Maternal Mortality: A National Embarrassment

Americans spend more money on childbirth than any other country, but we’re not getting a good return on our investment.

Less than a century ago, approximately one mother died for every 100 live births — an occurrence so common that nearly everyone belonged to a family, or knew of one, that was devastated by such a loss. Fortunately, in most nations, those tragedies have declined over the years. In fact, in the decade between 2003 and 2013, only eight countries saw their maternal mortality rates rise.

Unfortunately, the United States was one of those eight countries, joining a club that also includes Afghanistan and South Sudan. Within the 31 industrialized countries of the Organization for Economic Cooperation and Development, an American woman is more likely to die as a result of pregnancy than a citizen of any other country besides Mexico. Among developed countries, the United States has one of the highest maternal mortality rates — and those rates are only getting worse.

Graph: CDC

U.S. maternal mortality has attracted the attention of organizations whose oversight you wouldn’t expect. Amnesty International, which most Americans associate with the fight against human rights abuses in far-flung authoritarian regimes, considers our high maternal mortality rates to be a violation of human rights. Additionally — and pathetically — one of the biggest sources of funding for maternal health in the United States comes not from taxpayers but from the pharmaceutical company Merck. The Economist quoted a Merck spokesperson as saying, “We expected to be doing all our work in developing countries.”

Maternal Mortality by the Numbers

Each year, around 1,200 Americans die — and up to 60,000 of them come close to dying — as a result of complications during pregnancy or childbirth. A study examining 237 deaths between 2008 and 2017 found that more than 62 percent were preventable, and nearly half the deaths occurred among African-American women.

According to the World Health Organization (WHO), in 2015, four countries were tied for the lowest maternal mortality rate in the world — Finland, Greece, Iceland, and Poland had just 3 maternal deaths for every 100,000 live births. The United States came in at No. 46, with 14 maternal deaths per 100,000 live births — just behind Qatar and barely beating out Bahrain, Lebanon, and Uruguay. However, our maternal mortality rate isn’t uniform across the nation — in Texas, for example, there are 35.8 maternal deaths for every 100,000 live births, putting them in the same ballpark as former Soviet states Georgia and Uzbekistan.

WHO isn’t the only group keeping track. Using different statistical methods, a study published in The Lancet puts the U.S. maternal mortality rate at 26.4 deaths per 100,000 live births — nearly double the WHO’s estimate. In comparison, the same study found that for every 100,000 live births in Australia, Canada, and England, there are 5.5, 7.3, and 8.8 maternal deaths, respectively.

Unfortunately, the United States isn’t the best at tracking maternal mortality. Having trustworthy data is the first step to figuring out where the problems lie and how to address them. When California put robust data collection policies in place, they slashed their maternal mortality rate by more than half — an example that the rest of the country needs to follow. Unfortunately, collecting and analyzing this data requires funding, not to mention laws compelling the medical system to participate. Legislators who balk at increasing public funding or regulations might not lend support to such a program.

Politicians’ lack of enthusiasm for keeping tabs on something as life-or-death as maternal mortality is a sad indication that they don’t prioritize the health of mothers — no matter how stridently they might present themselves as champions of “family values,” “a culture of life,” or “protecting women.” It is impossibly cruel to put obstacles before access to birth control, emergency contraception, and abortion, while simultaneously refusing to put resources into reducing maternal mortality. The “All Lives Matter” crowd needs to put their money where their mouths are, whether it is supporting funding for data collection or expanding access to health care.

Maternal Mortality: A Toxic Brew of Causes

Why is childbirth so deadly in the United States compared to other developed countries? Many ideas have been proposed, ranging from our country’s relatively higher rates of poverty, ineffective sexual health education, obstacles to health insurance, difficulty accessing family planning services, poor access to obstetrics and postpartum care, few maternal mortality review boards, poor data collection, increasing prevalence of chronic health conditions, and the stress that can accompany poverty and racism. That toxic brew of contributing factors might be difficult to tease apart, but as a society we must address each component.

