Maternal Health in the US: Where We Stand Compared to Other Nations
After the recent proceedings of the Supreme Court overturning Roe v. Wade, limiting abortion services across the country has now made sexual reproductive health a public health emergency. As a high-income country, maternal and reproductive health services have failed to become the priorities on various political agendas for years even with the economic benefits of having healthy populations.
Written by Benjamin White, Tia Livingston, and Dhwani Babla
Maternal mortality (MM) is terrifyingly high in the United States and has been on the rise over the last two decades. The United States was ranked three, out of the thirty-six OECD countries, for maternal mortality with an average of 23.8 deaths per 100,000 live births in 2020. MM in the US is nearly 3 times more than in France and nearly two times more than in Korea and New Zealand. In 2020, 843 women suffered from pregnancy-related mortality in the US, and it is estimated that MM conditions cost the US $32.3 billion annually.
Despite high per-capita healthcare spending in the US, among high-income OECD countries, the US maternal mortality rate (MMR) is nearly double that of the MMR of other high-income OECD nations. Between 2000 and 2017, MM decreased globally by about 38%, however, the mortality rates continued to skyrocket in the US. According to healthcare professionals and researchers, approximately 60% of pregnancy-related deaths are preventable, yet MMR continues to rise in the United States. Investing in maternal health and sexual and reproductive health will not only help reduce the MMR but will also offer significant economic benefits.
Racial Disparities Drive Maternal Mortality in the US
When we dig into the US maternal mortality data, it becomes apparent that the biggest driving factor for our high overall maternal mortality is racial disparities. Racial disparities occur due to many reasons e.g., systematic racism, medical racism, and discrimination making Black and Native American women at a higher risk of death during childbirth and throughout and after pregnancy.
Black women are over three times more likely than white women to die from pregnancy-related complications. By 2018, the racial/ethnic disparities in pregnancy-related mortality ratios were 41.4 deaths per 100,000 live births for non-Hispanic Black persons and 26.5 deaths per 100,000 live births for non-Hispanic American Indian or Alaska Native persons.
While maternal mortality rates among Hispanic and Non-Hispanic White women are still higher than maternal mortality rates in other high-income OECD countries, the maternal mortality rates for Non-Hispanic Black women in the US are staggeringly higher than maternal mortality rates for women of other races in the US.
Why are US Maternal Mortality Rates So High?
One explanation for the high MMR in the United States is a lack of maternity care providers (OBGYNs and midwives). In a study of select OECD nations, it was found that the US had a supply that was half to one-sixth the size of most other OECD countries in the study. This study also found that every nation except the US guaranteed one maternal health home visit for new mothers within one week postpartum. Policies shape how healthcare is delivered and allow people to understand what type of benefits they may be able to receive from healthcare providers.
Another explanation for the high MMR is the high cesarean rates. Cesarean sections are supposed to be utilized as lifesaving surgery, however, if the mother does not have a high-risk pregnancy, the woman and baby would be put at unnecessary risk of short- and long-term health problems and an increase in mortality. Cesarian births are associated with an increased risk of maternal mortality and post-partum infection. According to the World Health Organization (WHO), cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize health outcomes. However, the average US cesarean delivery rate in 2020 was 31.8%. It is also worth noting that according to CDC data, Non-Hispanic Black women have higher cesarean rates than Hispanic and Non-Hispanic White women (36.6% compared to 31.4% and 30.8% respectively).
Investing in Sexual and Reproductive Health Services and Maternal Health
Investing in sexual and reproductive health (SRH) services and maternal health contributes to the county’s success in social and economic growth. As a result of health outcomes, stakeholders can foresee what future returns they will receive once services have been funded even though health outcomes will vary based on intervention options and depend on the stakeholders’ goal for maternal health. Policymakers should also make efforts to invest in maternal equity-focused health to make efforts to reduce or eliminate maternal health disparities.
A landmark study found that integration of more midwives into the US health system led to improved health outcomes for mothers and infants and that greater integration of midwifery could help reduce or eliminate racial disparities in maternal health. Some states like New Jersey have led the way in taking steps to increase midwife utilization in the healthcare system by appropriating funds to support midwifery education and training across the state. To make a larger impact on MMR across the US, policymakers should replicate these efforts in other states and at the federal level.
Educational interventions aid in improving MMR which include family planning options, childbirth preparations, emotional/psychosocial support, or contraception options. Therefore, women can understand the factors contributing to high-risk pregnancies and explore the options for sexual and reproductive health services. In the US, for every dollar spent on investing in public contraceptive services, the return was approximately $3 for medical costs for pregnancy-related health care and medical care for newborns. As a result of investments in SRH services or family planning the rate of unintended pregnancies decreased.
Conclusion
As a female-founded organization, the fight for women's and girls’ rights for health continues. This new era requires utilizing health to promote and convince stakeholders and decision-makers how important women’s health is to the global economy and what it will mean for the future. To learn more about HFI’s work, reach out at info@healthfinanceinstitute.org.
