From 1987 to 2006 the maternal mortality rate in the United States doubled, from 6.6 to 13.3 deaths per 100,00 live births, according to a report from Amnesty International (read the full report and executive summary at http://bit.ly/93uSiT). The report also notes that deaths from pregnancy-related complications are more likely in the United States than in 40 other countries.

Figure. Demonstrators from Amnesty International stage the mock death of a group of pregnant women, representing the death of one pregnant woman every minute, as part of a protest in London in March to highlight the global failure to tackle maternal mortality. Photo by Dominic Lipinski / PA Wire URN:8473654 (Press Association via AP Images).

The report identifies disparities in care based on ethnicity, income, and immigration status, among other factors, as major contributors to the maternal health care crisis. Women of color, who are more likely to die in pregnancy and childbirth than white women, make up a disproportionate number of women who receive health care from publicly funded programs, which suffer from insufficient resources to deliver effective prenatal, maternal, and postpartum care.

Other barriers to maternal health care include language barriers, restricted appointment hours, and a shortage of facilities with adequately trained professionals (in both rural areas and inner cities).

The report suggests several measures to reverse the trend of pregnancy-related complications in the United States:

* Address variations in the quality of obstetric practices. At present, there are no national guidelines or protocols for maternal health care or for preventing and managing obstetric emergencies.

* Ensure that women receive adequate prenatal care. The Healthy People 2010 initiative defined adequate prenatal care as at least 13 prenatal visits, beginning in the first trimester of pregnancy.

* Ensure adequate postpartum care. More than half of all maternal deaths occur one to 42 days after childbirth, although most women don't have a follow-up examination until the end of that period (six weeks).

* Establish an Office of Maternal Health to improve the collection of maternal health data, protect the right to nondiscrimination in maternal health care, and recommend regulatory changes.

* Provide temporary access to Medicaid for all pregnant women while permanent coverage applications are pending.-Wayne Kuznar