The U.S. is the only advanced economy in the world with a rising maternal mortality rate.
A woman giving birth in the U.S. is now twice as likely to die as a woman in Saudi Arabia, and three times more likely to die than a woman giving birth in the U.K. This is in spite of the fact that people spend more money in the United States on healthcare than in any other country in the world.
The U.S. is one of just eight countries to see a rise in maternal mortality (which counts death within 42 days after delivery) over the past decade, according to a study conducted by the Institute for Health Metrics and Evaluation at the University of Washington that was published last year in The Lancet.
The others are Afghanistan, Greece and several countries in Africa and Central America. By contrast, most countries have seen considerable decreases, including many in east Asia and Latin America.
The researchers estimated that 18.5 mothers died for every 100,000 births in the U.S. in 2013, a total of almost 800 deaths. This compares to 7.2 in 1987.
As a result, the U.S. now ranks 60 for maternal deaths on a list of 180 countries, down markedly from its rank of 22 in 1990. China, by contrast, is up to number 57.
Why Are So Many Women Dying In Childbirth?
According to Priya Agrawal, obstetrician and director of Merck for Mothers, there are three leading causes of maternal death in the U.S.: heavy bleeding after giving birth, high blood pressure during pregnancy, or preeclempsia and complications arising from pre-existing health conditions.
I know from personal experience about preeclempsia: my niece in the U.K. has an excellent doctor, who detected preeclempsia when she was six months pregnant and rushed Catharine into hospital. She gave birth two days later, and baby Eliza weighed in at just under three pounds. The alternative, waiting longer to give birth, would almost certainly have meant that neither mother nor baby would have survived. The next few months were hard, but both Catharine and her child are doing well now, four years later.
For the third cause of maternal death, pre-existing health conditions, Agrawal explains that women getting pregnant are increasingly less healthy. “This year, one in five women [in the US] who become pregnant are obese,” said Agrawal at this year’s Women in the World conference. “Then there’s diabetes and hypertension.”
Not only are women in poorer health when they get pregnant, but then they fail to get proper care. Obesity, hypertension, diabetes and heart disease are all increasingly common among pregnant American women, and each of them makes delivery more dangerous.
African-American Women Four Times More Likely To Die Than White Women
However, the picture is uneven across the U.S., and the risk varies dramatically by race. In some parts of the country, African-American women are nearly four times more likely to die from pregnancy-related complications than white women. Poor women are less likely to have access to proper health care, including contraception and prenatal care; African-Americans are more than twice as likely as their non-black peers to live below the poverty line.
As The Washington Post’s Danielle Paquette explained:
“Experts I have spoken to tell me that certain parts of the country there is — there are gaps in health insurance coverage, especially in the South. For example, Mississippi has one of the highest maternal mortality rates, that the state did not expand Medicaid.
There’s something like 100,000 people who don’t have access to any healthcare. And many of them are women. We have in Mississippi 160 doctors for every 100,000 residents. That drives part of this problem.”
Can Obamacare make a difference? By widening access to health care, let’s hope that the Affordable Care Act (ACA) will begin to force a change in these shocking statistics.
In the 31 states plus Washington, D.C., that expanded Medicaid under the ACA, poorer women will have access to medical care. This ensures that they are in better shape when they become pregnant and have access to frequent check-ups during and after their pregnancies.
It’s not true that all women in the U.S. run a higher risk of maternal mortality than other industrialized countries. Poor women, and especially African-Americans, are the ones at the greatest risk.
This is yet another sign of our unequal society, and one that needs to change.