The US has a far higher rate of maternal mortality than other peer wealthy nations, and an extraordinary disparity between white and Black Americans, according to a new brief released by the Commonwealth Fund.
The American outlier status persisted even as the maternal mortality rate has improved in the post-pandemic era, both in the US and globally.
“We could always be happy for going in the right direction, that’s for sure,” said Munira Z Gunja, senior researcher at the Commonwealth Fund’s international program in health policy and practice innovations. “But we still have a ways to go.”
The Commonwealth Fund report compares the US with 12 wealthy nations using data from the Centers for Disease Control and Prevention (CDC) and the Organisation for Economic Co-operation and Development, better known as the OECD, a group of developed democracies. Although OECD data is considered the gold standard for international comparison, researchers said there may be differences in how countries gather data.
Researchers found that in 2022, 22.3 US women per 100,000 died either during pregnancy or within a year of giving birth. That is an improvement from 2021, when American women died at a rate of 32.9 per 100,000.
Still, alarming disparities persist, particularly between white and Black mothers. White mothers in America died at a rate of 19 per 100,000 in 2022. By contrast, Black mothers died at a rate of 49.5 per 100,000, or roughly 2.5 times the rate of white Americans.
Nearly every demographic group of American mothers dies at a higher rate than all mothers in peer nations. Norway, for instance, did not document a single maternal death. The United Kingdom, which conducts an in-depth investigation into every death, counted 5.5 maternal deaths per 100,000.
Notably, most of the deaths of American mothers – more than 80% – are preventable, according to CDC data cited by the Commonwealth report.
“Any obstetrician could tell you about patients who have almost died and those people don’t make these surveys,” said Dr Erika Werner, chair of obstetrics and gynecology at Tufts medical center in Boston, Massachusetts, who was not involved in the research.
“Usually, there’s a missed opportunity – something we could have done before they got pregnant, during pregnancy or postpartum that might have prevented that morbidity,” as doctors call an illness or injury.
Gunja puts the outlier rate of the US down to outlier policies. The US provides neither universal healthcare nor paid maternity leave. Every peer nation provides both.
Switzerland provides the least maternity leave outside the US – and still mandates 14 weeks leave for new mothers. Norway provides 86 weeks paid. Roughly in the middle is the United Kingdom, which provides 39 weeks of leave.
“We’re going back to pre-pandemic levels, which is a good thing, but we also know there are a lot of policies we could put in place to eliminate deaths,” Gunja said. “Access to postpartum care and maternal care in general should not be dependent on where [people] live or who their employer is,” she said, referring to the US policy that ties health insurance to employment.
Outside researchers said the brief highlights the importance of comparing the US, and its uniquely private and difficult to access healthcare system, to universal health systems elsewhere. Roughly 26 million Americans have no health insurance.
“Best case, postpartum people have two visits after they deliver, and that’s when they’re actually at greatest risk for maternal mortality,” said Werner. “And many of them lose insurance weeks [or] months after delivering.”
The report comes as the US supreme court is expected to rule on whether states can ban emergency abortions to save a woman’s health – part of a conservative effort to impose near-total abortion bans.
The data from 2022 represents only six months after the fall of Roe v Wade, the supreme court decision that once provided a constitutional right to abortion. Since its fall, at least 17 states have severely restricted or banned abortion.
“Maternal mortality is an extremely important thing to be tracking,” said Ariana Thompson-Lastad, research faculty at the University of California San Francisco’s Osher Center for Integrative Health, who was not involved in the Commonwealth Fund research.
Though, she added, “not dying is a really low baseline for what we’re going for with parents of babies in the United States, and in particular with Black and Indigenous parents in the US”.
