U.S. Women More Likely to Die in Pregnancy, Childbirth, and Postpartum Than Women in Other High-Income Nations
U.S. Women More Likely to Die in Pregnancy, Childbirth, and Postpartum Than Women in Other High-Income Nations
Among high-income countries, the United States has the highest maternal mortality rates, reflecting deaths from complications of pregnancy and childbirth, according to a new international comparison from the Commonwealth Fund. The report also indicates that even more troubling trends stemming from a serious shortage of maternal health providers — particularly midwives — may lie ahead.
The report – Maternal Mortality and Maternity Care in the U.S. Compared to 10 Other Developed Countries – compares the United States to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.
Key findings include:
• Pregnancy and childbirth are more dangerous for women in the United States. U.S. women have the highest death rate from pregnancy and childbirth complications – 17 deaths per 100,000 live births – a maternal mortality rate that is more than double the rates of most other high-income countries. For example, in the Netherlands, Norway and New Zealand, there are three maternal deaths or fewer per 100,000 live births.
• The United States has a shortage of maternity care providers, and a far lower supply of midwives than other high-income countries: The U.S. and Canada have the lowest overall number of midwives and ob-gyns, with 12 and 15 providers per 1,000 live births, respectively. All other countries have a proportion two to six times higher. In many of these countries, midwives – which are proven to improve birth outcomes – play a central role in maternity care provision. Unlike in the other countries surveyed, ob-gyns in the U.S. and Canada far outnumber the amount of midwives.
• More than half (52 percent) of maternal deaths in the United States occur after birth. The majority of postpartum deaths occur between one week after birth and up to one year after childbirth, a period also known as the “fourth trimester.”
• Access to home visits after childbirth is guaranteed to women in other countries, but not in the United States. All countries, other than the U.S., guarantee at least one visit by a midwife or nurse within one week of childbirth. Evidence suggests that home visits are associated with improved mental health and breastfeeding outcomes, and also reduced health care costs.
• The United States is the only high-income country that does not guarantee paid maternity leave to mothers after childbirth. All countries in the study, other than the U.S., mandate at least 14 weeks of paid leave from work, with most mandating more than six months.
“Maternal death rates in the U.S. are unacceptable,” says Laurie Zephyrin, co-author of the report and Commonwealth Fund VP for Delivery System Reform. “We need to do better for birthing people, particularly those who are Black, and make sure they are receiving the care they need before, during, and after childbirth. This is especially critical right now, as women are most often on the front lines of the COVID-19 pandemic, and its disruptions to health care access are likely putting pregnant people in the U.S. even further at risk.”
According to David Blumenthal, M.D., Commonwealth Fund president, “Our health care system is failing women when they are most vulnerable. The good news is that we can learn from the significantly lower death rates for mothers in other wealthy nations, which invest in a robust maternity care workforce, including midwives. In those countries, women do not have to worry about lacking health insurance, having their coverage cut off shortly after they give birth, or having no paid leave or home visits after birth.”
The full report is available at: https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries