A new report from The Commonwealth Fund shows that, despite better outcomes since the pandemic, the United States “continues to have the highest rate of maternal deaths of any high-income nation” in the world.
Around four out of five of these deaths “are likely preventable,” the report states, suggesting that the U.S. could save lives through several societal and institutional changes, including shifting toward a universal form of health care.
Examining the U.S. rate of deaths for pregnant people in the year 2022 — the most recent data available — shows that 22.3 individuals died for every 100,000 live births that occurred. That rate is 395 percent higher than the median rate of wealthy nations, for which 4.5 deaths per 100,000 were observed, using the most recent data available in all countries.
Nordic countries fared the best, according to the report, including Norway, which reported zero postpartum mortalities for the year 2022.
Mortality rates were far worse for Black people who had just given birth, the report found, with 49.5 deaths per 100,000 births being observed — a rate that is around 160 percent higher than the white postpartum mortality rate of 19 deaths per 100,000.
While other studies have demonstrated that racism plays a bigger role than economics or wealth in adverse health outcomes for Black people in the U.S., there are several measures that could address the disparity in Black and white postpartum deaths while reducing mortality rates for all populations, The Commonwealth Fund study noted.
Around two in three maternal deaths occur within six weeks of birth, the group reported, noting that the U.S. lacks benefits that many wealthy countries have during this time, including regular home visits from caregivers and guaranteed paid leave for new parents. “A federally mandated paid leave policy would be especially beneficial to Black and lower-income women, who are less likely to have a paid leave policy through their employers,” the report said.
Other countries with low rates of postpartum mortality have a higher number of midwives than the U.S. “Midwifery-led care models have been shown to provide care that is comparable to, or sometimes even better than, that provided by obstetrician-gynecologists, or ob-gyns. In the U.S., Canada, and Korea, ob-gyns outnumber midwives, while in most other countries midwives greatly outnumber ob-gyns,” the report stated. (All three of those countries experience rates of postpartum mortality that are higher than the median rate.)
Finally, the U.S. is the only high-income country that doesn’t have some form of a government-funded national health care system, which would provide greater access to postpartum support for all communities. The lack of such a health care model leaves nearly 8 million parents of reproductive age uninsured, the report noted, adding that:
The racial or ethnic groups that are the least likely to have health insurance and the most likely to face cost-related barriers to getting care are Black, Hispanic, American Indian and Alaska Native, and Native Hawaiian and other Pacific Islanders.
Indeed, the expansion of Medicaid in states that accepted those funds through the Affordable Care Act “has been associated with better maternal health outcomes…particularly rates of maternal mortality for Black and Latina mothers,” the report said.
Munira Gunja, senior researcher at the Commonwealth Fund’s international program in health policy and practice innovations, noted that outcomes were improving in the U.S. over the past few years. But there is still a wide gap between the U.S. and other high-income countries that could be addressed through better forms of health care.
“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 to The Guardian regarding the report’s findings. “Access to postpartum care and maternal care in general should not be dependent on where [people] live or who their employer is.”
Fatimah Gifford, executive director of Provide, an organization dedicated to training and working with health and social service providers to offer holistic support to people seeking abortion and pregnancy care, told Truthout that The Commonwealth Fund’s findings were “disappointing, but unfortunately not surprising.”
“Provide’s own research on disparities in provider counseling is just one piece of the crisis around Black women’s disparate access to reproductive health care, which has already been shown to include lesser access to family planning clinics and pharmacies; higher abortion rates; higher rates of infant mortality, pregnancy-related complications, and death; less access to prenatal care; and higher rates of coercion into unnecessary c-sections,” Gifford said.
Gifford added:
Studies also have shown Black women are more likely to be refused hospital admission if they lack health insurance; report disrespectful treatment by providers, including having their pain ignored and concerns about reproductive health dismissed; and report that they must be particularly assertive with providers to have their needs met.
Gifford also stated that providers must play a deeper role “in interrupting racial disparities by listening to every patient, providing complete health information for every patient in every visit, and connecting patients with all the sexual and reproductive health resources they need, including referrals to safely end a pregnancy if that’s what they choose.”