Childbirth deadlier for Americans, especially Black women, study finds

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Childbirth is deadlier in the United States than in any other high-income nation, according to a study released Tuesday by the Commonwealth Fund that underscores the persistence of maternal mortality.

More than 80 percent of pregnancy-related deaths in the United States are preventable, but factors including a shortage of maternity care providers, limited access to after-birth home visits and lack of guaranteed paid parental leave have increased the risk of maternal mortality, especially for Black people, researchers have found.

In 2022, about 22 maternal deaths happened for every 100,000 live births in the United States. For Black people, that number rose sharply to 49.5 deaths per 100,000, according to the report from the Commonwealth Fund, which conducts independent research on health-care issues. Two out of three maternal deaths occur up to 42 days after birth, highlighting the importance of postpartum care, which only some state Medicaid programs and private health insurers cover.

The study compared 14 high-income countries. It used data from the Organization for Economic Co-operation and Development — known as the OECD — which tracks health system metrics across 38 high-income countries, and from the Centers for Disease Control and Prevention Maternal Mortality Review Committees in 36 states.

Although OECD data is widely regarded as the gold standard for international comparisons, the authors note that discrepancies in how countries gather health data may affect the findings.

“We can’t just think of reproductive health at the time of pregnancy because a lot happens after the baby is born. If we’re not supporting women during this crucial time period, we’re never going to solve this problem,” said Munira Z. Gunja, the study’s lead author and a senior researcher at the Commonwealth Fund.

The rate of maternal deaths in the United States has been rising since 2018. The statistics are most dire for Black women. (Video: Drea Cornejo, Jayne Orenstein/The Washington Post)

Ten of the countries listed in the report had a death rate of fewer than 10 per 100,000 live births; in 2022, Norway’s maternal death rate was zero.

Laurie C. Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund, said these numbers paint a stark picture of health care in the United States. She called for more focus on community-led investments, including birth centers and health-care teams working with patients in the weeks before and after delivery. She also said health systems should have incentives and accountability involving equitable quality of care, particularly for communities of color.

With 65 percent of maternal deaths occurring after birth, many health experts emphasize the need for not only more prenatal care but an increase in comprehensive postpartum care.

“We want this to be the cultural norm. We want this to be federal policy. We want there to be a big change because we know that we can completely minimize the rate of maternal deaths in this country,” Gunja said.

Health disparities are not unique to the United States. In Australia, Aboriginal people are twice as likely to die of maternal complications compared with other people giving birth, according to the report. Still, experts are hopeful that policy changes and awareness will help bridge the divide and decrease the overall maternal mortality rate in the United States.

The report highlighted the importance of access to midwives, whose work has been described as an important factor in countries with the lowest maternal mortality rates, the report found. Teams involving midwives could deliver 80 percent of essential maternal care and potentially prevent 41 percent of maternal deaths, 39 percent of neonatal deaths and 26 percent of stillbirths, the report said.

Some studies have found that teams led by midwives offer care comparable, or superior, to care provided by obstetrician-gynecologists. In the United States, Canada and South Korea, OB-GYNs outnumber midwives, but in most other high-income nations, midwives are more prevalent.

The United States and Canada face a shortage of midwives and OB/GYNs. Almost 7 million people in the United States live in areas without hospitals or birth centers offering obstetric care or any obstetric providers. The shortage is expected to worsen.

Since Roe v. Wade was overturned in 2022, some states have banned or restricted abortion access, and experts say these restrictions will have a trickle-down effect on health-care access.

“We are setting ourselves up for an absolute reproductive health provider shortage, and contributing to that is this interference into the patient-provider relationship and the restrictions that are being placed on us,” said Tamika C. Auguste, a D.C. OB/GYN and chair of the American College of Obstetricians and Gynecologists Foundation Board who was not involved with the study.

The United States is the only high-income nation without a federally mandated paid parental leave policy and universal health care. Only 13 states and D.C. have paid family and medical leave laws; these policies have been shown to improve health outcomes for pregnant people.

“We are in a dire time in our country, where we’re seeing firsthand the impact of these policy changes at the state level and how they are impacting people’s lives, Zephyrin said.

In recent years, abortion restrictions have sparked debates and legal battles. State legislatures have been enacting increasingly stringent laws aimed at limiting access to abortion services, such as mandatory waiting periods, ultrasound requirements and bans on certain procedures.

The current wave of abortion restrictions has significantly affected broader health-care services, particularly obstetric care. States that have imposed abortion restrictions often face closure of clinics offering a variety of health-care services, such as cancer screenings, contraceptive services and general reproductive health care. As a result, people in these states encounter greater challenges that exacerbate existing health disparities.

“Women’s health-care providers are being driven out of areas due to the restrictions on practicing full-scope reproductive health care,” Auguste said. “This creates areas where there are no health women’s providers for women.”

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