The United States continues to have the highest rate of women dying in pregnancy, childbirth, or postpartum compared to all other high-income nations, despite recent declines in the US maternal death rate, a new report shows.
In 2022, the US recorded about 22 maternal deaths for every 100,000 live births, more than double or triple the rates seen in most other high-income countries, according to the Commonwealth Fund, a private foundation focused on healthcare issues. The rate for Black women in the US was even higher, nearly 50 deaths per 100,000 live births.
Conversely, half of the high-income nations reported fewer than five maternal deaths per 100,000 live births, with Norway recording zero maternal deaths.
Maternal Care Workforce Shortages
Munira Gunja, lead author of the report and senior researcher at the International Program in Health Policy and Practice Innovations at the Commonwealth Fund, highlighted the US maternal care workforce shortage, which is expected to worsen. Limited access to midwives, who provide prenatal to postpartum support, exacerbates this issue. In many other countries, midwives outnumber ob-gyns and are integral to the healthcare system.
Barriers to Care
In the US, nearly 8 million women of reproductive age lack health insurance, contributing to the high maternal mortality rate. Norway, with universal health coverage, provides accessible prenatal care free of charge and effectively identifies high-risk pregnancies.
Comparative Data
The Commonwealth Fund analyzed maternal mortality data from 14 high-income countries. The US, Chile, and New Zealand had the highest rates, with Chile and New Zealand each recording about 14 deaths per 100,000 live births. Norway, Switzerland (1 death per 100,000), and Sweden (3 deaths per 100,000) had the lowest rates.
During the Covid-19 pandemic, maternal death rates increased in several countries, including the US, but have recently started to decline. The US maternal mortality rate dropped from 32.9 per 100,000 in 2021 to 22.3 per 100,000 in 2022.
Addressing the Crisis
Dr. Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund, emphasized the need to address racial inequities in healthcare quality and access. The report suggests that expanding health insurance coverage, strengthening the workforce, and implementing paid maternity leave could significantly reduce maternal deaths in the US.
The US has the lowest supply of midwives and ob-gyns among the countries analyzed, with only 16 and 13 providers per 1,000 live births, respectively. Additionally, nearly two-thirds of US maternal deaths occur in the postpartum period, yet the US lacks guaranteed postpartum home visits, unlike other high-income nations.
Policy Recommendations
The report calls for federally mandated paid leave, easy access to postpartum care, and home visits to prevent maternal deaths. The US remains the only high-income country without a universal health system and federally mandated paid leave for postpartum mothers.
Need for Maternal Health Equity
Racial disparities in maternal death rates persist in the US and other parts of the world. The report highlights the need to enhance maternal health care and equity, particularly in underserved populations. Experts stress the importance of timely diagnosis and treatment of complications, patient empowerment, and addressing systemic issues in healthcare policies.
Ongoing Efforts
The American College of Obstetricians and Gynecologists (ACOG) continues to work on improving maternal health outcomes, eliminating racism and bias in medicine, and advocating for supportive policies. Despite efforts, the US still faces significant challenges, exacerbated by recent setbacks like the Covid-19 pandemic and the overturning of Roe v. Wade.
Conclusion
Maternal deaths are a preventable problem, and many countries have successfully ensured safe maternity care. The US must adopt comprehensive policies and practices to provide safe and equitable care for all women during and after pregnancy.
