According to the World Health Organization, a woman’s lifetime risk of maternal mortality is 1 in 5,400 in high-income countries, yet 1 in 45 in low-income nations. In the United States, the numbers are also troubling, especially for some groups. In January 2020 the U.S. Centers for Disease Control and Prevention reported that throughout the previous decade, slightly more than 17 maternal deaths occurred per 100,000 live births. Among non-Hispanic Black women, however, there were 37 deaths per 100,000 births while among women over age 40, the rate approached 82 per 100,000. Unfortunately, these reported numbers may be underestimates: It wasn’t until 2017 that all states offered a way to indicate maternal death on death certificates.
It is inexplicable that in the twenty-first century fundamental physiological processes such as pregnancy and childbirth are causing so much damage and death. Or that each year, vast numbers of women worldwide suffer and die not only from sexual and reproductive disorders but increasingly from non-communicable diseases such as musculoskeletal disorders, cardiovascular disease, diabetes, and depression. The toll is great while our knowledge of how to help remains comparatively minuscule.
Women have long called for attention to these matters. Fortunately, those calls are increasing, demanding better clinical interventions and more research, particularly calls for including women as participants in all research and requiring explicit justification for any exclusion. And fortunately, the physicians and scientists in the HMS community are responding to these calls.
Many of our alumnae and faculty have been changing how medicine cares for women. In 1985, for example, Karen Carlson, MD ’80, founded Women’s Health Associates at Massachusetts General Hospital, a multidisciplinary women’s health practice that became a model for several National Centers of Excellence in Women’s Health established throughout this country. In 1989, anesthesiologist Nancy Oriol, MD ’79, developed what is known as the walking epidural, an anesthetic technique that allows laboring women to move and one that she introduced to China in 2002 as a possible solution to that country’s high elective cesarean rate. And for the past few decades, Karol Watson, MD ’89, a renowned cardiologist and guiding hand at the UCLA Barbra Streisand Women’s Heart Health Program, has helped advance our understanding of heart disease in all women.
Another encouraging sign of change: the composition of our student body. For several decades the percentage of women in our entering student classes has been steadily increasing. In 2020, women comprised 60 percent of our incoming class. This growth is especially encouraging since research increasingly indicates that gender concordance in care improves patients’ perception and outcomes.
There is still much to do. But we can be assured that the intelligence and talent of our alumni and our faculty will continue to drive change so that women’s health achieves the support and status it deserves.
George Q. Daley is the dean of Harvard Medical School.