One reason for the rising U.S. maternal mortality rate could be that the population’s health as a whole is getting worse, thanks in large part to policies that make preventive health care difficult to access. Health conditions that make childbirth more risky — obesity, hypertension, diabetes, and heart disease — are on the rise, and more folks are entering pregnancy in poorer health. These risk factors contribute to the top causes of maternal death.

When it comes to health care specific to pregnancy, prenatal care is crucial. Without it, a mother’s risk of death is tripled or quadrupled. After childbirth, postpartum care is essential to save women’s lives, as risk of infection, hemorrhage, and pulmonary embolism spikes in the days and weeks following childbirth. Before the Affordable Care Act (ACA) required maternity care to be covered in the individual insurance market, 60 percent of people with individual insurance plans had no maternity coverage at all — and those who did might have had limits as low as $2,000, which barely covers the high cost of birth. Nationwide, only 13 percent of insurance plans available to a 30-year-old female covered maternity care — in some locations, no plans included maternity care.

Aside from financial obstacles, maternity care could literally be out of reach for anyone with geographical or transportation barriers. People need local clinics to go to, and ways to get there. Unfortunately, the country is in the midst of a shortage of general and maternity care providers. Half of U.S. counties, home to 10 million women, don’t have an ob/gyn, usually because they are rural counties without a hospital offering maternity care.

The ACA was beginning to address problems like the difficulty accessing birth control or maternity care, the high costs of childbirth, and high proportions of the population without health insurance. Unfortunately, today’s government is trying to roll back those advances, led by the efforts of men who seem to believe they shouldn’t have to pay for maternity care when it has allegedly never benefited them personally (I guess they were all gestated in test tubes). Despite claiming to value “life” and promote “family values,” conservative lawmakers repeatedly uphold policies that kill mothers and destroy families:

  • Reducing access to birth control: Contraception lessens the risk of unintended pregnancy (which itself is associated with delayed prenatal care). Unintended pregnancies, which as a rule are higher-risk than planned pregnancies, can be decreased by effective birth control. Too many lawmakers obstruct access to contraception, whether they are trying to defund Planned Parenthood, purge people from the Medicaid rolls, or slash funding for the Title X program — or use it as a prop to divert funds away from birth control and toward promoting abstinence.
  • Reducing access to maternity care: The ACA brought many improvements to the country’s broken health-care delivery program, such as mandating that health insurers cover contraception and maternity care, and could not consider pregnancy to be a preexisting condition. Opponents are trying to roll back each one of these improvements.
  • Reducing access to health care: Although reproductive health is a favorite target, health care in general is important in keeping people healthy. Without access, people are more likely to enter pregnancy with undiagnosed or untreated health problems, putting them at higher risk of complications and death. Repeated attacks on the ACA may have led to millions of people losing their health insurance.
  • Promoting ignorance of sexual and reproductive health: Comprehensive sex education is associated with lower rates of unintended pregnancy, but some lawmakers prefer that sexually active folks live in ignorance. For example, the Trump administration cut funding for the evidence-based Teen Pregnancy Prevention Program.

Further Reading

Amnesty International has put together a lengthy report detailing the complex causes of the high U.S. maternal mortality rate, interspersed with heartbreaking stories of maternal deaths and near-deaths. Although it was published in 2010, based on research conducted before the ACA sought to counteract many of the problems identified in the report, it is a valuable look into the issues that still linger — and the world ACA opponents seek to return us to as they chip away at the progress made during the Obama administration. You can also find in-depth reporting at ProPublica, which recently published a series on U.S. maternal mortality.

Planned Parenthood health centers across the country can help educate you about prenatal health and refer you to additional resources if necessary. To help you have a healthy pregnancy, Planned Parenthood Arizona offers smoking cessation, and our Title X centers can provide you with prenatal vitamins if you qualify.