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For decades the disparities between women in the United States has led to maternal mortality rates that vary greatly by income, insurance type, race, ethnicity and geographic location. While rising rates of severe complications and death during pregnancy and childbirth underscored the shortcomings of the U.S. health system since 2000, the Covid-19 pandemic has exacerbated our failings at a rapid rate.
According to a new report published by the Commonwealth Fund, Maternal Mortality and Maternity Care in the U.S. Compared to 10 Other Developed Countries, among high-income countries, the United States has the highest maternal mortality rates. In fact, a woman giving birth in the U.S. is about 10 times more likely to die than a woman giving birth in New Zealand (17.4 and 1.7 deaths per 100,000 live births, respectively).
The international comparison looks at the U.S., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the U.K., concluding that pregnancy and childbirth are more dangerous for American women than their 10 counterparts. Further, the study suggests health workforce shortages are current pain points that may be worsened by the coronavirus – further undermining an already faulty system.
But there is much to learn from our understanding of what makes the American health system – and women’s access to care – different from the countries of comparison. Given that the U.S. has the highest maternal mortality rate among developed countries suggests there are a number of contributing factors, and that the issues run deep throughout our system. Further, that we have deficiencies from beginning to end of the birthing process.
Here are the most important conclusions for consideration in America:
- U.S. women have the highest death rate from complications of pregnancy and childbirth. In 2018 there were 17 deaths per 100,000 live births – a maternal mortality rate that is more than double the rates of most other high-income countries. In comparison, the Netherlands, Norway and New Zealand experience three maternal deaths (or less) per 100,000 live births.
- 17% of maternal deaths in America occur on the day of delivery.
- A shocking 52% (more than half) of maternal deaths in the U.S. occur after birth. A period of time often referred to as the fourth trimester - usually ranging from one week to one year postpartum – is when a majority of postpartum deaths occur.
- In 2018, the death rate for Black mothers was more than two times that for white mothers. As Covid-19 has widened disparities through the pandemic’s disproportionate health and economic burdens on Black people, racial and ethnic gaps are not only likely to persist, but potentially deteriorate for Black mothers.
- The U.S. and Canada have the lowest overall supply of OB-GYNs and midwives, having only 12 and 15 providers per 1,000 live births, respectively. In contrast, the nine other countries in the study have a proportion two to six times greater.
- Midwives are in far lower supply in the U.S. than other high-income countries. Despite deficiencies in both OB-GYNs and midwives, OB-GYNs in the U.S. and Canada far outnumber midwives. In many countries and cultures,midwives play a central role in maternity care, but are limited by scope-of-practice laws and requirements – with variation by state – in the U.S.
- Of the 11 countries studied, the U.S. is the only country that does not guarantee at least one home visit by a midwife or nurse within one week of childbirth, despite evidence suggesting that home visits are associated with improved outcomes such as mother’s mental health, breastfeeding and overall reductions in health care costs.
- The U.S. also stood out as the only high-income country that does not guarantee paid maternity leave to mothers after childbirth. All countries studied mandate a minimum of 14 weeks of paid leave from work, with most mandating more than six months, with the exception of America.
While this Commonwealth Fund report draws much needed attention to the distinctions of the U.S. health system from our other high-income counterparts, the many failings highlighted show just how far the U.S. has to go to protect our mothers and children. There is much to be gained from studying health systems and their priorities – particularly as it pertains to primary care and preventative care. Policy changes and practices ranging from access to more providers (particularly midwives) to insurance and payment reform to postpartum checkups and paid leave can all make a difference.
But none of these solutions is themselves a silver bullet nor do they operate in a vacuum. The United States needs to take these Commonwealth Fund findings to heart and reconsider the priorities and practices of our health care system. Mothers health and safety should be a top priority for every American.
