Maternal Mortality in the United States

What’s the issue? Between 2000 and 2014, maternal mortality (defined as the death of the mother from pregnancy related causes between the beginning of pregnancy until six weeks after birth) increased 27% in the United States. This happened during a time were global maternal mortality fell by more than a third, leaving the United States with the highest rate of maternal mortality of wealthy countries in the world. The maternal mortality rate in the United States is triple Canada’s and the UK‘s, about eight times that of the Netherlands, Norway, and Sweden, and higher even than some poorer countries including Iran, Russia, Vietnam, and Romania. While maternal mortality in the US has increased across all ages and races, black women are nearly four times more likely to die in childbirth than white women.

Why do I care? Simply put, we can do better. The United States has many laws and policies that show we do not value women or trust them to make decisions about their bodies. As maternal health expert Eugene Declercq explains, “The argument we make internationally is that [a high maternal death rate] is often a reflection of how the society views women. In other countries, we worry about the culture — women are not particularly valued, so they don’t set up systems to care for them at all. I think we have a similar problem in the US.”

We have some of the best care for infants in the world (which is a great thing), and we should be able to provide the same standard of care for our mothers. Only 6% of the funding from the Title V program to support maternal and child health targets mothers. Medicaid will cover infants for the first year, but their mothers for only 60 days postpartum. The CDC estimates that 60% of the US’s maternal mortality deaths are preventable. Some simple measures we can take to save mother’s lives include:

• Establish maternal death review boards. Maternal death review boards examine causes of maternal death and assess possibly policy solutions to counteract them. These boards are considered crucial to understanding maternal mortality in Australia, the UK, and many European countries. However, only half of states in the US have them.
• More consistent and higher quality postpartum healthcare for mothers. Postpartum care is an under-discussed area of women’s health and medicine. Most women in the United States do not receive follow-up care until 6 weeks postpartum, and even this visit is poorly attended. Meanwhile, women face a host of physical and mental ailments that can be detrimental to the health of both the mother and the baby. Even before a woman leaves the hospital, her vital signs are monitored less frequently than the baby’s and she is often given inadequate information about how to tell if she needs follow-up medical care.
• Hemorrhage carts in hospitals. While maternal mortality has been increasing across the United States, it has been declining in California. One reason has been the creation of toolkits and basic practices that lessen risk to mothers and babies. Hospitals have “hemorrhage carts” that save valuable time when a woman has a postpartum hemorrhage (when a woman can bleed to death in five minutes), and measure the amount of blood a woman loses in childbirth instead of eyeballing it. These measures have led to a 21% reduction in severe health problems associated with hemorrhages.
• Make health insurance accessible and affordable. Women who don’t  have insurance are 3-4 times more likely to die in childbirth than women who do. Meanwhile, the Congressional Budget Office estimates the Better Care Reconciliation Act (the currently GOP replacement for the ACA) would cause 22 million Americans to lose their health insurance.
• Better and consistent access to safe abortion. Globally, unsafe abortion is one of the leading causes of maternal mortality. Read more on my previous post about how access to safe abortion is under threat in the United States.
• Comprehensive parental leave. While not directly tied to maternal mortality, guaranteed, paid parental leave decreases infant mortality in both rich and poor countries. It can also increase breastfeeding, decrease postpartum depression, and allow fathers to form stronger bonds with their infants. The United States is the only advanced economy that doesn’t guarantee workers paid maternity leave.

What to do if you care too:

1. Call your senators! As you may have guessed, the Better Care Reconciliation Act (the currently GOP replacement for the ACA) is not good for mothers. It drops the requirement that insurance plans include maternity care (before the Affordable Care Act, only 12% of US health plans included maternity care) and makes big cuts to Medicaid, which pays for about half of all US births.
2. Support Planned Parenthood. Planned Parenthood provides safe abortion as well as birth control and pregnancy services. About half of the women who use Planned Parenthood qualify for Medicaid. See my previous suggestions on how to support Planned Parenthood here.
3. Support Black Mamas Matter. The Black Mamas Matter Alliance is a Black women-led cross-sectoral alliance made to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice. Check out their case for advancing maternal health as a human right’s issue, and their talking points for advocates.
4. Learn more. Some recommended further reading includes this piece from NPR and ProPublica examining how our health care system failed one new mother, this Vox article on how California is decreasing maternal mortality, and this article in Medium on some of the benefits to both mother and baby of parental leave.