worldwide. Globally, every two minutes, a woman dies during pregnancy or childbirth. In 2020, there were an estimated 287,000 deaths worldwide. About 70 per cent of those maternal deaths were in sub-Saharan Africa.”

“Pregnant women and newborns continue to die at unacceptably high rates worldwide, and the COVID-19 pandemic has created further setbacks to providing them with the healthcare they need. If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby – no matter where they live – has the best chance of health and survival.”

— Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at WHO

This statement preceded a recent WHO report that shows progress in improving survival of pregnant persons and infants has stagnated since 2015, with around 290 000 maternal deaths each year, 1.9 million stillbirths – babies who die after 28 weeks of pregnancy – and a staggering 2.3 million newborn deaths, which are deaths in the first month of life.

United States

The United States has maternal and infant mortality rates that are higher than average compared to other wealthy nations:

Maternal mortality
In 2021, the maternal mortality rate in the U.S. stood at 32.9 deaths per 100,000 live births , surpassing rates in most other high-income countries. Additionally, this rate is notably higher for Black women compared to White women and tends to increase with maternal age. Native Hawaiian and Pacific Islander wāhine are not specifically included in these statistics.

Infant mortality
In 2022, the infant mortality rate in the U.S. was 5.60 deaths per 1,000 live births , which is greater than that of Norway, the country with the lowest rate. Infant mortality rates also vary significantly by state, with some states reporting higher rates than others.

Additional key points regarding maternal and infant mortality in the United States:

• The maternal mortality rate has risen over the past decade. Click here .
• The infant mortality rate has decreased by 15% in the last ten years. Click here .
• The infant mortality rate for women aged 25–29 increased from 2021 to 2022. Click here .
• The highest rates of infant mortality in 2022 were observed among women under age 15 and those aged 15–19. Click here .

The State of Hawai ʻ i

In Hawaii, the data provides a bit of a clearer picture of what is happening here; but again, the data is still not completely clear since Native Hawaiian and Pacific Islanders are still mixed into the larger pot of Asian statistics, meaning we do not have a handle on how these percentages play out amongst these populations.

Infant mortality rate
In 2021, Hawaii’s infant mortality rate was 4.7 deaths per 1,000 live births , reflecting a decline of over 11% since 2011.

Maternal mortality rate
Approximately 10 to 12 women die each year in Hawaii due to pregnancy or pregnancy-related complications. The number of maternal deaths in the state has risen since 2013, which marked the lowest rate recorded.

Dr. Delafield’s research emphasizes the importance of better data, culturally competent care, and community support. By addressing these disparities and advocating for change, there is potential to improve health outcomes for mothers and infants in Hawaiʻi.

The journey toward better maternal and infant health is ongoing, and with continued effort and collaboration, communities can work together to create a brighter, healthier future for all.

As Dr. Delafield said, “We need to do things to make women feel more comfortable going into this experience and supported coming out of it.”

You can click here to learn more about University of Hawaiʻi John A. Burns School of Medicine Department of Native Hawaiian Health.

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