The current state of maternal care in the U.S.

This blogpost is part of a mini-series on maternal wellness in the U.S. As part of this project, we are proud to be working in collaboration with Noula, experts on all things maternal health.

You'd think mothers* dying from pregnancy or childbirth complications is something of the past, or something that only happens in far flung places. Unfortunately, this issue hits a lot closer to home. 

As one of the wealthiest countries in the world, America has the highest maternal mortality rate. In fact, women in America die of pregnancy-related causes at more than double the rate of other nations with similar levels of income. 

When compared to 10 other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the U.K., pregnancy and childbirth are more dangerous for American women than anywhere else. To put this into perspective, a woman giving birth in the U.S. is about 10 times more likely to die than a woman giving birth in New Zealand (17.4 and 1.7 deaths per 100,000 live births, respectively). Let that sink in.

To say the situation is bad would be an understatement. With maternal mortality statistics worsening over the past 20 years, and research suggesting the majority of maternal deaths are preventable, maternal care in America is quite frankly, shameful. Let’s take a closer look at the reasons for this.

First off, the U.S. healthcare system is hard to navigate and simply does not serve mothers. Depending on the state and region you live in, maternal care can differ in quality, accessibility and availability. What’s more, the way medical care is paid for in the U.S. is also highly complex; whether that’s through private insurance, Medicaid, Medicare, or self-pay, medical expenses in America is a headache in itself, and that’s if you’re even able to access quality care in the first place.

Another explanation for the high maternal mortality rate in America is the short supply of maternal care providers relative to its population. Unlike other wealthy countries, America is lagging far behind.

It’s also worth mentioning that in many European countries, as well as Australia and New Zealand, midwives make up the majority of the maternal care workforce. In fact, they often outnumber ob-gyns by several fold and play a central role in maternity care. Many studies have proven the efficacy of midwives in providing better outcomes for mothers and babies while keeping healthcare costs affordable. Yet in the American system, there is a noticeable lack of midwifery care; only 8% of births in the U.S. are attended by midwives.

Lastly, but by no means least, postpartum care for mothers in the U.S. is simply nonexistent. It  is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period. As a result, 1 in 4 women are forced to return to work only after 10 days of giving birth. When you consider that half of pregnancy-related deaths occur after the day of birth, it’s desperately clear how more postpartum support is needed.

Unmistakably, maternal care in the U.S. is not good enough, especially when compared to other high-income countries and their systems of care. The relative undersupply of maternity care providers, especially midwives, and the incomprehensive postpartum support is especially concerning. The system needs to be fixed. 

But this is also more than a structural issue. Pregnancy outcomes depend on a multitude of other factors, including socioeconomic status and race; it’s a complex issue riddled with inequities. When you look at maternal mortality rates across the U.S., there are stark differences where women are dying and the types of women who are at higher risk. A woman’s chance of dying in childbirth is twice as high in some states as in others. A Black woman is 3 times more likely to die from pregnancy or child-birth complications than a white woman. The statistics differ wildly across state, race and class lines and to get the full picture, we need to understand these nuances. In the next blogpost, we’ll take a deeper look at how maternal mortality and morbidity rates diverge across the country.

*Although we use the term ‘mothers’ we recognize that not everyone who carries a pregnancy refers to themselves this way; we respect the diversity of all birthing people.