In 2022, researchers found that U.S. women experienced a maternal death rate of 22 per 100,000 live births due to pregnancy and childbirth complications. This rate is more than double, and in some cases triple, that of other high-income countries. Photo by Adobe Stock/HealthDay News.
June 04, 2024 Story by: Editor
Childbirth in the United States is more hazardous than in any other high-income country, according to a report released by the Commonwealth Fund on Tuesday, which highlights the ongoing issue of maternal mortality.
The study reveals that over 80 percent of pregnancy-related deaths in the U.S. are preventable. Factors such as a shortage of maternity care providers, limited postpartum home visits, and the absence of guaranteed paid parental leave contribute to the heightened risk of maternal mortality, especially among Black women.
In 2022, the U.S. saw approximately 22 maternal deaths per 100,000 live births. For Black women, this rate soared to 49.5 per 100,000, as reported by the Commonwealth Fund, which specializes in independent health care research. Notably, two-thirds of maternal deaths occur within 42 days postpartum, underlining the critical need for comprehensive postpartum care, which is not universally covered by state Medicaid programs or private insurers.
The study compared data from 14 high-income nations, using statistics from the Organization for Economic Co-operation and Development (OECD) and the Centers for Disease Control and Prevention’s Maternal Mortality Review Committees across 36 states. While OECD data is highly regarded for international comparisons, the authors caution that differences in data collection methods between countries might influence the results.
“We can’t just think of reproductive health at the time of pregnancy because a lot happens after the baby is born. If we’re not supporting women during this crucial time period, we’re never going to solve this problem,” stated Munira Z. Gunja, the lead author and senior researcher at the Commonwealth Fund.
Of the countries analyzed, ten reported fewer than 10 maternal deaths per 100,000 live births. Remarkably, Norway recorded zero maternal deaths in 2022.
Laurie C. Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund, described these statistics as a stark representation of the U.S. health care system’s shortcomings. She advocated for greater community-led investments, including birth centers and healthcare teams that work closely with patients before and after delivery. She emphasized the need for health systems to be incentivized and held accountable for providing equitable care, particularly to communities of color.
With 65 percent of maternal deaths occurring postpartum, health experts stress the necessity of both increased prenatal care and enhanced postpartum services.
“We want this to be the cultural norm. We want this to be federal policy. We want there to be a big change because we know that we can completely minimize the rate of maternal deaths in this country,” Gunja asserted.
Health disparities are not exclusive to the U.S. The report mentions that in Australia, Aboriginal women face twice the risk of maternal complications compared to other birthing individuals. However, experts remain hopeful that policy changes and increased awareness can reduce the overall maternal mortality rate in the U.S.
The study underscores the significance of access to midwives, highlighting their role in countries with the lowest maternal mortality rates. Midwifery teams could provide 80 percent of essential maternal care and potentially prevent 41 percent of maternal deaths, 39 percent of neonatal deaths, and 26 percent of stillbirths.
Some research indicates that midwife-led care can be comparable or superior to that provided by obstetrician-gynecologists. In the U.S., Canada, and South Korea, OB-GYNs outnumber midwives, but in most other wealthy nations, midwives are more prevalent.
Both the U.S. and Canada are experiencing a shortage of midwives and OB/GYNs. Approximately 7 million people in the U.S. live in areas without hospitals or birth centers offering obstetric care. This shortage is expected to worsen.
Following the overturn of Roe v. Wade in 2022, some states have implemented abortion bans or restrictions, which experts say will further impact healthcare access.
“We are setting ourselves up for an absolute reproductive health provider shortage, and contributing to that is this interference into the patient-provider relationship and the restrictions that are being placed on us,” said Tamika C. Auguste, a D.C. OB/GYN and chair of the American College of Obstetricians and Gynecologists Foundation Board, who was not involved in the study. Source: The Washington Post
The U.S. remains the only high-income country without a federally mandated paid parental leave policy and universal health care. Only 13 states and D.C. have enacted paid family and medical leave laws, which have been shown to improve health outcomes for pregnant individuals.
“We are in a dire time in our country, where we’re seeing firsthand the impact of these policy changes at the state level and how they are impacting people’s lives,” Zephyrin remarked.
The recent wave of abortion restrictions has ignited debates and legal battles. State legislatures have passed increasingly strict laws to limit abortion access, such as mandatory waiting periods, ultrasound requirements, and bans on specific procedures.
These restrictions have significantly affected broader healthcare services, especially obstetric care. States with stringent abortion laws often face clinic closures that offer various health services, including cancer screenings, contraceptive services, and general reproductive healthcare. Consequently, individuals in these states face increased challenges that exacerbate existing health disparities.
“Women’s health care providers are being driven out of areas due to the restrictions on practicing full-scope reproductive health care,” Auguste noted. “This creates areas where there are no health women’s providers for women.”
